Time to Treatment of Esophageal Cancer in Ontario: A Population-Based Study

Abstract

Background: A patient’s journey from esophageal cancer diagnosis to treatment (treatment interval) is complex. They require numerous investigations and specialist visits before treatment can begin. Surgery is the cornerstone of treatment for resectable disease. Streamlining this pathway may shorten the treatment interval length, but this has not yet been studied in a contemporary Canadian cohort of patients with esophageal cancer. We aim to describe the length and geographical variation of the treatment interval (TI) by Local Health Integrated Networks (LHINs) and time to surgery (TTS) by Thoracic Cancer Surgery Centres (TCSCs) in Ontario, and identify factors associated with longer wait times. Methods: We conducted a population-level study using health administrative databases in Ontario, Canada. We identified patients diagnosed with esophageal cancer between January 2013 and December 2018 who underwent treatment and had at least one staging investigation or specialist visit. TI length was defined as the number of days from the date of a biopsy to the first treatment. TTS length was measured in a subgroup of patients undergoing neoadjuvant chemoradiotherapy then surgery and was defined as the number of days from the date of a biopsy to the surgery date. Univariate quantile regression was used to measure lengths at the median and 90th percentile, and multivariable quantile regression was used to identify associated factors. Results: Of the 5,759 patients identified, median and 90th percentile TI length was 36 and 77 days, respectively. The difference between the LHIN with the longest and shortest TI at the 50th and 90th percentile was 18 and 25 days, respectively. Older age, higher comorbidity, higher material deprivation, rurality, and treatment group were associated with a longer TI. Of the 733 subgroup patients, median and 90th percentile TTS length was 140 and 171 days, respectively. The difference between the TCSC with the longest and shortest TTS at the 50th and 90th percentile was 31 and 22 days, respectively. Older age was associated with a longer TTS. Conclusion: There is significant geographical variation in wait times to esophageal cancer treatment across the province. We have identified vulnerable patient populations at risk for protracted wait times.