Addressing wait times for endometrial cancer surgery in Ontario.
OBJECTIVE
Wait times for cancer surgery in Ontario have increased over the last decade. We reviewed trends in wait times for endometrial cancer surgery from 1996 to 2000 and identified determinants that may need to be addressed in order to reduce these wait times.


METHODS
The study population included women diagnosed with endometrial cancer (ICD-9 codes 179 or 182) prior to surgery. Surgical wait time was defined as the interval between date of diagnosis and hospital admission for surgery. Univariate analyses assessed demographic, treatment, and hospital factors associated with wait times. A multilevel linear regression model was created to account for clustering of patients at the hospital level and regional level defined by local health integration networks (LHINs). Effects of covariates were expressed as estimates of the median proportional change in wait time.


RESULTS
There were 2042 cases in this analysis. Mean wait time increased from 32 to 40 days (P = 0.0012). Prolonged wait times were associated with age > 70 years, presence of comorbidities, and surgery performed at a teaching hospital and by a gynaecologic oncologist. Wait times were not associated with income level or region of residence defined by LHIN.


CONCLUSIONS
Wait times for endometrial cancer surgery have increased significantly in Ontario. Determinants of these prolonged wait times need to be addressed, and criteria for referral to a teaching hospital and gynaecologic oncologist should be developed to ensure that local health integration networks provide equal and timely access to care.
Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston TX.
Janice S
JS
Kwon
Department of Systems Biology, MD Anderson Cancer Center, Houston TX.
Mark S
MS
Carey
Department of Epidemiology, Harvard School of Public Health, Boston MA.
E Francis
EF
Cook
Department of Programming and Biostatistics, Institute for Clinical Evaluative Sciences, Toronto ON.
Feng
F
Qiu
Department of Health Services Research, Institute for Clinical Evaluative Sciences, Toronto ON.
Lawrence F
LF
Paszat
D000367:Age Factors; D000368:Aged; D002391:Catchment Area, Health; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists