title: Wait times for cancer surgery in the United States: trends and predictors of delays.
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.
authors.affiliation: Cancer Programs, Commission on Cancer, American College of Surgeons, Chicago, IL 60611, USA. kbilimoria@facs.org
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: Denise L
authors.initials: DL
authors.lastname: Hynes
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
mesh_terms: D001071:Appointments and Schedules; D016208:Databases, Factual; D055088:Early Detection of Cancer; D005260:Female; D005544:Forecasting; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data / Q000639:trends; D013997:Time Factors; D014481:United States; D014850:Waiting Lists