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Study Shows Increased Wait Times for Surgical Cancer Treatment, Particularly at VA Medical Centers and NCI Cancer Centers


BACKGROUND:
Patients frequently voice concerns regarding wait times for cancer treatment. An extended interval from diagnosis to treatment increases patient anxiety, may lead to gaps in care, and potentially affects disease progression. The time from diagnosis to treatment also may be a reflection of the availability of hospital resources and the efficiency of the system of care. However, little is known about the length of wait times from diagnosis to treatment in the U.S. This study sought to assess changes in wait times over a decade (1995 - 2005) and to identify patient, tumor, and hospital factors associated with prolonged wait times for initial cancer treatment. Using data from the National Cancer Data Base, investigators identified more than one million patients who underwent resection for eight cancers at 1,443 healthcare facilities, including National Cancer Institute (NCI)-designated cancer centers, VA medical centers, academic hospitals, and community hospitals. The eight cancers included: non-metastatic breast, colon, esophageal, gastric, liver, lung, pancreatic, and rectal. Patients with Stage IV cancers were excluded from this study.

FINDINGS:

  • Wait times for cancer treatment progressively increased at all four hospital center types over the 10-year study period. The median time from diagnosis to treatment was significantly longer at VA medical centers and NCI-designated cancer centers compared to community hospitals for all eight cancers.
  • For patients who were diagnosed and treated at the same hospital, the median time from diagnosis to treatment was longest at VA medical centers, and shortest at community hospitals.
  • Patients were significantly more likely to undergo initial treatment more than 30 days following diagnosis if they were: older, African American, had more comorbidities, had Stage I disease, or were treated at NCI cancer centers or VA medical centers.

LIMITATIONS:

  • Advancements in early detection may partly explain the increasing wait times, as fewer patients present with acute disease requiring a relatively short interval between diagnosis and treatment.
  • Data limitations prevented an assessment of any relationship between treatment delay and clinical outcome.
  • Only about half of VA medical centers report cancer data to the National Cancer Data Base, so these findings are not a reflection of all VA medical centers.

IMPLICATIONS:
Overall, wait times increased more than 20% from 1995 to 2005. As case volumes increase, wait times are likely to further increase. Thus, additional resources and strategies are needed to reduce cancer treatment wait times.

AUTHOR/FUNDING INFORMATION:
Dr. Bentrem is supported by an HSR&D Career Development Award. Drs. Talamonti, Hynes, and Bentrem are from Hines VAMC, and Drs. Ko and Tomlinson are from the Greater Los Angeles VAMC.


PubMed Logo Bilimoria K, Ko C, Tomlinson J, Stewart A, Talamonti M, Hynes D, Winchester D, and Bentrem D. Wait Times for Cancer Surgery in the United States: Trends and Predictors of Delays. Annals of Surgery 2011 Feb 25;e-pub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.