Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study
Introduction A long breast cancer diagnostic process can affect patient anxiety and survival. Variations in the length of the diagnostic interval for similar patient presentations can indicate health system inequities and/or inefficiencies. Objectives and Approach We describe the breast cancer di...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Swansea University
2018-08-01
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| Series: | International Journal of Population Data Science |
| Online Access: | https://ijpds.org/article/view/616 |
| _version_ | 1797427934455136256 |
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| author | Mary McBride Patti Groome Kathleen Decker Eva Grunfeld Li Jiang Cynthia Kendell Robin Urquhart Khanh Vu Marcy Winget |
| author_facet | Mary McBride Patti Groome Kathleen Decker Eva Grunfeld Li Jiang Cynthia Kendell Robin Urquhart Khanh Vu Marcy Winget |
| author_sort | Mary McBride |
| collection | DOAJ |
| description | Introduction
A long breast cancer diagnostic process can affect patient anxiety and survival. Variations in the length of the diagnostic interval for similar patient presentations can indicate health system inequities and/or inefficiencies.
Objectives and Approach
We describe the breast cancer diagnostic interval across Canada and factors associated with its length.
We studied breast cancer patients diagnosed from 2004/7 to 2010/11/12 in the Canadian provinces: British Columbia, Alberta, Manitoba, Ontario, and Nova Scotia. Using administrative data, we created parallel population-based, provincial-level datasets and ran common analyses. The diagnostic interval was defined from the screening mammogram to the diagnosis for screen-led and from the first referral/test ordering date to the diagnosis for diagnostic-led patients. Stratified by these two diagnostic routes, we describe the variation in the interval across provinces and report on the province-specific associations between the diagnostic interval and: patient age, comorbid disease burden, socioeconomic status combined with rural residence, and continuity of primary care while controlling for cancer stage.
Results
The median diagnostic interval varied by 6 days (29 to 35 days) across provinces. Screen-led patients were diagnosed more quickly (median 2-12 days quicker). The 90th percentile diagnostic interval was 84-126 days longer in diagnostic-led patients. In the diagnostic-led group, increasing comorbid burden was consistently associated with longer diagnostic intervals and being >70 was associated with a shorter interval at the 90th percentile in Manitoba and Ontario. There was no evidence of a clear rural or low socioeconomic status effect and patients without a primary care physician had shorter intervals. In the screen-led group, patients age 40-49 and those in the medium or low income rural areas waited longer for a diagnosis.
Conclusion/Implications
Diagnostic wait times differ across Canada and are variably associated with comorbidity, age, area-level socioeconomic status and rural residence. These results point to practice and system-level effects that warrant further study. |
| first_indexed | 2024-03-09T08:50:43Z |
| format | Article |
| id | doaj.art-379763a78299443cbd858fdabaa20f73 |
| institution | Directory Open Access Journal |
| issn | 2399-4908 |
| language | English |
| last_indexed | 2024-03-09T08:50:43Z |
| publishDate | 2018-08-01 |
| publisher | Swansea University |
| record_format | Article |
| series | International Journal of Population Data Science |
| spelling | doaj.art-379763a78299443cbd858fdabaa20f732023-12-02T14:10:41ZengSwansea UniversityInternational Journal of Population Data Science2399-49082018-08-013410.23889/ijpds.v3i4.616Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT studyMary McBride0Patti Groome1Kathleen Decker2Eva Grunfeld3Li Jiang4Cynthia Kendell5Robin Urquhart6Khanh Vu7Marcy Winget8British Columbia Cancer AgencyQueen's UniversityCancerCare ManitobaDepartment of Family and Community Medicine, University of TorontoCritical Care Services OntarioNova Scotia Health AuthorityDalhousie UniversitySchool of Public Health, University of AlbertaStanford School of MedicineIntroduction A long breast cancer diagnostic process can affect patient anxiety and survival. Variations in the length of the diagnostic interval for similar patient presentations can indicate health system inequities and/or inefficiencies. Objectives and Approach We describe the breast cancer diagnostic interval across Canada and factors associated with its length. We studied breast cancer patients diagnosed from 2004/7 to 2010/11/12 in the Canadian provinces: British Columbia, Alberta, Manitoba, Ontario, and Nova Scotia. Using administrative data, we created parallel population-based, provincial-level datasets and ran common analyses. The diagnostic interval was defined from the screening mammogram to the diagnosis for screen-led and from the first referral/test ordering date to the diagnosis for diagnostic-led patients. Stratified by these two diagnostic routes, we describe the variation in the interval across provinces and report on the province-specific associations between the diagnostic interval and: patient age, comorbid disease burden, socioeconomic status combined with rural residence, and continuity of primary care while controlling for cancer stage. Results The median diagnostic interval varied by 6 days (29 to 35 days) across provinces. Screen-led patients were diagnosed more quickly (median 2-12 days quicker). The 90th percentile diagnostic interval was 84-126 days longer in diagnostic-led patients. In the diagnostic-led group, increasing comorbid burden was consistently associated with longer diagnostic intervals and being >70 was associated with a shorter interval at the 90th percentile in Manitoba and Ontario. There was no evidence of a clear rural or low socioeconomic status effect and patients without a primary care physician had shorter intervals. In the screen-led group, patients age 40-49 and those in the medium or low income rural areas waited longer for a diagnosis. Conclusion/Implications Diagnostic wait times differ across Canada and are variably associated with comorbidity, age, area-level socioeconomic status and rural residence. These results point to practice and system-level effects that warrant further study.https://ijpds.org/article/view/616 |
| spellingShingle | Mary McBride Patti Groome Kathleen Decker Eva Grunfeld Li Jiang Cynthia Kendell Robin Urquhart Khanh Vu Marcy Winget Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study International Journal of Population Data Science |
| title | Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study |
| title_full | Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study |
| title_fullStr | Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study |
| title_full_unstemmed | Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study |
| title_short | Factors associated with the breast cancer diagnostic interval across five Canadian provinces: a CanIMPACT study |
| title_sort | factors associated with the breast cancer diagnostic interval across five canadian provinces a canimpact study |
| url | https://ijpds.org/article/view/616 |
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