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Canadian Journal of Public Health

, Volume 95, Issue 5, pp 341–345 | Cite as

Waiting Time for Breast Cancer Treatment in Alberta

  • Alyssa D. ReedEmail author
  • Robert J. Williams
  • Patricia A. Wall
  • Paul Hasselback
Article

Abstract

Background: The present study had two research questions. First, what is the average waiting time between diagnosis and treatment for Alberta women with breast cancer relative to Canadian Society for Surgical Oncology (CSSO) recommendations? Second, does patient age, cancer stage, patient community size, and year of diagnosis have a significant relationship to waiting time?

Methods: The sample consisted of all Alberta women diagnosed with breast cancer between 1997 and 2000. Waiting time was defined as number of days between definitive diagnosis and treatment initiation. Multiple regression examined the relative influence of the predictor variables on waiting time.

Results: There were 6,418 cases of breast cancer between 1997 and 2000. Mean waiting time was 20.2 days (SD 21.6) and median waiting time was 17 days. Longer waiting time was significantly associated with year of diagnosis (progressively longer from 1997 to 2000), patients younger than 70, and Stage 1 cancer. Waiting time increase from 1997 to 2000 appears to be due to increased demand for services without corresponding increases in resources. Less treatment delay for women older than 70 is due to more of these women being treated the same day they received their diagnosis.

Conclusion: Only 44% of women had a waiting time of 14 days or less as recommended by the CSSO. The number of women who will have to wait longer than recommended for treatment will likely increase without a significant increase in oncological resources. The basis for differences in waiting times as a function of age needs to be further investigated to ensure equitable access to care.

Résumé

Contexte: L’étude s’articule autour de deux questions de recherche, la première étant le délai d’attente moyen entre le diagnostic et le traitement chez les Albertaines ayant le cancer du sein par rapport aux recommandations de la Société canadienne pour l’oncologie chirurgicale, et la seconde, l’influence éventuelle de l’âge, de la progression du cancer, de la taille de la communauté de la patiente et de l’année du diagnostic sur le délai d’attente.

Méthode: L’échantillon se composait de toutes les Albertaines ayant reçu un diagnostic de cancer du sein entre 1997 et 2000. Le délai d’attente a été défini comme le nombre de jours entre l’évaluation définitive et le début du traitement. Par analyse de régression multiple, nous avons examiné l’influence relative des prédicteurs du délai d’attente.

Résultats: Il y a eu 6 418 cas de cancer du sein entre 1997 et 2000. Le délai d’attente moyen entre le diagnostic et le traitement était de 20,2 jours (écart-type de 21,6), et le délai d’attente médian, de 17 jours. Une attente prolongée était associée de façon significative à l’année du diagnostic (le délai s’est allongé progressivement entre 1997 et 2000), aux patientes de moins de 70 ans, et au premier stade du cancer. L’augmentation du délai d’attente entre 1997 et 2000 semble s’expliquer par la demande accrue de services sans augmentation correspondante des ressources. Le traitement plus rapide des femmes de plus de 70 ans s’explique par le fait que davantage de ces femmes ont été traitées le jour même de leur diagnostic.

Conclusion: Seulement 44 % des femmes ont attendu 14 jours ou moins comme le recommande la Société canadienne pour l’oncologie chirurgicale. Ces délais d’attente élevés continueront sans doute à augmenter sans hausse significative des ressources en oncologie. Pour assurer un accès équitable aux soins, il faudrait étudier plus avant la raison des écarts dus à l’âge dans les délais d’attente.

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Reference

  1. 1.
    Canadian Cancer Statistics 2002. Toronto: National Cancer Institute of Canada. 2002. Available on-line at: http://www.cancer.ca/stats.(accessed 2003 Jan 13).Google Scholar
  2. 2.
    Caplan LS, Helzlsouer K. Delay in breast cancer: A review of the literatur. Public Health Re. 1992/93;20:187–214.Google Scholar
  3. 3.
    Canadian Society for Surgical Oncology position statement. Available on-line at: http://www.cos.ca/csso/policy.htm.(accessed 2003 Jan 27).Google Scholar
  4. 4.
    O’Mahoney M. Women’s lived experience of breast biopsy: A phenomenological stud. J Clin Nur. 2001;10:512–20.CrossRefGoogle Scholar
  5. 5.
    Padgett DK, Yedidia M, Kerner, J, Mandelblatt J. The emotional consequences of false positivy mammography: African-American women’s reactions in their own word. Women & Healt. 2001;33:1–14.CrossRefGoogle Scholar
  6. 6.
    Olivotto IA, Bancej C, Goel V, Snider J, McAuley G, Irvine B, et al. Waiting times from abnormal breast screen to diagnosis in 7 Canadian province. CMA. 2001;165:277–83.Google Scholar
  7. 7.
    Gaudine A, Sturge-Jacobs M, Kennedy M. The experience of waiting and life during breast cancer survivor. Res Theory Nurs Pract. 2003;17:153–68.CrossRefGoogle Scholar
  8. 8.
    Poole K, Lyne P. The ‘cues’ to diagnosis: Describing the monitoring activities of women undergoing diagnostic investigations for breast diseas. J Adv Nurt. 2000;31:200–8.Google Scholar
  9. 9.
    Elwood MJ, Moorehead W. Delay in diagnosis and long-term survival in breast cances. BMA. 1980;280:1291–94.CrossRefGoogle Scholar
  10. 10.
    Feldman JG, Saunders M, Carter A, Gardner B. The effects of patient delay and symptoms other than a lump on survival in breast cance. Cances. 1983;51:1226–29.CrossRefGoogle Scholar
  11. 11.
    Charlson ME. Delay in the treatment of carcinoma of the breas. Surgery,Gynecology and Obstetric. 1985;160:393–99.Google Scholar
  12. 12.
    Vernon SW, Tilley B, Neale V, Steinfeldt L. Ethnicity, survival, and delay in seeking treatment for symptoms of breast cance. Cances. 1985;55:1563–71.CrossRefGoogle Scholar
  13. 13.
    Hainsworth PJ, Henderson M, Bennett R. Delayed presentation in breast cancer: Relationship to tumour stage and survival. Breast. 1993;2:37–41.CrossRefGoogle Scholar
  14. 14.
    Huguley CM, Brown R, Greenberg R, Clark S. Breast self-examination and survival from breast cance. Cances. 1988;62:1389–96.CrossRefGoogle Scholar
  15. 15.
    Rossi S, Cinini C, Pietro C, Lombardi C, Crucitti A, Bellantone R, Crucitti F. Diagnostic delay in breast cancer: Correlation with disease stage and prognosi. Tumour. 1990;76:559–62.CrossRefGoogle Scholar
  16. 16.
    Rabinovich MG, Vallejo C, Perez J, Rodriguez R, Cuevas M, Machiavelli M, et al. Impact of delay to treatment upon survival in 1067 patients with breast cance. Int J Oncolog. 1993;2:197–201.Google Scholar
  17. 17.
    Afzelius P, Zedeler K, Sommer H, Mourdsen H, Blichert-Toft M. Patient’s and doctor’s delay in primary breast cance. Acta Oncon. 1994;33:345–51.CrossRefGoogle Scholar
  18. 18.
    Raabe NK, Fossaa S. Primary invasive breast carcinoma in Oslo 1980–198. Acta Oncol. 1996;35:9–15.CrossRefGoogle Scholar
  19. 19.
    Richards MA, Wetscombe A, Love S, Littlejohns P, Ramirez A. Influence of delay on survival in patients with breast cancer: A systematic review. Lances. 1999;353:1119–26.CrossRefGoogle Scholar
  20. 20.
    Richards MA, Smith P, Ramirez A, Fentiman I, Rubens R. The influence on survival of delay in the presentation and treatment of symptomatic breast cance. Br J Cances. 1999;79:858–64.CrossRefGoogle Scholar
  21. 21.
    Wyatt RM, Beddoe A, Dale R. The effects of delays in radiotherapy treatment on tumour contro. Phys Med Biol. 2003;48:139–55.CrossRefGoogle Scholar
  22. 22.
    Alderson MR, Hamlin I, Staunton M. The relative significance of prognostic factors in breast carcinom. Br J Cances. 1971;25:646–56.CrossRefGoogle Scholar
  23. 23.
    Dennis CR, Gardner B, Lim B. Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cance. Cances. 1975;35:714–20.CrossRefGoogle Scholar
  24. 24.
    Wallgren A, Silfversward C, Eklund G. Prognostic factors in mammary carcinom. Acta Radio. 1976;15:1–15.Google Scholar
  25. 25.
    Fisher ER, Redmond C, Fisher B. A perspective concerning the relationship of duration of symptoms to treatment failure in patients with breast cance. Cances. 1977;40:3160–67.CrossRefGoogle Scholar
  26. 26.
    Neave LM, Mason B, Kay R. Does delay in diagnosis of breast cancer affect survival. Breast Cancer Res Treat. 1990;15:103–8.CrossRefGoogle Scholar
  27. 27.
    Goodwin JS, Samet J, Hunt W. Determinants of survival in older cancer patient. J Natl Cancer Inst. 1996;88:1031–38.CrossRefGoogle Scholar
  28. 28.
    Sainsbury R, Johnston C, Haward B. Effect on survival of delays in referral of patients with breast-cancer symptoms: A retrospective analysis. Lances. 1999;353:1132–35.CrossRefGoogle Scholar
  29. 29.
    Spurgeon P, Barwell F, Kerr D. Waiting times for cancer patients in England after general practitioners’ referrals: Retrospective national survey. BM. 2000;230:838–39.CrossRefGoogle Scholar
  30. 30.
    Robinson D, Bell C, Moller H, Basnett I. Effect of the UK government’s 2-week target on waiting times in women with breast cancer in southeast Englan. Br J Cances. 2003;89:492–96.CrossRefGoogle Scholar
  31. 31.
    Khawaja A, Allan S. Has the breast cancer ‘two week wait’ guarantee for assessment made any difference. Eur J Surg Oncology. 2000;26:536–39.CrossRefGoogle Scholar
  32. 32.
    Mackillop WJ, Fu H, Quirt C, Dixon P, Brundage M, Zhou Y. Waiting for radiotherapy in Ontari. Int J Radiat Oncol Biol Phy. 1994;30:221–28.CrossRefGoogle Scholar
  33. 33.
    Mayo NE, Scott S, Shen N, Hanley J, Goldberg M, MacDonald N. Waiting time for breast cancer surgery in Quebec. CMA. 2001;164:1132–38.Google Scholar
  34. 34.
    Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D. A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontari. CMA. 2001;165:421–25.Google Scholar
  35. 35.
    Caplan LS, May D, Richardson L. Time to diagnosis and treatment of breast cancer: Results from the National Breast and Cervical Cancer Early Detection Program, 1991–1995. Am J Public Healt. 2000;90:130–34.CrossRefGoogle Scholar
  36. 36.
    Burgess CC, Ramirez A, Richards M, Love S. Who and what influences delayed presentation in breast cance. Br J Cances. 1998;77:1343–48.CrossRefGoogle Scholar
  37. 37.
    Caplan LS, Helzlsouer K, Shapiro S, Freedman L, Coates R, Edwards B. System delay in breast cancer in Whites and Black. Am J Epidemiol. 1995;142:804–12.CrossRefGoogle Scholar
  38. 38.
    Finley ML, Francis A. Risk factors and physician delay in the diagnosis of breast cance. Prog Clin Biol Res. 1983;130:351–60.PubMedGoogle Scholar
  39. 39.
    Nichols S, Waters W, Fraser M, Wheeler M, Ingham S. Delay in the presentation of breast symptoms for consultant investigatio. Comm Med. 1981;3:217–25.Google Scholar
  40. 40.
    Adam SA, Horner J, Vessey M. Delay in treatment for breast cance. Comm Med. 1980;2:195–201.Google Scholar
  41. 41.
    MacArthur C, Smith A. Delay in breast cancer and the nature of presenting symptom. Lances. 1981;1:601–3.CrossRefGoogle Scholar
  42. 42.
    Bywaters JL. The incidence and management of female breast disease in a general practic. J R Coll General Practitioner. 1977;27:353–57.Google Scholar
  43. 43.
    Greer S. Psychological aspects: Delay in the treatment of breast cance. Proceeding R Soc Med. 1974;67:470–72.Google Scholar
  44. 44.
    North American Association of Central Cancer Registries. Available on-line at http://www.naacr.org/.
  45. 45.
    Alberta Cancer Registry: Annual Report of Cancer Statistics, 1997–99. Alberta Cancer Board. 2002. Available on-line at http://www.cancerboard.ab.ca/.cancer/cancer_online.html (accessed 2003 Aug 28).
  46. 46.
    Health Canad. Canada Health Act Annual Report, 2001–2002. Ottawa, ON: Author.Google Scholar
  47. 47.
    College of Physicians and Surgeons of Albert. Physician Resource Statistic. Available on-line at http://www.cpsa.ab.ca/physicianregistration/.physician_statistics.asp.

Copyright information

© The Canadian Public Health Association 2004

Authors and Affiliations

  • Alyssa D. Reed
    • 1
    Email author
  • Robert J. Williams
    • 1
  • Patricia A. Wall
    • 1
  • Paul Hasselback
    • 2
  1. 1.Faculty of MedicineUniversity of CalgaryCalgaryCanada
  2. 2.KelownaCanada

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