Waiting time for radiotherapy in women with cervical cancer

Nascimento, Maria Isabel do; Silva, Gulnar Azevedo e

doi:10.1590/S0034-8910.2015049005953

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Sumário

Public Health Practice • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005953 copy

Waiting time for radiotherapy in women with cervical cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To describe the waiting time for radiotherapy for patients with cervical cancer.

METHODS

This descriptive study was conducted with 342 cervical cancer cases that were referred to primary radiotherapy, in the Baixada Fluminense region, RJ, Southeastern Brazil, from October 1995 to August 2010. The waiting time was calculated using the recommended 60-day deadline as a parameter to obtaining the first cancer treatment and considering the date at which the diagnosis was confirmed, the date of first oncological consultation and date when the radiotherapy began. Median and proportional comparisons were made using the Kruskal Wallis and Chi-square tests.

RESULTS

Most of the women (72.2%) began their radiotherapy within 60 days from the diagnostic confirmation date. The median of this total waiting time was 41 days. This median worsened over the time period, going from 11 days (1995-1996) to 64 days (2009-2010). The median interval between the diagnostic confirmation and the first oncological consultation was 33 days, and between the first oncological consultation and the first radiotherapy session was four days. The median waiting time differed significantly (p = 0.003) according to different stages of the tumor, reaching 56 days, 35 days and 30 days for women whose cancers were classified up to IIA; from IIB to IIIB, and IVA-IVB, respectively.

CONCLUSIONS

Despite most of the women having had access to radiotherapy within the recommended 60 days, the implementation of procedures to define the stage of the tumor and to reestablish clinical conditions took a large part of this time, showing that at least one of these intervals needs to be improved. Even though the waiting times were ideal for all patients, the most advanced cases were quickly treated, which suggests that access to radiotherapy by women with cervical cancer has been reached with equity.

Uterine Cervical Neoplasms, radiotherapy; Appointments and Schedules; Waiting Lists; Referral and Consultation; Health Services Accessibility; Equity in Access

Variable	n	%
Age group (years)
20 to 29	14	4.1
30 to 39	51	14.9
40 to 49	100	29.2
50 to 59	87	25.4
60 to 69	45	13.2
70 to 79	36	10.5
80 and over	9	2.6
Clinical staging
IA to IB	33	9.6
IIA to IIB	135	39.5
IIIA to IIIB	157	45.9
IVA to IVB	17	5.0
Morphology
Squamous	311	90.9
Adenocarcinoma	20	5.8
Adenosquamous	5	1.5
Other	6	1.8
Treatment scheme with External Radiotherapy +
Brachytherapy and chemotherapy	60	17.5
Brachytherapy	94	27.5
Reinforcement	20	5.8
Chemotherapy	58	17.0
Chemotherapy and reinforcement	31	9.1
Brachytherapy and reinforcement	1	0.3
Brachytherapy and reinforcement and chemotherapy	1	0.3
External specialized radiotherapy	77	22.5

Biennium	Total interval between diagnostic confirmation and beginning radiotherapy at the specialized unit			Interval between diagnostic confirmation and first oncological consultation at the specialized unit			Interval between first oncological consultation and beginning radiotherapy at the specialized unit

	Mean	Median	IQR*	Mean	Median	IQR	Mean	Median	IQR
1995 to 1996	21.6	11	12	17.1	5	2	4.5	5	5
1996 to 1997	15.1	11	15	8.5	6	6	6.5	3	5
1999 to 2000	35.3	15	40	30.6	12	35	4.6	1	1
2001 to 2002	29.9	17	26	21.5	7	20	8.3	6	8
2003 to 2004	40.6	30	39.5	30.1	16.5	38	10.4	5	9.5
2005 to 2006	77.1	58	39	73.2	56.5	35	3.9	1	5.5
2007 to 2008	69.1	60	37	62.9	56	31	6.2	4	7
2009 to 2010	82.1	64	26	71.2	53	22	10.9	8.5	8
1995 to 2010	48.3	41	50	41.1	33	50	7.2	4	7

Variable	Total		Access within 15 days		Access within 30 days		Access within 60 days		Access within 90 days		Access within 120 days

	n	%	n	%	n	%	n	%	n	%	n	%
Total			104	30.4	150	43.8	247	72.2	302	88.3	322	94.1
Biennium
1995 to 1996	10	2.9	7	70.0	9	90.0	9	90.0	9	90.0	10	100
1997 to 1998	47	13.7	34	72.3	41	87.2	46	97.9	47	100	47	100
1999 to 2000	43	12.6	22	51.2	29	67.4	34	79.1	37	86.0	41	95.4
2001 to 2002	49	14.3	22	44.9	34	69.4	43	87.8	47	96.0	47	96.0
2003 to 2004	56	16.4	17	16.3	29	51.8	48	85.7	50	89.3	53	94.6
2005 to 2006	48	14.0	0	0	3	6.2	26	54.2	39	81.2	43	89.6
2007 to 2008	51	14.9	2	1.9	5	9.8	26	51.0	41	80.4	47	92.2
2009 to 2010	38	11.1	0	0	0	0	15	39.5	32	84.2	34	89.5
p				< 0.001		< 0.001		< 0.001		0.032		0.364
Staging
From IA to IIA	55	16.1	10	18.2	15	27.3	35	63.6	43	78.2	47	85.5
From IIB to IIIB	270	78.9	87	32.2	126	46.7	201	74.4	244	90.4	260	96.3
Of IVA and IVB	17	5.0	7	41.2	9	52.9	11	64.7	15	88.2	15	88.2
p				0.073		0.023		0.206		0.037		0.004
Age group (years)
≥ 50	177	51.7	57	32.2	82	46.3	128	72.3	155	87.6	165	93.2
< 50	165	48.3	47	28.4	68	41.2	119	72.1	147	90.0	157	95.1
p				0.455		0.341		0.968		0.662		0.447

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence
: Maria Isabel do Nascimento Rua Marquês do Paraná, 303 Prédio Anexo, 3^o andar Centro 24033-900 Niterói, RJ, Brasil E-mail: ysamaria@uol.com.br