Waiting times for radiotherapy: variation over time and between cancer networks in southeast England

The aim of this study was to investigate variations in the length of time that patients with cancer wait from diagnosis to treatment with radiotherapy. A total of 57 426 men and 71 018 women diagnosed with cancer between 1992 and 2001 and receiving radiotherapy within 6 months of diagnosis were identified from the Thames Cancer Registry database. In total, 12 sites were identified for which a substantial number or proportion of patients received radiotherapy: head and neck, oesophagus, colon, rectum, lung, nonmelanoma skin cancer, breast, uterus, prostate, bladder, brain and non-Hodgkin's lymphoma. Median waiting times from diagnosis to radiotherapy were calculated, together with the proportion of patients who received radiotherapy within 60 days of diagnosis, and analysed by year of diagnosis, cancer site, deprivation quintile, age at diagnosis, sex and cancer network of either residence or treatment. Logistic regression was used to adjust the proportion receiving treatment within 60 days for the effects of the other factors. There were significant differences in the proportions receiving radiotherapy within 60 days between different networks and different cancer sites, which remained after adjustment. Median waiting times varied from 42 to 65 days across networks of residence, with the adjusted proportion treated within 60 days ranging from 44 to 71%. There was no difference between male and female patients after adjustment for the other factors, particularly site. There was a highly significant trend over time: the median wait increased from 45 days in 1992 to 76 days in 2001, while the adjusted proportion being treated within 60 days declined by almost a half, from 64 to 35%, over the same period

Oral and pharyngeal cancer:Analysis of patient delay at different tumor stages

Background. The aim of this study was to examine which factors are related to patient delay in a cohort of consecutive patients with pharyngeal cancer and oral cancer and to determine whether the different stages of patient delay (ie, appraisal, illness, behavioral, and scheduling) were related to different tumor stages. Methods. Before treatment, 55 patients with pharyngeal cancer and 134 patients with oral cancer were interviewed about their prediagnostic period. To verify the data, a questionnaire was sent to the general practitioner and/or dentist and a close relative, Results. Patients with a delay of more than 30 days were significantly more often diagnosed with late-stage (T3-T4) disease (pharynx, p = .01, odds ratio [OR] = 4.5; oral, p =.01, OR = 3.2). No sociodemographic characteristics were associated with patient delay. Conclusions. Prolonged patient delay was associated with late-stage disease for both patients with pharyngeal cancer and patients with oral cancer. Although for most patients the symptoms are vague or might look like a common cold or infection, the general public should be better informed about tumor symptoms. This may enhance earlier visits to a health care professional. (c) 2005 Wiley Periodicals, Inc

Scheduling delay in suspected cases of oral cancer Atraso de agendamento em casos suspeitos de câncer bucal

The objective of the study was to evaluate scheduling delay of dental exams in the city of São Paulo of patients suspected of having oral cancer. A cross-sectional study was performed in which telephone conversations simulated clinical situations that represented two types of patients: one presenting symptoms suggestive of oral cancer (CA), and another one suggesting the need for prostheses (PR). The scheduling delay was evaluated by the days until an appointment for care; and among public offices, by type of schedule (emergency or routine). Negative binomial regression was used (95% statistical significance). Five hundred and seventy-five public and private dental offices participated in the study. The mean scheduling delay for the CA group was 2.88 days, and for the PR group, 4.34 days (p = 0.01). The mean scheduling delay was shorter in private dental offices (2.59 days) than in offices that accepted health insurance (2.74 days) (p = 0.01); the delay was shorter when performed by the dentist rather than by the dental assistant, 2.45 versus 4.21 days (p = 0.01). In public services, 69% of patients in the cancer group were sent to the emergency service. Dental services were accessible for scheduling clinical examinations among patients suspected of having oral cancer.<br>O objetivo do estudo foi avaliar o atraso de agendamento de pacientes com suspeita de câncer bucal aos exames odontológicos na cidade de São Paulo. Realizou-se estudo transversal, em que conversações telefônicas simularam situações clínicas, representando dois tipos de pacientes-padrão: um com sintomas sugestivos de câncer bucal e outro com necessidade de prótese. O atraso do agendamento foi avaliado pelo tempo de agendamento para a consulta e, no caso de estabelecimentos públicos, pelo tipo de agendamento (rotina ou urgência). Utilizou-se regressão binomial negativa (95% de nível de significância). Participaram do estudo 575 estabelecimentos públicos e privados. O tempo médio, em dias, para o agendamento no grupo câncer foi de 2,88 e no grupo prótese, 4,34 (p = 0,01). O tempo médio de agendamento foi menor nos consultórios particulares 2,59 que nos conveniados 2,74 (p = 0,01); quando realizado pelo dentista foi menor do que pelos auxiliares, 2,45 versus 4,21 (p = 0,01). No serviço público, 69% dos pacientes do grupo câncer foram encaminhados ao serviço de urgência. Os serviços de atendimento odontológico foram acessíveis com relação ao agendamento para exame clínico dos pacientes com suspeita de câncer de boca