NEW YORK (Reuters Health) Nov 26 - Women diagnosed with uterine cancer benefit from undergoing surgery promptly, a new study shows.
In a large population-based study from Canada, a longer wait from diagnosis to definitive surgery had a negative impact on overall survival.
Unfortunately, it may be out of the surgeon's hands, said Dr. Lorraine Elit from the Juravinski Cancer Centre in Hamilton, who worked on the study.
"The health care system ultimately governs access to the operating room. The system needs to constantly measure wait times and react appropriately given the evidence about whether wait times impact on outcomes. Novel strategies are required to have the appropriate patients getting appropriate timing to the OR," she told Reuters Health by email.
Using the Ontario Cancer Registry, the researchers identified 9,417 women who had surgery for uterine cancer. They calculated five-year survival by wait time to surgery.
Dr. Elit said her gynecologic oncology group was "frustrated" by the long wait times for their patients to get access to surgery. "It was not clear if longer wait times were associated with a survival disadvantage so the study was done," she said.
The results showed that women who had surgery within two weeks of biopsy diagnosis and those with wait times of more than 12 weeks had worse overall survival (71% and 72%, respectively) than women who had surgery from two to six weeks (82%) and six to 12 weeks (80%) from diagnosis.
In the Journal of Clinical Oncology online November 25, the researchers say wait times of two weeks or less were adversely prognostic for survival after adjusting for other significant factors in the multivariable model, and patients with wait times of more than 12 weeks had worse survival than those who had wait times between 2.1 and 12.0 weeks.
They note that surgery within two weeks of diagnosis is thought to be related to acute issues, such as anemia associated with the need for blood transfusion. "Scenarios such as more advanced disease or histologies such as sarcoma (which were not extractable from this database) are likely associated with poor prognosis. Evidence of this can be seen in our data set: 15.5% (compared with 7.5% overall) of patients who had surgery within two weeks of diagnosis were for sarcoma histologies and 11.4% (compared with 2.0% overall) were for emergent surgeries which occurred after hours or on weekends," the researchers note.
They also say a causal relationship between wait times and improved survival cannot be established. Still, "these results suggest that a reduction in wait times from diagnosis to surgery could potentially reduce mortality from this disease," they write.
Use of administrative data is a limitation of the study, one that doesn't allow for pinpointing specific causes of longer wait times, such as patient preference and unavailability of surgical time. The researchers also didn't have information on disease recurrence or cause of death, meaning that noncancer deaths contributed to the survival times.
Prognostic factors such as stage and depth of myometrial invasion, which are known to influence survival, were also unavailable. "Intuitively, patients with worse prognoses would often be considered a higher priority and have reduced wait times; thus, it is possible that if staging and myometrial invasion information were available and accounted for in the regression model, this would exacerbate the observed relationship that longer wait times lead to poorer survival, although this is not known," Dr. Elit and colleagues say.
Despite these limitations, they say resources should be directed to reduce wait times among those cancer types in which prolonged wait times are known to reduce survival.
SOURCE: http://bit.ly/1hfK9aM
J Clin Oncol 2013.
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