Determinants of variability in waiting times for radiotherapy in the treatment of breast cancer.

Abstract

To examine psycho-social and geographic determinants of delay in starting radiotherapy in early invasive breast cancer patients. Waiting time was defined as the time elapsed until the beginning of radiotherapy, starting from the date of surgery (in absence of chemotherapy) or from the end of chemotherapy. Eight hundred and ninety six women aged 24-89 took part in the study. Mean waiting times were 52 days (sd=19) between surgery and radiotherapy and 31 days (sd=14) between chemotherapy and radiotherapy. Differences between radiotherapy centres (p<0.0001) accounted for 30% and 12%, respectively, of total variance in waiting times. Using a multivariate mixed analysis that took into account intra-centre correlation, the time between surgery and radiotherapy was shorter for young patients (p=0.020), those who had sought information about their illness (p=0.024) and those who had undergone surgery and radiotherapy in the same centre (p=0.021). On the other hand, no patient characteristic was associated with the time between chemotherapy and radiotherapy. Centre is the major factor that explained longer waiting times in radiotherapy, emphasising the structural hypothesis. It is important to pursue initiatives to improve the organization within radiotherapy centres and then to verify that these initiatives have succeeded in shortening waiting times.