title: A Patient-Centered Approach to Wait Times in the Surgical Management of Breast Cancer in the Province of Ontario.
abstract: BACKGROUND
  Wait time for breast cancer is an important contributor to cancer outcomes and patient satisfaction. This study sought to define a patient-centered wait time by measuring the time from the first abnormal imaging to definitive surgery. The authors hypothesized that multiple preoperative investigations significantly increase the patient-centered wait time.
  
  
  METHODS
  A retrospective analysis of prospectively maintained databases at the Institute for Clinical and Evaluative Sciences in Ontario, Canada was performed. Women undergoing primary surgery for invasive breast cancer from 2003 to 2011 were evaluated. The median wait time between the first abnormal imaging and definitive surgery was calculated. Uni- and multivariable analyses were performed to identify characteristics of the patients, treating institution, and diagnostic pathway that contribute significantly to the patient-centered wait time.
  
  
  RESULTS
  Our final cohort consisted of 42,179 patients: 31,837 (75 %) who had breast conserving surgery and 10,342 (25 %) who underwent mastectomy. The median wait time from the first abnormal imaging to definitive surgery was 52 days (intraquartile range 35-76 days). In adjusted analysis, older patient age, later year of surgery, additional preoperative imaging, and biopsies beyond those required for diagnosis significantly and independently extended the surgical wait time. Preoperative consultations and institutional factors such as volume of breast surgery performed and geographic location also independently had an impact on surgical wait time.
  
  
  CONCLUSIONS
  This study defined a novel patient-centered measure of surgical wait time that more fully embraces the wait experienced by the patient. Many common preoperative interventions had a significant impact on overall wait time experienced by the patient. Evidence-based quality initiatives to coordinate appropriate investigations are needed to reduce wait times.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, ON, Canada, erin.cordeiro@gmail.com.
authors.forename: Erin
authors.initials: E
authors.lastname: Cordeiro
authors.forename: Matthew
authors.initials: M
authors.lastname: Dixon
authors.forename: Natalie
authors.initials: N
authors.lastname: Coburn
authors.forename: Claire M B
authors.initials: CM
authors.lastname: Holloway
mesh_terms: D000368:Aged; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D009864:Ontario; D018802:Patient-Centered Care / Q000379:methods*; D057234:Preoperative Period; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed; D016217:Ultrasonography, Mammary