Waiting Time for Breast Cancer Surgery in Quebec (original) (raw)
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Wait Time from Suspicion to Surgery for Breast Cancer in Manitoba
Cureus, 2016
Introduction: Breast cancer (BC) is the most common cancer in women. The pathway for its diagnosis and treatment is relatively standardized. Nevertheless, there can be significant delays affecting the journey. The aim of this retrospective study is to describe the BC wait times (WT) from suspicion to first surgery in Manitoba and to examine factors associated with WT variability. Methods: The cohort is composed of patients with stages I-III breast cancer who were diagnosed between September 1, 2009, and August 31, 2010, and referred to a cancer center. Patients' journeys were tracked and divided into three sequential intervals from suspicion to first diagnostic test, from first diagnostic test to diagnosis and from diagnosis to first surgery. Results: Four hundred and four patients were included of whom 134 presented through the screening program. There was no difference between the study cohort and population data from the provincial Cancer Registry concerning the distribution of age, stage of cancer or residence. The median WT from suspicion to surgery was 78 days. In the screen-detected group (SD), a difference in median WT from suspicion to first diagnostic test was found for distance. This finding was first to test location, where those who travel less had longer WT than those who have longer journeys. Patients who went to centers that offer both imaging and biopsy services, even if the required test is imaging only, had to wait longer than those who went to centers that provide imaging only. SD patients needing more than one diagnostic test had a longer WT from the first test to pathological diagnosis if the first test did not include a biopsy. Patients who were seen by surgeons before final pathological diagnosis had a shorter WT from diagnosis to first surgery than those who had the surgical consult after tissue diagnosis was made. A delay to surgery was observed in the whole cohort if a plastic surgeon is required in addition to the surgical oncologist and the non-screen detected group if a radiologist is necessary. Conclusions: Variability in WT from suspicion to surgical management was found between various BC patient groups and between diagnostic centers with different types of services. The order of the provided diagnostic and surgical services may have contributed to WT. Addressing this variability by restructuring the care pathway and improving communication between different disciplines, has the potential to reduce WT.
Evaluation of waiting times for breast cancer diagnosis and surgical treatment
Clinical and Translational Oncology, 2018
Purpose To analyse any delays in breast cancer diagnosis and surgical treatment, influence of clinical and biological factors and influence of delays on survival. Methods/patients A descriptive, observational, and retrospective study was conducted between 2006 and 2016 on stages I-III breast cancer patients. This is a retrospective review of health records to collect data on delays, patients' clinical data, biological features of the tumour and information on treatment. Mortality data from the National Death Index. Results In 493 evaluable patients, the median of days from the first symptom to mammography, biopsy, and surgery was 41, 57, and 92, respectively. The median of days from screening mammography to biopsy and surgery was 10 and 51, respectively. From biopsy to surgery, the median was 34 days in every case. Over the last 5 years, an increase in biopsy-surgery delay has been observed (p = 0.0001). Tumour stages I and II vs. stage III (RR 1.74. 95% CI 1.08-2.80, p = 0.027), diagnosis in screening (RR 0.66. 95% CI 0.45-0.96, p = 0.030), and use of magnetic resonance imaging (RR 2.08. 95 CI 1.21-3.56, p = 0.008) condition a greater biopsy-surgery delay. No influence of delays on survival has been identified. Conclusions Delays in diagnosis and surgery in the case of women diagnosed on the basis of symptoms may be improved. There is a temporary tendency to a greater delay in surgery. Some clinical and biological factors must be taken into account to optimise delays. Survival results are not adversely affected by delays.
Determinants of delay for breast cancer diagnosis
Cancer Detection and Prevention, 2007
Background: A study was conducted to identify determinants of diagnostic delay in order to develop strategies to reduce the waiting time for breast cancer diagnosis. Methods: A cohort of 696 women diagnosed with early breast cancer was recruited in two radiation oncology centers of Quebec, Canada, in 2002. A structured questionnaire was administered to identify potential determinants of diagnostic delay. Dates for all of the breast procedures were extracted from medical records. ''Diagnostic delay'' was defined as a time interval of more than 5 weeks between the first breast specific procedure and the final diagnostic procedure. A logistic regression model was used to estimate adjusted odds ratios (OR) of diagnostic delay and their 95% confidence intervals (CI). Results: The two main determinants of diagnostic delay were the medical indication for the breast investigation and the scheduling of the diagnostic procedures. Compared to screened women, those referred because of clinical findings had an OR of diagnostic delay of 0.34 (95% CI = 0.22-0.54). Women who underwent breast procedures during visits on at least four separate days had an OR of 6.31 (95% CI = 3.85-10.34) compared to those who completed their investigation during visits on at most two separate days. Women who had complementary procedures the day of the first procedure were less likely to experience a diagnostic delay (OR = 0.51, 95% CI = 0.31-0.82). Finally, diagnostic delay was also significantly associated with the interpretation of the first diagnostic procedure, type of final diagnostic procedure, size of tumor, and family income. Conclusions: This study suggests that a promising strategy for reducing the waiting time for breast cancer diagnosis is to better integrate the services during the investigation period. #
BMJ, 2007
Objective To investigate the long term impact of the two week wait rule for breast cancer on referral patterns, cancer diagnoses, and waiting times. Design Prospective cohort study. Setting A specialist breast clinic in a teaching hospital in Bristol. Participants All patients referred to breast clinic from primary care between 1999 and 2005. Main outcome measures Number, route, and outcome of referrals from primary care and waiting times for urgent and routine appointments. Results The annual number of referrals increased by 9% over the seven years from 3499 in 1999 to 3821 in 2005. Routine referrals decreased by 24% (from 1748 to 1331), but two week wait referrals increased by 42% (from 1751 to 2490) during this time. The percentage of patients diagnosed with cancer in the two week wait group decreased from 12.8% (224/1751) in 1999 to 7.7% (191/2490) in 2005 (P<0.001), while the number of cancers detected in the "routine" group increased from 2.5% (43/1748) to 5.3% (70/1331) (P<0.001) over the same period. About 27% (70/261) of people with cancer are currently referred in the non-urgent group. Waiting times for routine referrals have increased with time. Conclusion The two week wait rule for breast cancer is failing patients. The number of cancers detected in the two week wait population is decreasing, and an unacceptable proportion is now being referred via the routine route. If breast cancer services are to be improved, the two week wait rule should be reviewed urgently.
Delays in diagnosis and treatment of breast cancer: a multinational analysis
Background: Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient-and system-related delays in commencing breast cancer treatment in different countries. Methods: A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy). Results: The average patient-related delay time and total delay time were 4.7 (range: 3.4-6.2) weeks and 14.4 (range: 11.5-29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3-24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times. Conclusions: The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.
The Breast, 2013
Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France.
Reasons for Delay in Breast Cancer Diagnosis
Preventive Medicine, 1996
Background. A study of system delay, the time between the initial medical consultation and the establishment of a diagnosis, in breast cancer patients revealed that almost 40% of women reported delays of at least 4 weeks. The objective of this study was to explore the reasons for these prolonged intervals between initial medical consultation and establishment of a diagnosis.
British Journal of Cancer, 2003
A government target of a maximum 2-week wait for women referred urgently with suspected breast cancer was introduced in April 1999. We have assessed changes in the distributions of waiting times and the proportions of cases meeting proposed targets before and after this date, using clinical audit data on 5750 women attending 19 hospitals in southeast England during the period July 1997-December 2000, who were subsequently found to have breast cancer. The proportion of cases being seen within 2 weeks of referral rose from 66.0 to 75.2%, and the median wait to first appointment fell from 13.6 to 12.3 days, following the introduction of the government target. The proportion of cases waiting 5 weeks or less between first hospital appointment and treatment fell from 83.8 to 80.3%, and median waits for treatment increased from 21.4 to 24.1 days. We also examined the effects on waiting times of various sociodemographic and care related factors. A total of 85.7% of screening cases vs 67.9% of symptomatic cases were seen within 2 weeks, and 95.0% of cases treated with tamoxifen received treatment within 5 weeks, as opposed to 77.6% of cases treated with surgery, 81.2% of chemotherapy cases and 52.8% of radiotherapy cases. While waiting times from GP referral to first hospital appointment have improved since the introduction of the government target, times from first appointment to treatment have increased, and consequently total waiting times have changed little.
An Assessment of Delays in Obtaining Definitive Breast Cancer Treatment in Southern Italy
Breast Cancer Research and Treatment, 2001
Female population is medically underserved in Southern Italy (in comparison with other Italian regions). In a recent systematic review of published studies, delays of 3-6 months between symptom onset and treatment have been clearly associated with lower survival rates for breast cancer patients. The aim of this study was to examine breast cancer delays in medically underserved patients in Southern Italy, in order to recognize their determinating factors so as to provide women with a better opportunity for survival. The variables examined were age, education, symptom status at first presentation: symptomatic and asymptomatic, date of first symptom presentation, date of first consultation with a health provider, consulted provider, tumor size and nodal status, according to the pTNM system. Time intervals were categorized into: < 1 month, 1-3 months and > 3 months for patient and medical delay; 1-3 months, 3-6 months, > 6 months for overall delay. Patient delay was associated with education: a higher risk was found for women with ≤ 5 years school attendance (OR = 3.3, 95%, CI 2.0-5.6). Medical delay was seen to be associated with the professional figure: significant differences were found between senologists (oncologist exclusively dedicated to breast cancer) and other specialists (OR 3.5, 95%, CI 1.5-8.4). Age and symptomatic presentation were found to be high risk factors. Concerning tumor size in overall delay in cases > 2 cm had OR values were of 2.4 (95%, CI 1.5-3.7). In conclusion our study suggests that diagnostic delay is associated with medically underserved status and can be reduced by educating younger and less educated women, as suggested in other studies and by providing training programs for members in the medical profession.
JCO Global Oncology
PURPOSE Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them. METHODS Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review. RESULTS The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek ...