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Understanding how wait time affects outcomes

WaittimebookA new book on wait times for breast cancer is shedding important new light on the issue.

“We know that waiting is inevitable, but we wanted to look at the implications of that wait time in one key area – outcomes,” says Dr. Tallal Younis, a medical oncologist with the Capital Health Cancer Care Program.

Dr. Younis co-wrote Wait Times in the Management of Early Stage Breast Cancer with Dr. Daniel Rayson, a medical oncologist with the Capital Health Cancer Care Program and Director of the Atlantic Clinical Cancer Research Unit and Ms. Nathalie Saint-Jacques, an epidemiologist with Cancer Care Nova Scotia. He notes that the book does not focus on the anxiety that patients and their families feel when waiting for diagnosis or treatment. Rather it explores the impact of waiting on a number of key points along the cancer management pathway: diagnosis, surgery, radiation and chemotherapy.

“We tried to figure out if long waits in each of these areas are associated with poor outcomes,” explains Dr. Younis.

The researchers discovered that for patients with early-stage breast cancer who undergo surgery, a wait up to 12 weeks from surgery to chemotherapy does not seem to compromise outcomes, but studies showed that radiation treatment should be given as early as feasible (although no specific time threshold could be identified).

“If there is an abnormal mammogram, we also found it is best to act as early as feasible,” notes Dr. Younis.

As well, the research team, whose book took a year and a half from concept to publication, looked at who was most likely to experience longer waits in Canada. “There were certain predictors,” notes Dr. Younis, who is Co-chair of Cancer Care Nova Scotia’s Provincial Breast Cancer Site Team.

For example, factors affecting wait time included a patient’s age, where they lived, and their socio-economic status. There were also factors linked to health care providers. “There is a perception, among providers, that waiting is not good,” says Dr. Younis. “Our research indicated that health professionals tend to prioritize care based on perception of who they believe is at greatest risk of cancer relapse.”

The book, which was partly supported by Cancer Care Nova Scotia, also includes a chapter that proposes an innovative way to study wait times that will overcome current limitations.

Dr. Younis and his colleagueswill be planning further research in the area. “Previous studies looked at wait times in Nova Scotia compared to current standards – but we didn’t know what constituted acceptable wait times. We didn’t have a gold standard,” says Dr. Younis. “Now we can compare actual wait times in Nova Scotia against these standards.”

The book, Wait Times in the Management of Early Stage Breast Cancer, is written for health care professionals, but its message is intended for the general public as well. “People are anxious about wait times,” notes Dr. Younis. “This book may answer some questions for them and offer some reassurance.”

Dr. Younis and his colleagues aren’t waiting to spread the word about their book and its findings. They have already presented to the multidisciplinary Breast Cancer Site Team. Interest in the publication is also growing across Canada.

“We have evidence regarding potential impact of wait times on breast cancer outcomes. Now we have to act on it,” stresses Dr. Younis. “This could positively affect treatment outcomes.”