Alyson B Crawford1, Carolyn Nessim2, Joel Weaver3, Carl van Walraven4,5,6. 1. Division of General Surgery, The Ottawa Hospital, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada. 2. Division of General Surgery, The Ottawa Hospital, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada. cnessim@toh.ca. 3. Division of General Surgery, The Queensway Carleton Hospital, Ottawa, ON, Canada. 4. Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 5. Institute for Clinical Evaluative Sciences (ICES), Ottawa, ON, Canada. 6. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Abstract
INTRODUCTION: Wait times for access to care have been of increasing interest to public health care officials, health care providers, and the public. There is a paucity of data determining whether extended wait times for melanoma surgery influence patient outcomes. This study measured the association of wait times to surgical treatment with overall survival in patients with melanoma. METHODS: Population-based health administrative databases were used to identify all Ontario adults diagnosed with melanoma between 2004 and 2011, time to various treatment modalities, and death dates. Proportional hazards modeling using time-dependent covariates was used to determine the adjusted association of time from melanoma diagnosis to various post-diagnostic surgical interventions with overall survival. RESULTS: A total of 2573 patients were included. The 5-year overall survival was 81.1% [95% confidence interval (CI) 79.1-83.0]. Of all patients, 82.9% underwent a wide local excision (WLE) with a median wait time of 43 days [interquartile range (IQR) 24-64], 29.1% underwent a sentinel lymph node biopsy (SNB) with a median wait time of 59 days (IQR 41-81), and 35.0% underwent a lymph node dissection (LND) with a median wait time of 63 days (IQR 43-91). After adjusting for age, sex, rural residence, and risk of mortality from comorbidities, wait times to WLE [hazard ratio (HR) 0.97; 95% CI 0.87-1.08; p = 0.62], SNB [HR 1.04; 95% CI 0.68-1.59; p = 0.86], and LND [HR 0.99; 95% CI 0.89-1.11; p = 0.92] were not associated with overall survival. CONCLUSIONS: Overall survival for patients with melanoma was not influenced by wait times to WLE, SNB, and LND.
INTRODUCTION: Wait times for access to care have been of increasing interest to public health care officials, health care providers, and the public. There is a paucity of data determining whether extended wait times for melanoma surgery influence patient outcomes. This study measured the association of wait times to surgical treatment with overall survival in patients with melanoma. METHODS: Population-based health administrative databases were used to identify all Ontario adults diagnosed with melanoma between 2004 and 2011, time to various treatment modalities, and death dates. Proportional hazards modeling using time-dependent covariates was used to determine the adjusted association of time from melanoma diagnosis to various post-diagnostic surgical interventions with overall survival. RESULTS: A total of 2573 patients were included. The 5-year overall survival was 81.1% [95% confidence interval (CI) 79.1-83.0]. Of all patients, 82.9% underwent a wide local excision (WLE) with a median wait time of 43 days [interquartile range (IQR) 24-64], 29.1% underwent a sentinel lymph node biopsy (SNB) with a median wait time of 59 days (IQR 41-81), and 35.0% underwent a lymph node dissection (LND) with a median wait time of 63 days (IQR 43-91). After adjusting for age, sex, rural residence, and risk of mortality from comorbidities, wait times to WLE [hazard ratio (HR) 0.97; 95% CI 0.87-1.08; p = 0.62], SNB [HR 1.04; 95% CI 0.68-1.59; p = 0.86], and LND [HR 0.99; 95% CI 0.89-1.11; p = 0.92] were not associated with overall survival. CONCLUSIONS: Overall survival for patients with melanoma was not influenced by wait times to WLE, SNB, and LND.