Wait times for breast cancer surgery in lean and traditional care pathways: a multi-group path analysis

Research examining the impact of different models of care on wait times for breast cancer surgery indicates that organized assessment can reduce wait times, but few researchers have explored different care approaches between care sites serving a mixture of urban and rural patients and breast cancer care outcomes, especially within the Canadian context. Therefore, we sought to explore whether wait times from mammogram to surgery differed between lean referral and traditional referral pathways and what areas of inefficiencies need to be addressed.

We used a retrospective case review design and collected information on female patients (aged ≥ 19 yr) with stage 0-III breast cancer who were surgically treated between February 2016 and July 2019.

Patients referred in the traditional pathway of care (n = 208) had longer wait times than patients in the lean pathway of care (n = 248), with an average wait time difference of 9.3 days. For both care pathways, receiving a screening mammogram, living farther from the hospital, and receiving magnetic resonance imaging (MRI) increased wait times to surgery.

Conducting the biopsy immediately after an abnormal mammogram, improving wait times for MRIs, and improving access for rural patients may be important areas of change-related focus. Shorter wait times to breast cancer surgery in the lean pathway support the advantage of a referral system whereby organized navigated systems coordinate all aspects of diagnosis and treatment.