Time to treatment of esophageal cancer in Ontario: a population-level cross-sectional study

Objective — Timely cancer treatment improves survival and anxiety for some sites. Patients with esophageal cancer require specific workup before treatment, which can prolong the time from diagnosis to treatment (treatment interval). The geographical variation of this interval remains uninvestigated in patients with esophageal cancer.

Methods — This retrospective population-level study conducted in Ontario used linked administrative healthcare databases. Patients treated for esophageal cancer between 2013-2018 were included. The Treatment Interval (TI) was time from diagnosis to treatment. Patients were assigned a geographical Local Health Integrated Network (LHIN) based on postal code. Covariates included patient, disease, and diagnosing physician characteristics. Quantile regression modelled TI length at the 50th and 90th percentile and identified associated factors.

Results — Of 7,509 patients, 78% were male and most were aged between 60-69 years. The 50th and 90th percentile TI was 36 (IQR 22-55) 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 (p<0.0001), higher comorbidity (p=0.0005), higher material deprivation (p=0.001), rurality (p=0.03), histology (p=0.02), and treatment group (p<0.0001) were associated with a longer median TI. Older age (p=0.03), higher comorbidity (p=0.003), higher material deprivation (p=0.005), rurality (p=0.04), and treatment group (p<0.0001) were associated with a longer 90th percentile TI.

Conclusion — We demonstrated significant geographic variability of time to treatment. Investigation of facility-level differences is warranted. Patient and disease factors are associated with longer wait times. These results may inform future healthcare policy and resource allocation.