Decreasing waiting time for treatment before and during implementation of cancer patient pathways in Norway |
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| Institution: | 1. Department of Registration, Cancer Registry of Norway, Oslo, Norway;2. Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway;3. Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway;4. Institute of Clinical Medicine, University of Oslo, Oslo, Norway;5. Section of Urology, Vestfold Hospital Trust, Tønsberg, Norway;6. Institute of Cancer Genomics and Informatics, Oslo University Hospital, Oslo, Norway;7. Oslo University Hospital, Oslo, Norway;1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;2. Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences Durham, NC, United States;3. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;4. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States;5. Biospecimen Processing Center, University of North Carolina, Chapel Hill, NC, United States;6. Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;7. Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States;8. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States;9. Showers Center for Childhood Cancer and Blood Disorder, Akron Children’s Hospital, Akron, OH, United States;10. Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Children’s Oncology Group Statistics & Data Center, Gainesville, FL, United States;11. Department of Otolaryngology, Washington University School of Medicine, St Louis, MO, 63110;1. Centre for Big Data Research in Health, University of New South Wales Sydney, NSW, Australia;2. Centre for Primary Health Care and Equity, University of New South Wales Sydney, NSW, Australia;3. School of Medicine, University of Wollongong, NSW, Australia;4. National Drug and Alcohol Research Centre, University of New South Wales Sydney, NSW, Australia;5. Faculty of Medicine and Health, University of Sydney, NSW, Australia;6. Cancer Voices NSW, NSW, Australia;1. Moffitt Cancer Center, Department of Health Outcomes and Behavior, 4115 E. Fowler Ave., Tampa, FL 33617, United States;2. Moffitt Cancer Center, Center for Immunization and Infection Research in Cancer, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;3. Moffitt Cancer Center, Department of Cancer Epidemiology, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;4. Moffitt Cancer Center, Department of Biostatistics and Bioinformatics, 12902 USF Magnolia Drive, Tampa, FL 33612, United States;5. University of South Florida, Department of Family Medicine, 13330 USF Laurel Drive, Tampa, FL 33612, United States;6. University of South Florida, Department of Epidemiology & Biostatistics, 13201 Bruce B Downs Blvd, Tampa, FL 33612, United States;8. University of Florida, Department of Medicine, 1600 SW Archer Rd., Gainesville, FL 32608, United States;9. University of Florida Health, Department of Health Outcomes and Biomedical Informatics, 2004 Mowry Road, Ste 2245, Gainesville, FL 32610, United States;10. University of Florida Health, Cancer Population Sciences, 2004 Mowry Road, Ste 2245, Gainesville, FL 32610, United States;1. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Department of Health and Human Performance, University of Houston, TX, USA;3. Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain;2. Program Against Cancer Therapeutic Resistance (ProCURE), IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain;3. Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública, CIBERESP), Spain;4. Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain;5. Hereditary Cancer Program, IDIBELL, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain;6. ASSIR Delta, Direcció d''Atenció Primària Costa de Ponent, SAP Delta del Llobregat, Gerència Territorial Metropolitana Sud / ICS, Barcelona, Spain;7. Departament de Ciències Bàsiques, Universitat Internacional de Catalunya, Barcelona, Spain;8. Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), Madrid, Spain;9. Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain;10. Department of Medical Oncology, IDIBELL, Catalan Institute of Cancer, Hospitalet de Llobregat, Barcelona, Spain;11. Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain;12. PATH, Seattle, United States;1. Department of Medicine, University of Kentucky, Lexington, KY, United States;2. Department of Neurology, University of Kentucky, Lexington, KY, United States;3. Departments of Neurosurgery, University of Kentucky, Lexington, KY, United States;4. Departments of Pathology, Division of Neuropathology, University of Kentucky, Lexington, KY, United States;5. Markey Cancer Center, University of Kentucky, Lexington, KY, United States |
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| Abstract: | Background: In 2015, Norway implemented cancer patient pathways to reduce waiting times for treatment. The aims of this paper were to describe patterns in waiting time and their association with patient characteristics for colorectal, lung, breast and prostate cancers.Methods: National, population-based data from 2007 to 2016 were used. A multivariable quantile regression examined the association between treatment period, age, stage, sex, place of residence, and median waiting times.Results: Reduction in median waiting times for radiotherapy among colorectal, lung and prostate cancer patients ranged from 14 to 50 days. Median waiting time for surgery remained approximately 21 days for both colorectal and breast cancers, while it decreased by 7 and 36 days for lung and prostate cancers, respectively. The proportion of lung and prostate cancer patients with metastatic disease at the time of diagnosis decreased, while the proportion of colorectal patients with localised disease and patients with stage I breast cancer increased (p < 0.001). After adjusting for case-mix, a patient’s place of residence was significantly associated with waiting time for treatment (p < 0.001), however, differences in waiting time to treatment decreased over the study period.Conclusions: Between 2007 and 2016, Norway experienced improved stage distributions and consistently decreasing waiting times for treatment. While these improvements occurred gradually, no significant change was observed from the time of cancer patient pathway implementation. |
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| Keywords: | Cancer epidemiology Waiting times Surgery Radiotherapy Colorectal Breast Lung Prostate |
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