title: Retrospective analysis on timeframes of referral, diagnosis and treatment of patients with endometrial carcinomas in Dunedin Hospital, 2008-2011.
abstract: OBJECTIVE
  To quantify time taken for patients diagnosed and treated for endometrial cancer in Dunedin Hospital in context of Ministry of Health New Zealand (MoHNZ) best practice indicators for cancer diagnosis and treatment, and to identify factors which could potentially cause delays if present.
  
  
  METHODS
  Retrospective audit was carried out based on patients discussed at a Gynaecology-Oncology Multi-Disciplinary Meeting (GOMDM) at Dunedin Hospital during 2008-2011 for primary endometrial cancer. Median time taken between referral dates, first specialist appointment, date of histological diagnosis, staging scan, date when patients were waitlisted for surgery, and date of first treatment were calculated. Possible factors which could contribute to delay if present were identified and further explored.
  
  
  RESULTS
  44 eligible patients were identified. Compared to MoHNZ recommendations delays were present from initial referral to first treatment (93 days actual timeframe vs. 62 days recommended timeframe) and some delays present from initial referral to first specialist assessment (21 days vs. 14 days), with only 20% and 32% of patients being seen and treated within the best practice timeframes respectively. Patients were treated within the recommended time once they were wait-listed for first definitive treatment (19 days vs. 31 days) with 75% of patients being treated within the recommended timeframe. Waiting time for hysteroscopy and dilatation and curettage was seen to contribute towards considerably longer delays in diagnosis and treatment of endometrial cancers. Other potential factors contributing to delay identified were patients not attending clinic appointments and difficulty in obtaining a conclusive histological sample through pipelle biopsy at the initial clinic visit.
  
  
  CONCLUSIONS
  Currently the practice in Dunedin Hospital does not meet the planned MoHNZ standards, and significant changes in practice and reallocation of resource will be required to meet the MOH standards for women with endometrial cancer. Training of General Practitioners in pipelle biopsy, better patient education about post-menopausal bleeding, reducing the time taken for radiological scans, and expediting referrals to the first specialist appointment and hysteroscopy for patients with high suspicion, could reduce delays.
authors.affiliation: Middlemore Hospital, Auckland, New Zealand. kanmi875@gmail.com.
authors.forename: Michael Yoon
authors.initials: MY
authors.lastname: Kang
authors.forename: Peter
authors.initials: P
authors.lastname: Sykes
authors.forename: Peter Yoon
authors.initials: PY
authors.lastname: Herbison
authors.forename: Simone
authors.initials: S
authors.lastname: Petrich
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D004107:Dilatation and Curettage / Q000706:statistics & numerical data; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009520:New Zealand; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014850:Waiting Lists