Prostate Wait Times for Surgery

What are we measuring and why?

This indicator measures the wait time for men with prostate cancer from the booking date of a surgery to when the surgery actually takes place. The booking date is considered to represent the point at which the patient and physician agree that surgery is the treatment of choice and that the patient is ready to have the surgery. Results are presented for surgeries occurring in 2014.

• Due to the slow-growing nature of most prostate cancers, wait times of a few weeks for treatment are often unlikely to affect outcomes. However, a prolonged delay between cancer suspicion and treatment is stressful and can lead to excess anxiety for patients and their family members.^1,2 For system managers and health care planners, having reliable surgical wait times data is crucial for assessing system capacity and demand, and for managing the use of resources.
• The surgery performed to remove prostate cancer is radical prostatectomy (RP), which involves removal of the prostate gland, surrounding tissues and the seminal vesicles. The main intent of RP is curative. Pelvic lymphadenectomy, which involves removal of the pelvic lymph nodes, may also be done to improve prognosis.
• Transurethral resection of the prostate (TURP), where the prostate tissue is removed via the urethra, may be performed as a palliative procedure for men with advanced prostate cancer to relieve symptoms related to urination.³

What are the results?

• Median wait times from booking date to day of surgery ranged from a low of 26 days in New Brunswick to a high of 56 days in Nova Scotia (Figure 4.8).
• There was also wide interprovincial variation for the 90^th percentile wait time (defined as the number of days by which time 90% of men have had their surgery). In New Brunswick, 90% of men had their surgery within 59 days of the booking date compared to 105 days in Saskatchewan.

What do the results mean?

• Wait times may be affected by various factors, including risk category of the cancer, whether neo-adjuvant treatment is being undertaken and delays that are patient-driven. But these factors are not expected to vary substantially between provinces. The majority of inter-provincial variation in wait times for prostate cancer surgery is likely related to differences in system capacity available for prostate cancer surgery (e.g., the number of urologists, availability of hospital operating rooms and surgical beds).
• A recent report by CIHI showed that the wait time for prostate cancer surgery in 2013 and 2014 was longer than the wait times for surgery for bladder, breast, colorectal and lung cancers.⁴ Because of the slow-growing nature of localized prostate cancer, surgery may not be considered as urgent as it is for other cancers; as a result, system resources may be intentionally organized so that prostate cancer surgeries are booked further out. This could be one explanation for the longer wait times.
• It is important to keep in mind that the time period measured here is just one phase in the patient journey; other key points (e.g., time from suspicion to diagnosis, time from diagnosis to decision-to-treat) are also important when assessing person-centred care and system effectiveness.

References

1. Dale W, Bilir P, Han M, Meltzer D. The role of anxiety in prostate carcinoma: a structured review of the literature. Cancer. 2005 Aug 1;104(3):467-78.
2. Gray RE, Fitch MI, Phillips C, Labrecque M, Klotz L. Presurgery experiences of prostate cancer patients and their spouses. Cancer Pract. 1999 May-Jun;7(3):130-5
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Version 1.2015. Chicago (IL); 2015.
4. Canadian Institute for Health Information. Wait times for priority procedures in Canada, 2015. Ottawa (ON): CIHI; 2015 Apr 19 p.