WAITING FOR RADIOTHERAPY IN ONTARIO

Purpose: Waiting lists for radiotherapy are a fact of life at many Can adian cancer centers. The purpose of this study was to provide a detai led description of the magnitude of the problem in Ontario. Methods an d Materials: The interval between diagnosis and initiation of radiatio n treatment was calculated for all patients receiving primary radiothe rapy for carcinoma of the larynx, cervix, lung, and prostate at seven Ontario cancer centers between 1982 and 1998. The interval between sur gery and initiation of postoperative radiotherapy for breast cancer wa s also calculated over the same period. The intervals between diagnosi s and referral (t(1)), between referral and consultation (t(2)), and b etween consultation and initiation of radiotherapy (t(3)), were analyz ed separately to determine where delay occurred. Results: Median waiti ng times between diagnosis and initiation of radical treatment for car cinoma of the larynx, carcinoma of the cervix, nonsmall cell lung canc er, and carcinoma of the prostate were 30.3 days, 27.2 days, 27.3 days , and 93.3 days, respectively. The exceptional interval between diagno sis and treatment of prostate cancer was due to much longer delays bet ween diagnosis and referral. The median waiting time between diagnosis and initiation of postoperative radiotherapy for breast cancer was 61 .4 days and the median time between the completion of surgery and init iation of postoperative radiotherapy was 57.8 days. There were signifi cant intercenter variations in median waiting times, but in every situ ation the median waiting time in Ontario as a whale increased steadily between 1982 and 1991. Median waiting times from diagnosis to the sta rt of curative treatment for laryngeal cancer, cervical cancer, nonsma ll cell lung cancer, and prostate cancer increased by 178.7%, 105.6%, 158.3%, and 62.9%, respectively. Waiting time from completion of surge ry to initiation of postoperative radiotherapy for breast cancer incre ased by 102.7%. Most of the increase in treatment delay was found in t he interval between consultation and initiation of radiotherapy. Concl usions: The Committee on Standards of the Canadian Association of Radi ation Oncologists recommends that the interval between referral and co nsultation should not exceed 2 weeks and that the interval between con sultation and initiation of radiotherapy should also not exceed 2 week s. The majority of patients treated in Ontario met both those standard s in 1982, but by 1991 few patients received care within the prescribe d intervals.