Effect of the UK government's 2-week target on waiting times in women with breast cancer in southeast England

Abstract

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.

The two-week wait cancer initiative on oral cancer; the predictive value of urgent referrals to an oral medicine unit

“…A longer wait from fi rst appointment to treatment was also reported for breast cancer in Southeast England following a two-week target on waiting times to see a consultant. 9 Substantial delays experienced by oral cancer patients are discussed by previous authors. 10 Among 120 oral cancers diagnosed in a hospital setting, only 75% had an indication of a suspected malignancy.…”

Wait times for breast cancer care

“…It has become apparent that the measurement of care time intervals is complex and definition of the care interval monitored may bias the detection of change in wait times . For example, in the United Kingdom, the introduction of a 'guaranteed' 2-week maximum wait for urgent referrals from general practitioners (GP) to first hospital appointment for women with breast cancer, resulted in shorter timelines for the observed interval (Robinson et al, 2003). However, the overall wait time from GP referral to treatment did not improve as the shorter timelines in the targeted care interval were offset by increases in others (Robinson et al, 2003).…”

“…For example, in the United Kingdom, the introduction of a 'guaranteed' 2-week maximum wait for urgent referrals from general practitioners (GP) to first hospital appointment for women with breast cancer, resulted in shorter timelines for the observed interval (Robinson et al, 2003). However, the overall wait time from GP referral to treatment did not improve as the shorter timelines in the targeted care interval were offset by increases in others (Robinson et al, 2003). Wait time assessment is further complicated by the interplay of demographic, clinical and epidemiologic factors, and the need to interact with a series of health professionals working in care settings where information flow is imperfect at best (Reed et al, 2004;Robinson et al, 2005).…”

Waiting times for radiotherapy: variation over time and between cancer networks in southeast England

“…In an earlier study (Robinson et al, 2003), we showed that this had a knockon effect, with decreased waiting times during this earlier part of the cancer pathway being offset by increased waits from first hospital appointment to treatment -particularly for radiotherapy.…”

“…In a previous study (Robinson et al, 2003), in which we investigated the immediate effect of the introduction of the government '2-week wait' target, we found that the wait from first hospital appointment to first treatment for women with breast cancer in southeast England was highly dependent on the type of treatment. The small group of women who received radiotherapy as their first treatment experienced long delays, with little more than half being treated within the target time of 5 weeks from first hospital appointment.…”