Factors influencing time between surgery and radiotherapy: A population based study of breast cancer patients.
This study describes variation in the time interval between surgery and radiotherapy in breast cancer (BC) patients and assesses factors at patient, hospital and radiotherapy centre (RTC) level influencing this variation. To do so, the factors were investigated in BC patients using multilevel logistic regression. The study sample consisted of 15,961 patients from the Netherlands Cancer Registry at 79 hospitals and 19 (RTCs) with breast-conserving surgery or mastectomy directly followed by radiotherapy. The percentage of patients starting radiotherapy ≤42 days varied from 14% to 94%. Early year of incidence, higher age, higher stage, mastectomy, higher ASA category and no availability of radiotherapy facilities were significantly associated with a longer time interval between radiotherapy and surgery. More patients received radiotherapy ≤42 days in hospitals with on-site radiotherapy facilities (OR 1.36, p = 0.024). Among the remainder, significant variation was found at the RTC level (11.1%, σ(2) = 0.254, SE 0.054), and at the hospital level (6.4% σ2 = 0.443, SE 0.163) (ICC 0.064). The significant delay and unexplained variance remaining at the RCT and hospital level suggests delays caused by the patient referral pathway from hospital to RCT, and indicates potential for improvement at both levels.
Dept. of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. Electronic address: s.katik@iknl.nl.
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Katik
Dept. of Registration and Research, Comprehensive Cancer Center the Netherlands, Utrecht, The Netherlands. Electronic address: m.gort@iknl.nl.
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M
Gort
Dept. of Radiotherapy, Medical Spectrum Twente, Enschede, The Netherlands. Electronic address: j.jobsen@mst.nl.
J J
JJ
Jobsen
Dept. of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.h.maduro@umcg.nl.
J H
JH
Maduro
Dept. of Radiotherapy, Medical Center Haaglanden, The Hague, The Netherlands; Dept. of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: h.struikmans@mchaaglanden.nl.
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H
Struikmans
Dept. of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Dept. of Registration and Research, Comprehensive Cancer Center the Netherlands, Utrecht, The Netherlands. Electronic address: s.siesling@iknl.nl.
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Siesling
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D012042:Registries; D013997:Time Factors
Breast cancer; Practice guidelines; Quality of care; Radiotherapy; Timelines