An Audit of Wait Times for Service Offered by the Gynaecology Oncology Unit at the University Hospital in Jamaica: Are We Meeting the Standards?

Abstract

Abstract 53 Background: The European Board and College of Obstetrics and Gynaecology recommends that time from referral of suspected or proven gynaecological cancers to consultation should be within two weeks and that initiation of treatment should occur within six weeks. It is has been shown that a delay in waiting times beyond these international standards results in significantly increased morbidity and mortality. Methods: An audit of wait times was performed for all patients who presented to the gynaecology oncology unit at the University Hospital in Jamaica for consultation between January 1, 2013 and December 31, 2013. Wait time for consultation was calculated as the date of first referral to the date of initial consultation. Wait time for treatment was calculated as time from consultation to either surgery or initiation of radiation therapy or chemotherapy. Primary site, stage, and the region from which the referrals came were abstracted from the medical record. Results: A total of 1,289 unique patients were seen at least once during the audit period; of these, 108 were new consultations and 1,219 were patients seen for follow-up. 72% were from the greater metropolitan area (Kingston & St. Andrew), while the others were from the surrounding parishes of Jamaica. Of the 108 new patients, malignancy was confirmed in 70 (65%). Case make-up included 23 cases of endometrial cancer (33%); 20 cases of cervical cancer (29%); 16 cases of ovarian cancer (23%); and 11 cases of other gynecologic cancers (vulvar, vaginal, choriocarcinoma) (15%). At presentation, there were 23 patients with stage 1 disease (33%), 16 patients with stage 2 disease (23%), 27 patients with stage 3 disease (38%); and 4 patients with stage 4 disease (6%). 39 out of 70 patients with malignancy (56%) underwent surgery; 11 (15.7%) were treated with radiation therapy; and 22 (31%) were treated with chemotherapy. Among patients with a cancer diagnosis, the mean time from referral to consultation was 2.1 weeks. Mean time from consultation to surgery was 7.6 weeks; mean time from consultation to start of radiotherapy was 16 weeks; and mean time from consultation to start of chemotherapy was 11.6 weeks. 66% of patients underwent surgery within the international standard of six weeks from referral. Only 36% initiated radiation therapy and 14% initiated chemotherapy within six weeks from referral. Conclusion: While the majority of patients met international standards for time to consultation to surgery, wait times for initiation of radiation and chemotherapy were sub-standard. This audit has provided information that will help us to assess the inadequacy of available services and could potentially inform national cancer policies in Jamaica. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.