title: A population-based study of the waiting times for prostatectomy in Ontario.
abstract: OBJECTIVE
  Despite the high incidence of prostate cancer in Canada, there is currently limited information describing how these patients are being managed. The aim of this study was to review the surgical waiting times for radical prostatectomy in Ontario, utilizing existing population-based cancer databases, and to describe factors associated with prolonged waiting times.
  
  
  METHODS
  This is a retrospective, population-based, observational study of men diagnosed with prostate cancer in Ontario between 1980 and 2000. The sources of data include the Ontario Cancer Registry linked to hospital discharge data, as well as census data from Statistics Canada. Study variables include age, county of residence, teaching hospital status, hospital surgical volume, area-level median household income and cause-specific survival. Waiting times were compared across study variables using univariate and graphical methods. Survival was compared across geographic regions with differing average wait times.
  
  
  RESULTS
  We identified 9524 men treated with radical prostatectomy in Ontario over the study period and found the percentage of all patients with the disease who were treated surgically increasing from 3% to 20% over the last 2 decades. The overall time to prostatectomy has almost doubled with a median waiting time of 55 days in earlier eras to 91 days in 1996-2000. A few counties had significantly different wait times, whereas age and socio-economic factors were not associated with wait times across most eras. In the most recent eras, acute care hospitals and hospitals with higher surgical volumes had significantly higher waiting times (up to 20 days longer in 1996-2000, p<0.0001). Patients living in regions with the shortest wait times had statistically significant worse survival (p=0.02), implying that triaging has a greater impact than the potential effect of prolonged waits.
  
  
  CONCLUSIONS
  The observed increases in waiting times for radical prostatectomy from this study are similar to the known increases in waiting times for radiotherapy. This increased time to treatment is an illustration of the stress on the health care system in Ontario.
authors.affiliation: Department of Urology, Queen's University, Kingston, Ontario, Canada.
authors.forename: D Robert
authors.initials: DR
authors.lastname: Siemens
authors.forename: Karleen M
authors.initials: KM
authors.lastname: Schulze
authors.forename: William J
authors.initials: WJ
authors.lastname: Mackillop
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brundage
authors.forename: Patti A
authors.initials: PA
authors.lastname: Groome
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011468:Prostatectomy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists