title: [Waiting times for cancer care in four most frequent cancers in several French regions in 2011 and 2012].
abstract: Measuring waiting times is a good indicator of quality of cancer care and could reveal inequalities in cancer care access.
  
  
  OBJECTIVE
  To determine the most representative waiting times in breast, lung, colon and prostate cancer care in several regions of France. To analyze the influence of individual, medical or health care system factors on those waiting times.
  
  
  METHODS
  This study was piloted by the French Cancer Institute in partnership with the National Federation of the Regional Health Observatories and was driven by the Regional Oncology Networks and the Regional Health Observatories. In 2011, 2,530 women with breast cancer and 1,945 patient with lung cancer were included in eight regions, and in 2012, 3,248 patients with colon cancer and 4,207 men with prostate cancer were included in 13 regions, two of which were overseas departments. Data were analyzed from multidisciplinary discussion reports and from medical records.
  
  
  RESULTS
  The mean time intervals (± standard deviation) for the various components of access to care were as follows in breast cancer: mammography to pathologist diagnosis, 17,7 days (±15,9); diagnosis (or treatment proposal) to surgery, 22,9 days (±13,9). In lung cancer: first suspect medical image to pathologist diagnosis, 21,5 days (±17,6); diagnosis to treatment proposal, 13,5 days (±10,7). In colon cancer: coloscopy to pathologist diagnosis, 4,5 days (±4,1); diagnosis to surgery, 18,9 days (±14,9). In prostate cancer: pathologist diagnosis to treatment proposal, 36,5 days (±26,5); treatment proposal to surgery, 45,2 days (±30,1). Data collection was particularly difficult because of very heterogeneous way in medical records filling by care centers, so the data collection method used in the study could not be used in routine procedures. Waiting times measured in the four cancers had an important variability. In fact, age, circumstance of diagnosis, tumor stage and category of care center had an influence. After considering those different factors, differences between regions remained from range 2 to 4. Those regional differences could be explained by organizational factors but were not explored in our study. In the same way, data on individual factors (social vulnerability, category of employment) were not available to measure their effects on this study. Besides, our results were comparable to those in international publications or national recommendations in other countries.
  
  
  CONCLUSIONS
  These results suggest that waiting times could be good indicators and could reveal inequalities in cancer care access. Measuring them would lead to characterize those inequalities and to propose actions to improve access to cancer care whose impact could be measured.
authors.affiliation: Institut national du cancer (INCa), département parcours de soins et relations avec les professionnels, 52, avenue André-Morizet, 92513 Boulogne-Billancourt cedex, France.
authors.forename: Graziella
authors.initials: G
authors.lastname: Pourcel
authors.affiliation: Fédération nationale des Observatoires régionaux de santé (FNORS), 75015 Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Ledesert
authors.affiliation: Institut national du cancer (INCa), département observation-veille-évaluation, 92513 Boulogne-Billancourt, France.
authors.forename: Philippe-Jean
authors.initials: PJ
authors.lastname: Bousquet
authors.affiliation: Institut national du cancer (INCa), département parcours de soins et relations avec les professionnels, 52, avenue André-Morizet, 92513 Boulogne-Billancourt cedex, France.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ferrari
authors.affiliation: Institut national du cancer (INCa), direction du pôle santé publique et soins, Boulogne-Billancourt, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Viguier
authors.affiliation: Institut national du cancer (INCa), Boulogne-Billancourt, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Buzyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012041:Regional Medical Programs / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014850:Waiting Lists
keywords: cancer; impacting factors; inequalities in cancer care access; organizational factors; regional disparities; waiting times