Mackillop W J, Fu H, Quirt C F, Dixon P, Brundage M, Zhou Y
Radiation Oncology Research Unit, Queen's University, Kingston Regional Cancer Centre, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 1994 Aug 30;30(1):221-8. doi: 10.1016/0360-3016(94)90538-x.
Waiting lists for radiotherapy are a fact of life at many Canadian cancer centers. The purpose of this study was to provide a detailed description of the magnitude of the problem in Ontario.
The interval between diagnosis and initiation of radiation treatment was calculated for all patients receiving primary radiotherapy for carcinoma of the larynx, cervix, lung, and prostate at seven Ontario cancer centers between 1982 and 1991. The interval between surgery and initiation of postoperative radiotherapy for breast cancer was also calculated over the same period. The intervals between diagnosis and referral (t1), between referral and consultation (t2), and between consultation and initiation of radiotherapy (t3), were analyzed separately to determine where delay occurred.
Median waiting times between diagnosis and initiation of radical treatment for carcinoma of the larynx, carcinoma of the cervix, nonsmall cell lung cancer, and carcinoma of the prostate were 30.3 days, 27.2 days, 27.3 days, and 93.3 days, respectively. The exceptional interval between diagnosis and treatment of prostate cancer was due to much longer delays between diagnosis and referral. The median waiting time between diagnosis and initiation of postoperative radiotherapy for breast cancer was 61.4 days and the median time between the completion of surgery and initiation of postoperative radiotherapy was 57.8 days. There were significant intercenter variations in median waiting times, but in every situation the median waiting time in Ontario as a whole increased steadily between 1982 and 1991. Median waiting times from diagnosis to the start of curative treatment for laryngeal cancer, cervical cancer, nonsmall cell lung cancer, and prostate cancer increased by 178.7%, 105.6%, 158.3%, and 62.9%, respectively. Waiting time from completion of surgery to initiation of postoperative radiotherapy for breast cancer increased by 102.7%. Most of the increase in treatment delay was found in the interval between consultation and initiation of radiotherapy.
The Committee on Standards of the Canadian Association of Radiation Oncologists recommends that the interval between referral and consultation should not exceed 2 weeks and that the interval between consultation and initiation of radiotherapy should also not exceed 2 weeks. The majority of patients treated in Ontario met both those standards in 1982, but by 1991 few patients received care within the prescribed intervals.
在许多加拿大癌症中心，放疗等候名单是现实存在的情况。本研究的目的是详细描述安大略省这一问题的严重程度。
计算了1982年至1991年间在安大略省七个癌症中心接受喉癌、宫颈癌、肺癌和前列腺癌原发性放疗的所有患者从诊断到开始放疗的间隔时间。同时也计算了同期乳腺癌患者从手术到开始术后放疗的间隔时间。分别分析了从诊断到转诊（t1）、从转诊到会诊（t2）以及从会诊到开始放疗（t3）的间隔时间，以确定延误发生的环节。
喉癌、宫颈癌、非小细胞肺癌和前列腺癌从诊断到开始根治性治疗的中位等待时间分别为30.3天、27.2天、27.3天和93.3天。前列腺癌诊断与治疗之间的特殊间隔是由于诊断到转诊之间的延误时间长得多。乳腺癌从诊断到开始术后放疗的中位等待时间为61.4天，从手术完成到开始术后放疗的中位时间为57.8天。各中心之间的中位等待时间存在显著差异，但在每种情况下，安大略省总体的中位等待时间在1982年至1991年间都稳步增加。喉癌、宫颈癌、非小细胞肺癌和前列腺癌从诊断到开始根治性治疗的中位等待时间分别增加了178.7%、105.6%、158.3%和62.9%。乳腺癌从手术完成到开始术后放疗的等待时间增加了102.7%。治疗延迟的增加主要发生在会诊到开始放疗的间隔时间内。
加拿大放射肿瘤学家协会标准委员会建议，转诊到会诊的间隔时间不应超过2周，会诊到开始放疗的间隔时间也不应超过2周。1982年在安大略省接受治疗的大多数患者都符合这两个标准，但到1991年，很少有患者在规定的间隔时间内得到治疗。
