title: Factors associated with wait times across the breast cancer treatment pathway in Ontario.
abstract: BACKGROUND
  Longer times from diagnosis to breast cancer treatment are associated with poorer prognosis. This study examined factors associated with wait times by phase in the breast cancer treatment pathway.
  
  
  METHODS
  There were 1760 women eligible for the study, aged 50-69 diagnosed in Ontario with invasive breast cancer from 1995-2003. Multivariate logistic regression examined factors associated with greater than median wait times for each phase of the treatment pathway; from diagnosis to definitive surgery; from final surgery to radiotherapy without chemotherapy and from final surgery to chemotherapy.
  
  
  RESULTS
  The median wait times were 17 days (Inter Quartile Range (IQR) = 0-31) from diagnosis to definitive surgery, 44 days (IQR = 34-56) from final surgery to postoperative chemotherapy and 75 days (IQR = 57-97) from final surgery to postoperative radiotherapy. Diagnosis during 2000-2003 compared to 1995-1999 was associated with significantly longer wait times for each phase of the treatment pathway. Higher income quintile was associated with longer wait time from diagnosis to surgery (OR = 1.47, 95% CI = 1.05-2.06) and shorter wait times from final surgery to radiotherapy (OR = 0.60, 95% CI = 0.37-0.96). Greater stage at diagnosis was associated with shorter wait times from diagnosis to definitive surgery (stage III vs I: OR = 0.49, 95% CI = 0.34-0.71).
  
  
  CONCLUSIONS
  While diagnosis during the latter part of the study period was associated with significantly longer wait times for all phases of the treatment pathway, there were variations in the associations of stage and income quintile with wait times by treatment phase. Continued assessment of factors associated with wait times across the breast cancer treatment pathway is important, as they indicate areas to be targeted for quality improvement with the ultimate goal of improving prognosis.
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON M5G 2L7 Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Amalia
authors.initials: A
authors.lastname: Plotogea
authors.forename: Anna M
authors.initials: AM
authors.lastname: Chiarelli
authors.forename: Lucia
authors.initials: L
authors.lastname: Mirea
authors.forename: Maegan V
authors.initials: MV
authors.lastname: Prummel
authors.forename: Nelson
authors.initials: N
authors.lastname: Chong
authors.forename: Rene S
authors.initials: RS
authors.lastname: Shumak
authors.forename: Frances P
authors.initials: FP
authors.lastname: O'Malley
authors.forename: Claire M B
authors.initials: CM
authors.lastname: Holloway
keywords: Breast cancer; Chemotherapy; Demographic factors; Radiotherapy; Surgery; Treatment wait time