Kang Michael Yoon, Sykes Peter, Herbison Peter Yoon, Petrich Simone
Middlemore Hospital, Auckland, New Zealand.
N Z Med J. 2013 Oct 18;126(1384):84-95.
To quantify time taken for patients diagnosed and treated for endometrial cancer in Dunedin Hospital in context of Ministry of Health New Zealand (MoHNZ) best practice indicators for cancer diagnosis and treatment, and to identify factors which could potentially cause delays if present.
Retrospective audit was carried out based on patients discussed at a Gynaecology-Oncology Multi-Disciplinary Meeting (GOMDM) at Dunedin Hospital during 2008-2011 for primary endometrial cancer. Median time taken between referral dates, first specialist appointment, date of histological diagnosis, staging scan, date when patients were waitlisted for surgery, and date of first treatment were calculated. Possible factors which could contribute to delay if present were identified and further explored.
44 eligible patients were identified. Compared to MoHNZ recommendations delays were present from initial referral to first treatment (93 days actual timeframe vs. 62 days recommended timeframe) and some delays present from initial referral to first specialist assessment (21 days vs. 14 days), with only 20% and 32% of patients being seen and treated within the best practice timeframes respectively. Patients were treated within the recommended time once they were wait-listed for first definitive treatment (19 days vs. 31 days) with 75% of patients being treated within the recommended timeframe. Waiting time for hysteroscopy and dilatation and curettage was seen to contribute towards considerably longer delays in diagnosis and treatment of endometrial cancers. Other potential factors contributing to delay identified were patients not attending clinic appointments and difficulty in obtaining a conclusive histological sample through pipelle biopsy at the initial clinic visit.
Currently the practice in Dunedin Hospital does not meet the planned MoHNZ standards, and significant changes in practice and reallocation of resource will be required to meet the MOH standards for women with endometrial cancer. Training of General Practitioners in pipelle biopsy, better patient education about post-menopausal bleeding, reducing the time taken for radiological scans, and expediting referrals to the first specialist appointment and hysteroscopy for patients with high suspicion, could reduce delays.
根据新西兰卫生部（MoHNZ）癌症诊断和治疗的最佳实践指标，量化达尼丁医院诊断和治疗子宫内膜癌患者所花费的时间，并确定如果存在可能导致延误的因素。
基于2008 - 2011年期间在达尼丁医院妇科肿瘤多学科会议（GOMDM）上讨论的原发性子宫内膜癌患者进行回顾性审计。计算了从转诊日期、首次专科预约、组织学诊断日期、分期扫描、患者列入手术等待名单的日期到首次治疗日期之间的中位时间。确定了如果存在可能导致延误的潜在因素并进行了进一步探讨。
确定了44例符合条件的患者。与MoHNZ的建议相比，从初次转诊到首次治疗存在延误（实际时间框架为93天，建议时间框架为62天），从初次转诊到首次专科评估也存在一些延误（21天对14天），分别只有20%和32%的患者在最佳实践时间框架内接受诊治。患者一旦列入首次确定性治疗的等待名单，就在建议时间内接受治疗（19天对31天），75%的患者在建议时间框架内接受治疗。宫腔镜检查及刮宫术的等待时间被认为是导致子宫内膜癌诊断和治疗延误时间显著延长的原因。确定的其他导致延误的潜在因素包括患者未按时就诊以及在初次门诊就诊时通过子宫内膜吸取活检难以获得确定性组织样本。
目前达尼丁医院的做法未达到MoHNZ计划的标准，需要在实践中进行重大改变并重新分配资源，以满足卫生部对子宫内膜癌女性患者的标准。对全科医生进行子宫内膜吸取活检培训、更好地对患者进行绝经后出血教育、缩短放射学扫描时间以及加快对高度可疑患者转诊至首次专科预约和宫腔镜检查，可减少延误。
