Taylor Ferrier B.Sc, Chris French MD, Maria Mathews PhD. Memorial University of Newfoundland

First, we used frequencies to describe the characteristics of the sample. Second, chi-square tests were used to detect differences between the six wait time benchmarks (outcomes), covariates, and three independent variables: (a) community of residence, (b) urgency, and (c) age of men with suspected of confirmed prostate cancer. For each outcome, significant variables from the chi-square analyses were included in a multiple logistic regression. The final model was used to identify any significant predictors in whether or not men met or did not meet each individual benchmark. Statistical analysis was performed using SPSS 18.0.

Using a retrospective chart review, we examined the charts of all men who had a biopsy for suspected prostate cancer between April 1, 2009-March 31, 2010 at the Health Science Centre in St. John’s, NL. Eligible men were NL residents and who had their first prostate biopsy within the study period. Patients whose charts were not available or if we could not determine eligibility, who were younger than 19 years of age, died, or had a previous cancer diagnoses were excluded. Since there were no established Canadian benchmarks for these tested wait intervals, we asked a local urologist to identify acceptable wait times for each interval.

There were 341 men eligible for this study. We found in Table 1 men experienced the longest median wait of 68 days (0-310) between general practitioner (GP) referral to first visit with the urologist, 28 days (0-151) from the decision to biopsy to date of biopsy, 40 days (13-404) from the biopsy date to notification of the results, and 30 days (0-272) from decision to treat to first treatment. Throughout each interval, men meeting the locally established benchmarks ranged from 13.4 to 50.7%. Seven percent of men met the Canadian Society for Surgical Oncology’s (CSSO) benchmark for referral to first consultation and 33.1% of men met the CSSO’s benchmark for conclusion of preoperative tests to first treatment. Table 2 suggests older age (≥70 years) was a significant predictor for three of the six outcomes. After controlling for other significant predictors, compared to younger men (<70 years), older men were 5.82, 3.12 and 3.53 times more likely to have met the locally established benchmarks between decision to treat to first treatment, GP referral to notification of results, and GP referral to first treatment, respectively. Table 3 shows that radical prostatectomy and radiotherapy made up 75.2% of the treatment modalities.

Objectives

Wait Times for Prostate Cancer Care in Newfoundland and Labrador

Benchmark Reference Benchmark Definition Benchmark Met Benchmark n (%)

Did Not Meet Benchmark n (%)

Median (days)

90th Percentile (days)

1. NL Expert Opinion, 2010 2. CSSO, 2010 GP Referral to first visit with urologist 1. ≤ 60 days

2. ≤ 14 days 1.145 (42.5)

2. 24 (7.0) 1. 196 (57.5) 2. 317 (93.0) 68.0 146.6

NL Expert Opinion, 2010 Decision to biopsy to date of biopsy ≤ 14 days 114 (33.4) 227 (66.6) 28.0 69.0

NL Expert Opinion, 2010 Date of biopsy to notification of results ≤ 40 days 173 (50.7) 168 (49.3) 40.0 140.4

1. NL Expert Opinion, 2010 2. CSSO, 2010 Decision to treat to first treatment 1. ≤ 14 days

2. ≤ 14 days 1. 52 (33.1) 2. 52 (33.1)

1. 105 (66.9) 2. 105 (66.9) 30.0 91.4

NL Expert Opinion, 2010 GP Referral to notification of results ≤ 102 days 56 (16.4) 285 (83.6) 154.0 292.2 NL Expert Opinion, 2010 GP Referral to first treatment ≤ 116 days 21 (13.4) 136 (86.6) 188.0 289.6

Benchmark Definition Variable Odds Ratio

95% Confidence Interval p-value

GP Referral to first visit with urologist

Community of residence Urban (≥10 000) Rural (<10 000)

1.00 0.60 0.39 – 0.94

0.025

Decision to biopsy to date of biopsy

Community of residence Urban (≥10 000) Rural (<10 000)

1.00 2.02 1.27 – 3.22

0.003

Date of biopsy to notification of results

Prostate cancer No Cancer Has Cancer

1.00 2.82 1.81 – 4.39

<0.001

Decision to treat to first treatment

Age Young (<70 years) Old (≥ 70 years)

1.00 5.82 2.43 – 13.95

<0.001

Gleason Low (≤ 6) Medium (7) High (>7)

1.00 0.20 0.52

0.08 – 0.50 0.19 – 1.46

0.003

0.001 0.217

GP Referral to notification of results

Age Young (<70 years) Old (≥ 70 years)

1.00 3.12 1.54 – 6.31

0.002

GP Referral to first treatment Age Young (<70 years) Old (≥ 70 years)

1.00 3.53 1.52 – 8.19

0.003

Introduction

Results

Table 1: Proportion of Men Meeting Local & National Benchmarks

Table 2: Predictors of Men Who Met the Local Benchmarks

Three independent variables were tested in each regression. Only significant predictors are illustrated. Urgency variable was defined differently based on available information to the urologist at each interval.

Table 3: Distribution of Treatment Modalities Treatment Modality n (%)

Radical prostatectomy 76 (48.4) Radiotherapy 42 (26.8) Watchful waiting (including active surveillance) 28 (17.8)

Other (brachytherapy*, palliative care, hormone therapy) 11 (7.0) Brachytherapy is not offered to men with prostate cancer in NL. Men in our study choosing brachytherapy received their treatment in Ontario.

Conclusions Men seeking care for suspected or confirmed prostate cancer in NL experience lengthy delays throughout the care pathway. Few men met both locally and nationally established benchmarks. Study results will be used to identify strategies to improve the timeliness of specialist care in the province. They will also provide the groundwork for ongoing monitoring and interprovincial comparisons.

Acknowledgements Taylor Ferrier holds a Master’s Fellowship Award from NLCAHR. This study was support by a Canadian Institute for Health Research (CIHR) grant to study wait times held by Dr. Maria Mathews.