Waiting times for cancer surgery in Ontario: 1984-2000

Aims: Despite persistent public interest and the perception among clinicians and patients that increased waiting time for cancer surgery is related to worse outcomes, little is known about waiting time for cancer surgery. Our aim is to describe changes in waiting times for cancer surgery in Ontario between 1984 and 2000, and associated factors. Materials and methods: The interval between date of diagnosis and admission for surgery for all patients receiving surgical treatment for cancers of the larynx, hypopharynx, stomach, colon, rectum, breast, cervix, uterus, prostate, bladder, lung and oesophagus was calculated for all patients in Ontario between 1984 and June 2000. This was accomplished by retrospective review of prospectively gathered electronic records. Results: Median waiting times for cancer surgery increased for all cancer types, including substantial increases for oesophageal cancer (from 14 days between 1984 and 1987 to 33 days between 1998 and 2000), breast cancer (12-27 days), and laryngeal cancer (16-33 days). A similar increase in waiting times for patients awaiting radiation therapy was identified. The proportion of patients receiving diagnosis and definitive resection on the same admission for colon cancer decreased (from 79.4% between 1984 and 1987 to 47.9% between 1998 and 2000) for laryngeal cancer (35.5-9.4%), and for lung cancer (61.6-23.0%). Age, sex, cancer site, hospital type, household income and cancer centre location were all independently related to waiting times. Conclusions: Waiting times for cancer surgery increased substantially between 1984 and 2000. Waiting times were influenced by disease, patient and health-system-related factors.