Wait times from diagnosis to treatment in cancer

a cancer diagnosis is anxiety provoking. Waiting for definitive treatment for cancer augments this anxiety [1-7]. Waiting for treatment also decreases patient satisfaction with their medical center and results in a poorer quality of life [4,8]. The underlying concern is whether longer wait times lead to spreading of tumor, the need for more extensive therapy and ultimately poorer survival. There have been studies across cancer types addressing the relationship between wait times and overall survival. Table 1 shows those studies where there is a clear detrimental re lation-ship on survival and those where the relationship is in con clusive [4,8-35]. With the exception of esophageal cancer, each disease site has studies showing divergent answers as to whether there is a relationship between wait times for surgery and survival. In part this is related to the quality of the studies. All of the studies are retrospective cohort studies that may be single center or population based. Such studies have the risk of confounding and so it is important to conduct multivariate analysis with risk adjustment. Unfortunately, many studies do not have details about stage, or histology which should be included in the model. Duration of follow-up can lead to variation in results. In addition the reason for treatment delay is not always clear (i.e., patient comorbidities impacting the timing of surgery). Single center studies often have small sample sizes which may limit the ability to find a relationship even if one exists. Rather than looking at wait times as a continuous relationship, often the studies look at wait times in a dichotomous variable and so miss an issue. There is a clear relationship between better outcomes (quality of care) in high volume hospitals compared to low volume centers across many cancer types [10]. In many jurisdictions we have seen a displacement of surgical volume to high volume cancer centers [36]. Rising wait times in this setting reflects a compromised ability of the system of care to deal with this volume in terms of availability of resources and efficiencies [9]. Specific stresses are seen in diagnostic (i.e., diagnostic radiology, interventional radiology, pathology) and treatment resources (number of quality oncology surgeons, operating room access, inpatient beds) [4,8,9,36-38]. To compound this, fixed hospital budgets limit capacity and provide little incentive for medical staff to increase production. To deal with this problem, there has been a plea that wait times be considered when formulating national …