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Wait Times for Melanoma Surgery: Is There an Association with Overall Survival?

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Wait times for access to care have been of increasing interest to public health care officials, health care providers, and the public. There is a paucity of data determining whether extended wait times for melanoma surgery influence patient outcomes. This study measured the association of wait times to surgical treatment with overall survival in patients with melanoma.

Methods

Population-based health administrative databases were used to identify all Ontario adults diagnosed with melanoma between 2004 and 2011, time to various treatment modalities, and death dates. Proportional hazards modeling using time-dependent covariates was used to determine the adjusted association of time from melanoma diagnosis to various post-diagnostic surgical interventions with overall survival.

Results

A total of 2573 patients were included. The 5-year overall survival was 81.1% [95% confidence interval (CI) 79.1–83.0]. Of all patients, 82.9% underwent a wide local excision (WLE) with a median wait time of 43 days [interquartile range (IQR) 24–64], 29.1% underwent a sentinel lymph node biopsy (SNB) with a median wait time of 59 days (IQR 41–81), and 35.0% underwent a lymph node dissection (LND) with a median wait time of 63 days (IQR 43–91). After adjusting for age, sex, rural residence, and risk of mortality from comorbidities, wait times to WLE [hazard ratio (HR) 0.97; 95% CI 0.87–1.08; p = 0.62], SNB [HR 1.04; 95% CI 0.68–1.59; p = 0.86], and LND [HR 0.99; 95% CI 0.89–1.11; p = 0.92] were not associated with overall survival.

Conclusions

Overall survival for patients with melanoma was not influenced by wait times to WLE, SNB, and LND.

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Acknowledgment

This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.

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Authors and Affiliations

  1. Division of General Surgery, The Ottawa Hospital, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Alyson B. Crawford MD, MSc & Carolyn Nessim MD, MSc

  2. Division of General Surgery, The Queensway Carleton Hospital, Ottawa, ON, Canada

    Joel Weaver MD, MSc

  3. Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

    Carl van Walraven MD, MSc

  4. Institute for Clinical Evaluative Sciences (ICES), Ottawa, ON, Canada

    Carl van Walraven MD, MSc

  5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Carl van Walraven MD, MSc

Authors
  1. Alyson B. Crawford MD, MSc
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  2. Carolyn Nessim MD, MSc
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  3. Joel Weaver MD, MSc
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  4. Carl van Walraven MD, MSc
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Corresponding author

Correspondence to Carolyn Nessim MD, MSc.

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Crawford, A.B., Nessim, C., Weaver, J. et al. Wait Times for Melanoma Surgery: Is There an Association with Overall Survival?. Ann Surg Oncol 25, 265–270 (2018). https://doi.org/10.1245/s10434-017-6146-2

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  • DOI: https://doi.org/10.1245/s10434-017-6146-2

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