Factors influencing time between surgery and radiotherapy : A population based study of breast cancer patients
2015
This study describes variation in the time interval between surgery and radiotherapy in breast cancer
(BC) patients and assesses factors at patient, hospital and radiotherapy centre (RTC) level influencing this
variation. To do so, the factors were investigated in BC patients using multilevel logistic regression. The
study sample consisted of 15,961 patients from the Netherlands Cancer Registry at 79 hospitals and 19
(RTCs) with breast-conserving surgery or mastectomy directly followed by radiotherapy. The percentage
of patients starting radiotherapy �42 days varied from 14% to 94%. Early year of incidence, higher age,
higher stage, mastectomy, higher ASA category and no availability of radiotherapy facilities were
significantly associated with a longer time interval between radiotherapy and surgery. More patients
received radiotherapy �42 days in hospitals with on-site radiotherapy facilities (OR 1.36, p ¼ 0.024).
Among the remainder, significant variation was found at the RTC level (11.1%, s2 ¼ 0.254, SE 0.054), and
at the hospital level (6.4% s2 ¼ 0.443, SE 0.163) (ICC 0.064). The significant delay and unexplained
variance remaining at the RCT and hospital level suggests delays caused by the patient referral pathway
from hospital to RCT, and indicates potential for improvement at both levels.
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