Wait Times for Cancer Surgery in the United States: Trends... : Annals of Surgery (original) (raw)

Original Articles

Trends and Predictors of Delays

Bilimoria, Karl Y. MD, MS*,†; Ko, Clifford Y. MD, MS, MSHS*,‡; Tomlinson, James S. MD‡; Stewart, Andrew K. MA*; Talamonti, Mark S. MD§; Hynes, Denise L. RN, PhD¶; Winchester, David P. MD*,§; Bentrem, David J. MD, MS†,#

*Cancer Programs, Commission on Cancer, American College of Surgeons, Chicago.

†Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.

‡Department of Surgery, UCLA and Greater Los Angeles VA, Los Angeles, CA.

§Department of Surgery, NorthShore University HealthSystem, Evanston, IL.

¶Center for the Management of Complex Chronic Care, Edward Hines Jr. VA, Hines, IL.

#Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL.

Reprints: Karl Y. Bilimoria, MD, MS, American College of Surgeons, 633 N. St. Clair Street, 22nd Floor, Chicago, IL 60611 ([email protected]).

Supported by a Priority Grant from Northwestern University. K.Y.B. is supported by the American College of Surgeons Clinical Scholars in Residence program. D.J.B. is supported by a grant from the Illinois Division of the American Cancer Society and the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Career Development Award.

Presented at the 94th Annual American College of Surgeons Clinical Congress on October 12, 2008 in San Francisco, CA.

Background:

Patients frequently voice concerns regarding wait times for cancer treatment; however, little is known about the length of wait times from diagnosis to surgery in the United States. Our objectives were (1) to assess changes in wait times over the past decade and (2) to identify patient, tumor, and hospital factors associated with prolonged wait times for initial cancer treatment.

Methods:

Using the National Cancer Data Base (1995–2005), 1,228,071 patients were identified who underwent resection for nonmetastatic breast, colon, esophageal, gastric, liver, lung, pancreatic, and rectal cancer at 1443 hospitals. Multivariable models were developed to assess factors associated with time to treatment.

Results:

From 1995 to 2005, the median time from diagnosis to treatment increased for all cancers (P < 0.0001). The time from diagnosis to treatment was significantly longer at National Cancer Institute Comprehensive Cancer Centers and Veterans' Administration institutions versus community hospitals (_P_ < 0.0001). On multivariable analysis, patients were significantly more likely to undergo initial treatment > 30 days from diagnosis if older (6 of 8 cancers), black (5 of 8 cancers), had more comorbidities (6 of 8 cancers), had Stage I disease (7 of 8 cancers), or were treated at National Cancer Institute Comprehensive Cancer Centers or Veterans' Affairs institutions (all cancers).

Conclusions:

Wait times for cancer treatment have increased over the last decade. As case loads increase, wait times for treatment are likely to continue increasing, potentially resulting in additional treatment delay. Additional resources and strategies are needed to reduce wait times for cancer treatment in the United States.