Can we assess Cancer Waiting Time targets with cancer survival? A population-based study of individually linked data from the National Cancer Waiting Times monitoring dataset in England, 2009-2013

• DOI: 10.1371/journal.pone.0201288
• Publication Date: 2018-08-22T13:28:57Z
• Authors: Chiara Di Girolamo; Sarah Walters; Carolynn Gildea; Sara Benitez Majano; Bernard Rachet; Melanie Morris
• Keywords: Adult; Aged, 80 and over; Male; Time Factors; Databases, Factual; Science; Q; R; Middle Aged; Disease-Free Survival; 3. Good health; Survival Rate; 03 medical and health sciences; 0302 clinical medicine; England; Neoplasms; Medicine; Humans; cancer England waiting times; Female; Research Article; Aged; Quality of Health Care

Background Cancer Waiting Time targets have been integrated into successive cancer strategies as indicators of care quality in England. These are reported national statistics for all cancers combined, but there is mixed evidence their benefits and it unclear if meeting targets, currently defined published, associated with improved survival individual patients, thus a good metric judging the utility targets. Methods findings We used individually-linked data from National Times Monitoring Dataset (CWT), registry other routinely collected datasets. The study population consisted adult patients diagnosed England (2009–2013) colorectal (164,890), lung (171,208) or ovarian (24,545) cancer, whom 82%, 76%, 77%, respectively, had CWT matching record. main outcome was one-year net matched by target attainment ('met/not met'). time to each type treatment 31-day 62-day estimated using multivariable analyses, adjusting age, sex, tumour stage deprivation. two-week wait (TWW) GP referral specialist consultation decision treat start were met more than 95% missed often. There little an association between TWW survival, worse those (e.g. cancer: 89.1% (95%CI 88.9–89.4) met, 96.9% 96.1–91.7) not met). Time-to-treatment analyses showed that treatments recorded palliative given earlier time, potentially curative intent. possible limitations accuracy categorisation variables which do allow fully distinguishing, example, intent; difficult these assess appropriateness stage. nature affect estimates found, mean separate times referral, could actually impact on clinical outcomes. This means use measures evaluate would be misleading. Conclusions Based data, we looked at, did find being translates survival. Patients may benefit psychologically limited waits encourage timely treatment, useful measure evaluating Trust performance regards stratified type. As such, current composition compliance needs further evaluation before assessment