Determinants of waiting time from initial diagnostic procedure to surgery among women with localized breast cancer in Quebec, 1992–1997

• Main Author: Shen, Ningyan
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2002
• Subjects: Breast cancer; Medical diagnosis; Medical procedures; Oncology; Public health; Women; Canada; Quebec Canada
• ISBN: 0612787729; 9780612787728

Background. The early diagnosis and treatment of breast cancer has become an important health care concern. A recent study reported the median waiting time for breast cancer surgery in Quebec was 34 days with 14% of women waiting in excess of 90 days. Understanding the determinants of long waiting is essential to develop optimum interventions to reduce delay. Objective. The purpose of this study was to identify the determinants of waiting time to surgery among women with primary breast cancer in Quebec between 1992 and 1997. Methods. The target population was all women 20 years and older diagnosed with primary breast cancer in Quebec between 1992 and 1997. The data was compiled from physician fee-for-service claims maintained by the Régie de I'assurance maladie du Québec (RAMQ); the Quebec hospital discharge database (MedEcho), and the 1991 Canadian census. Waiting time was defined as the number of days from the initial breast diagnostic procedure to the first definitive surgical treatment. Three-level hierarchical linear models were used for statistical analysis. Findings . Overall, 13,383 women with primary breast cancer treated by 614 surgeons in 107 hospitals were identified. No statistically significant variation of waiting time was found among hospitals. Longer waiting times for breast cancer surgery were observed for women 50 to 64 years of age, without comorbidity, with history of benign breast disease, living in the lower education areas, having surgery at day-surgery setting, having surgery in more recent years, or having surgery performed by younger a surgeon (20 to 49 years old). Women who had surgery performed in a teaching hospital had longer waiting times and this effect was larger when mastectomy was performed. These results could be used to identify women and care delivery practices at higher risk for delays which could be the focus of interventions.