Wait times in prostate cancer diagnosis and radiation treatment

Abstract

Introduction: Wait times for cancer diagnosis and treatment area significant concern for Canadians. Men with prostate cancerexperience longer waiting times for diagnosis and treatment thanthose observed for other cancers. Longer waits are associated withboth patient and family psychosocial distress and may be associatedwith worse prognosis.Methods: Men referred for treatment of prostate cancer at a singleCanadian cancer centre were interviewed. The intervals from suspicionto definitive therapy were calculated, factors associated withdelays along this pathway were identified, and common causes ofdelay identified by patients were described.Results: A total of 41 consecutive patients participated. The medianinterval from suspicion to the first fraction of radiotherapy forall patients was 247 days (interquartile range [IQR] 168-367 d).The median diagnostic interval was 53 days (IQR 28-166 d). Themedian treatment interval was 127 days (IQR 100-180 d). Patientsunder 70 years old and patients with <T2c disease had shorterintervals from suspicion to treatment. From diagnosis to start ofradiotherapy, patients with low-risk disease had longer intervals.Seventy percent of patients perceived a delay in their care, ofwhich 45%, 31% and 24% of patients felt the delays were due tothe health care system, patient or physician factors, respectively.Interpretation: In this study, 12% and 0% of patients met CanadianStrategy for Cancer Control and Canadian Association of RadiationOncologists wait time recommendations, respectively. A large componentof wait time is patient driven. Alternate strategies shouldbe developed and measured to shorten the intervals between thesuspicion and treatment of prostate cancer.Introduction : Les temps d’attente pour recevoir un diagnosticde cancer et un traitement constituent une source importante depréoccupation pour les Canadiens. Les hommes atteints de cancerde la prostate attendent encore plus longtemps que les patientsatteints d’autres types de cancer pour obtenir un diagnostic etentreprendre un traitement. Ces attentes plus longues se traduisentpour le patient et sa famille par un stress psychosocial et peuventêtre liés à un pronostic plus sombre.Méthodologie : Des hommes aiguillés vers le même centre decancérologie au Canada pour la prise en charge d’un cancer dela prostate ont été interviewés. L’intervalle entre le soupçon decancer et le début réel du traitement a été calculé; on a cernéles facteurs liés aux retards le long du processus, et les causes deretards signalées par les patients ont été décrites.Résultats : Au total, 41 patients consécutifs ont participé. La duréemédiane de l’intervalle entre le soupçon de cancer et la premièreséance de radiothérapie pour tous les patients était de 247 jours(écart interquartile [EIQ], 168 à 367 jours). La durée médianede l’intervalle avant le diagnostic était de 53 jours (EIQ, 28 à166 jours). La durée médiane de l’intervalle avant le début dutraitement était de 127 jours (EIQ, 100 à 180 jours). Les patients deplus de 70 ans et les patients porteurs d’une tumeur T2c ou moinsavancée signalaient des intervalles plus courts entre les premierssoupçons de cancer et le traitement. Entre le diagnostic et le débutde la radiothérapie, les patients présentant une maladie à faiblerisque avaient des intervalles plus longs. Soixante-dix pour centdes patients ont perçu un retard dans leur prise en charge, parmilesquels 45 % croyaient ce retard lié au système de santé, 31 %, àdes facteurs liés au patient, et 24 %, à des facteurs liés au médecin.Interprétation : Dans cette étude, 12 % et 0 % des patients,respectivement, ont présenté des temps d’attentes conformes auxrecommandations de la Stratégie canadienne de lutte contre lecancer et de l’Association canadienne de radio-oncologie. Letemps d’attente est déterminé en grande partie par des facteurs liésau patient. D’autres stratégies devraient être élaborées et évaluéesafin de réduire les intervalles entre les premiers soupçons de cancerde la prostate et le début du traitement.

Late Diagnosis among patients with Prostate Cancer at the Uganda Cancer Institute: A retrospective cohort study.

“…Patients who had biopsies within 4 months of initiation of symptoms were two times likely to be diagnosed early compared to patients who had biopsies after 4 months. This is comparable to a studies conducted in Florida, USA and Toronto, Canada which found that men diagnosed with early stage prostate cancer had a shorter wait time to diagnosis (14). We further found that most patients were lost to follow up while others had succumbed to prostate cancer within two years.…”

Waiting times for cancer patients in Sweden: A nationwide population-based study

“…Despite these aspects, the very long waiting times for men with prostate cancer in Sweden as well as the differences between counties are unacceptable and need to be addressed. It is not known whether these long waiting times have a negative impact on outcome, but it has been shown in previous studies that a prolonged wait causes psychological distress to these patients [14,15].…”

Wait Times for Prostate Cancer Treatment and Patient Perceptions of Care in Canada: A Mixed-Methods Report

“…However, studies have demonstrated that wait times for treatment (for example, between the decision to treat and the start of treatment) continue to be longer for men with pca than for individuals with other cancers in Canada's universal health care system [6][7][8][9][10][11] . Prolonged delays between cancer diagnosis and treatment have been associated with anxiety, stress, and perceived powerlessness for patients and their family members [12][13][14] . Longer wait times might also be associated with poorer prognosis, although the evidence is inconclusive 14 .…”

“…Prolonged delays between cancer diagnosis and treatment have been associated with anxiety, stress, and perceived powerlessness for patients and their family members [12][13][14] . Longer wait times might also be associated with poorer prognosis, although the evidence is inconclusive 14 . Examination of wait times for cancer care across Canada is therefore an ongoing need.…”