A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario

Background: There is evidence that delays in treatment result in increased psychosocial morbidity for patients diagnosed with cancer. We evaluated wai ting times for care among cancer patients treated by surgeons affiliated wi th regional cancer centres in Ontario. Methods: Dates for 5 key events related to the surgical management of a pat ient with cancer were collected by a convenience sample of surgeons who tre at breast, gynecologic, colorectal, head and neck, thoracic and urologic ca ncers. The key events were initial referral, first surgical visit, main tre atment decision, major surgery and receipt of postoperative pathology repor t. The surgeons were also asked to judge the appropriateness of the waiting times for the intervals studied and to identify factors associated with in appropriate delays. Results: A total of 62 surgeons affiliated with 8 regional cancer centres p articipated; data were collected for 1456 patients who underwent assessment and whose surgical visit occurred between Jan. 31 and May 31, 2000. The me dian waiting time from referral to first visit was 11.0 days, from first vi sit to treatment decision 0.0 days, from treatment decision to surgery 20.0 days and from surgery to receipt of the pathology report 8.0 days. The med ian waiting times for the 2 summary intervals (referral to surgery and refe rral to receipt of the pathology report) were 37.0 and 48.0 days respective ly. The waiting times varied by cancer type; for example, the median time f rom referral to surgery varied from 29.0 days for colorectal cancers to 64. 0 days for urologic cancers. The same interval varied from 19.0 to 43.0 day s by treatment centre. The waiting times did not vary substantially by pati ent age. The surgeons judged that 344 (37.2%) of the 925 patients with date s for the referral-to-surgery interval had inappropriately long waiting tim es. They indicated that contributing factors to these inappropriate waits w ere shortage of operating room time (in 181 cases), lack of other resources such as diagnostic tests or allied health personnel (in 156) and patient p reference or circumstance (in 28) (factors were not mutually exclusive). Interpretation: Many of the patients with cancer seen by surgeons affiliate d with regional cancer centres in Ontario may be experiencing significant d elays in the assessment and treatment of their cancer.