Trends in Wait Times for Cancer Surgery in the US
Background: Patients frequently voice concerns regarding wait times for cancer treatment; however, little is known about the length of wait times from diagnosis to surgery in the United States. Our objectives were (1) to assess changes in wait times over the past decade and (2) to identify patient, tumor, and hospital factors associated with prolonged wait times for initial cancer treatment.
Methods: Using the National Cancer Data Base (1995–2005), 1,228,071 patients were identified who underwent resection for nonmetastatic breast, colon, esophageal, gastric, liver, lung, pancreatic, and rectal cancer at 1443 hospitals. Multivariable models were developed to assess factors associated with time to treatment.
Results: From 1995 to 2005, the median time from diagnosis to treatment increased for all cancers (P < 0.0001). The time from diagnosis to treatment was significantly longer at National Cancer Institute Comprehensive Cancer Centers and Veterans' Administration institutions versus community hospitals (P < 0.0001). On multivariable analysis, patients were significantly more likely to undergo initial treatment > 30 days from diagnosis if older (6 of 8 cancers), black (5 of 8 cancers), had more comorbidities (6 of 8 cancers), had Stage I disease (7 of 8 cancers), or were treated at National Cancer Institute Comprehensive Cancer Centers or Veterans' Affairs institutions (all cancers).
Conclusions: Wait times for cancer treatment have increased over the last decade. As case loads increase, wait times for treatment are likely to continue increasing, potentially resulting in additional treatment delay. Additional resources and strategies are needed to reduce wait times for cancer treatment in the United States.
Cancer is the second leading cause of death in the United States. Although cancer incidence rates have seen modest declines during the last decade, the overall number of patients diagnosed with a solid organ malignancy has been increasing, likely due to an increasing elderly population. For cancers with available screening methods, initiatives have focused on early cancer detection resulting in an increased proportion of patients presenting with early-stage malignancies where surgery remains a curative option. Thus, hospitals will likely experience a continued increase in treatable malignancies.
This effect may be particularly burdensome at certain hospitals. Oversight agencies and insurance providers are attempting to shift complex cancer operations to high-volume hospitals and designated cancer centers, citing studies which demonstrate that these specialized hospitals have better outcomes. Regionalization of surgical care could force a large proportion of patients to change hospitals, thus increasing the case volume at high-volume, designated cancer centers. Moreover, studies examining the healthcare needs for the next decade have predicted a surgeon shortage, particularly for cancer surgery.
As the complexity of multimodality cancer care increases, several weeks may elapse as a patient moves through the initial care path from diagnosis to treatment. Patients frequently voice concerns regarding wait times for cancer surgery. An extended interval from diagnosis to treatment adds to patient anxiety, leads to gaps in care, and perhaps affects disease progression. Importantly, the time from diagnosis to treatment is a reflection of the availability of resources at a hospital and the efficiency of the overall system of care.
The cumulative impact of a growing elderly population, an increase in early-stage cancer patients, potential regionalization of surgical care, and an impending surgeon shortage may lead to considerable increases in wait times for cancer surgery. However, to our knowledge, a comprehensive assessment of wait times for cancer surgery in the United States has not been performed. The objectives of this study are (1) to determine whether the time from diagnosis to treatment has increased over time; (2) to examine differences in time from diagnosis to treatment for National Cancer Institute (NCI) designated cancer centers, other academic hospitals, Veterans' Affairs (VA) facilities, and community hospitals; and (3) to assess patient and hospital factors associated with longer times from diagnosis to treatment.
Abstract and Introduction
Abstract
Background: Patients frequently voice concerns regarding wait times for cancer treatment; however, little is known about the length of wait times from diagnosis to surgery in the United States. Our objectives were (1) to assess changes in wait times over the past decade and (2) to identify patient, tumor, and hospital factors associated with prolonged wait times for initial cancer treatment.
Methods: Using the National Cancer Data Base (1995–2005), 1,228,071 patients were identified who underwent resection for nonmetastatic breast, colon, esophageal, gastric, liver, lung, pancreatic, and rectal cancer at 1443 hospitals. Multivariable models were developed to assess factors associated with time to treatment.
Results: From 1995 to 2005, the median time from diagnosis to treatment increased for all cancers (P < 0.0001). The time from diagnosis to treatment was significantly longer at National Cancer Institute Comprehensive Cancer Centers and Veterans' Administration institutions versus community hospitals (P < 0.0001). On multivariable analysis, patients were significantly more likely to undergo initial treatment > 30 days from diagnosis if older (6 of 8 cancers), black (5 of 8 cancers), had more comorbidities (6 of 8 cancers), had Stage I disease (7 of 8 cancers), or were treated at National Cancer Institute Comprehensive Cancer Centers or Veterans' Affairs institutions (all cancers).
Conclusions: Wait times for cancer treatment have increased over the last decade. As case loads increase, wait times for treatment are likely to continue increasing, potentially resulting in additional treatment delay. Additional resources and strategies are needed to reduce wait times for cancer treatment in the United States.
Introduction
Cancer is the second leading cause of death in the United States. Although cancer incidence rates have seen modest declines during the last decade, the overall number of patients diagnosed with a solid organ malignancy has been increasing, likely due to an increasing elderly population. For cancers with available screening methods, initiatives have focused on early cancer detection resulting in an increased proportion of patients presenting with early-stage malignancies where surgery remains a curative option. Thus, hospitals will likely experience a continued increase in treatable malignancies.
This effect may be particularly burdensome at certain hospitals. Oversight agencies and insurance providers are attempting to shift complex cancer operations to high-volume hospitals and designated cancer centers, citing studies which demonstrate that these specialized hospitals have better outcomes. Regionalization of surgical care could force a large proportion of patients to change hospitals, thus increasing the case volume at high-volume, designated cancer centers. Moreover, studies examining the healthcare needs for the next decade have predicted a surgeon shortage, particularly for cancer surgery.
As the complexity of multimodality cancer care increases, several weeks may elapse as a patient moves through the initial care path from diagnosis to treatment. Patients frequently voice concerns regarding wait times for cancer surgery. An extended interval from diagnosis to treatment adds to patient anxiety, leads to gaps in care, and perhaps affects disease progression. Importantly, the time from diagnosis to treatment is a reflection of the availability of resources at a hospital and the efficiency of the overall system of care.
The cumulative impact of a growing elderly population, an increase in early-stage cancer patients, potential regionalization of surgical care, and an impending surgeon shortage may lead to considerable increases in wait times for cancer surgery. However, to our knowledge, a comprehensive assessment of wait times for cancer surgery in the United States has not been performed. The objectives of this study are (1) to determine whether the time from diagnosis to treatment has increased over time; (2) to examine differences in time from diagnosis to treatment for National Cancer Institute (NCI) designated cancer centers, other academic hospitals, Veterans' Affairs (VA) facilities, and community hospitals; and (3) to assess patient and hospital factors associated with longer times from diagnosis to treatment.
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