Waiting for radiotherapy in Ontario

Waiting lists for radiotherapy are a fact of life at many Canadian cancer centers. The purpose of this study was to provide a detailed description of the magnitude of the problem in Ontario.

The interval between diagnosis and initiation of radiation treatment was calculated for all patients receiving primary radiotherapy for carcinoma of the larynx, cervix, lung, and prostate at seven Ontario cancer centers between 1982 and 1991. The interval between surgery and initiation of postoperative radiotherapy for breast cancer was also calculated over the same period. The intervals between diagnosis and referral (t1), between referral and consultation (t2), and between consultation and initiation of radiotherapy (t3), were analyzed separately to determine where delay occurred.

Median waiting times between diagnosis and initiation of radical treatment for carcinoma of the larynx, carcinoma of the cervix, nonsmall cell lung cancer, and carcinoma of the prostate were 30.3 days, 27.2 days, 27.3 days, and 93.3 days, respectively. The exceptional interval between diagnosis and treatment of prostate cancer was due to much longer delays between diagnosis and referral. The median waiting time between diagnosis and initiation of postoperative radiotherapy for breast cancer was 61.4 days and the median time between the completion of surgery and initiation of postoperative radiotherapy was 57.8 days. There were significant intercenter variations in median waiting times, but in every situation the median waiting time in Ontario as a whole increased steadily between 1982 and 1991. Median waiting times from diagnosis to the start of curative treatment for laryngeal cancer, cervical cancer, nonsmall cell lung cancer, and prostate cancer increased by 178.7%, 105.6%, 158.3%, and 62.9%, respectively. Waiting time from completion of surgery to initiation of postoperative radiotherapy for breast cancer increased by 102.7%. Most of the increase in treatment delay was found in the interval between consultation and initiation of radiotherapy.

The Committee on Standards of the Canadian Association of Radiation Oncologists recommends that the interval between referral and consultation should not exceed 2 weeks and that the interval between consultation and initiation of radiotherapy should also not exceed 2 weeks. The majority of patients treated in Ontario met both those standards in 1982, but by 1991 few patients received care within the prescribed intervals.