Plotogea Amalia, Chiarelli Anna M, Mirea Lucia, Prummel Maegan V, Chong Nelson, Shumak Rene S, O'Malley Frances P, Holloway Claire M B
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.
Springerplus. 2013 Aug 19;2:388. doi: 10.1186/2193-1801-2-388. eCollection 2013.
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.
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.
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).
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.
从乳腺癌诊断到治疗的时间越长，预后越差。本研究探讨了乳腺癌治疗路径各阶段等待时间相关的因素。
1760名年龄在50 - 69岁之间、1995年至2003年在安大略省被诊断为浸润性乳腺癌的女性符合研究条件。多因素逻辑回归分析了治疗路径各阶段等待时间超过中位数的相关因素；从诊断到确定性手术；从最终手术到不进行化疗的放疗以及从最终手术到化疗。
从诊断到确定性手术的中位等待时间为17天（四分位间距（IQR）= 0 - 31），从最终手术到术后化疗为44天（IQR = 34 - 56），从最终手术到术后放疗为75天（IQR = 57 - 97）。与1995 - 1999年相比，2000 - 2003年诊断的患者在治疗路径各阶段的等待时间显著更长。收入五分位数较高与从诊断到手术的等待时间较长相关（比值比（OR）= 1.47，95%置信区间（CI）= 1.05 - 2.06），而从最终手术到放疗的等待时间较短（OR = 0.60，95% CI = 0.37 - 0.96）。诊断时分期较高与从诊断到确定性手术的等待时间较短相关（III期与I期相比：OR = 0.49，95% CI = 0.34 - 0.71）。
虽然在研究后期诊断与治疗路径所有阶段的等待时间显著延长相关，但分期和收入五分位数与各治疗阶段等待时间的关联存在差异。持续评估乳腺癌治疗路径中与等待时间相关的因素很重要，因为它们指明了质量改进的目标领域，最终目的是改善预后。
