Monitoring treatment wait times for cancer patients in Japan.

Abstract

289 Background: Treatment wait times for cancer patients is among the key performance indicators of cancer policy in Japan, but has never been measured across a large number of patients. We aimed to measure treatment wait times for cancer patients across a large number of hospitals in Japan using health claims data. Methods: We developed a database of claims data (Jan 2011 - Dec 2012) linked to 2011 hospital-based cancer registry data of breast, cervical, colorectal, liver, lung, prostate and stomach cancer patients from 126 designated cancer hospitals in Japan. Treatment wait time was defined as the number of days between the date of diagnosis (the date on which a pathological test or imaging exam that contributed the most to the diagnosis was performed) and initiation of treatment. Dates of diagnostic tests, therapeutic procedures, and chemotherapy (chemo) administration were obtained from health claims data. We calculated wait times by cancer type, treatment, and stage, and investigated if these factors were significantly associated with wait times even after adjusting for age using multiple linear regression. Results: Among 44,102 cancer patients who received cancer treatment, the median wait time was 31 days (IQR=18-50) for all patients, and 32, 42, 31, 22, 22, 55 and 31 days for breast, cervical, colon, liver, lung, prostate and stomach cancer patients, respectively. Wait times were longer for surgery (36 days) compared to radiation (22 days) and chemo (21 days), and shorter for later stage patients: 48, 36, 35, 23, and 14 days for stages 0, I, II, III, and IV, respectively. Cancer type, treatment type, and stages were all independently and significantly associated with treatment wait times even after adjusting for age (p<0.05). Conclusions: This is the first study to investigate treatment wait times across a large number of cancer hospitals in Japan. Treatment wait times were particularly longer for cervical and prostate cancer patients. While the effect of prolonged treatment wait times on clinical outcomes is unknown, longer treatment wait time increases the psychosocial stresses of cancer patients. Continuous monitoring and feedback of study findings to hospitals are required for improvements in the future.