ENGAGING ADMINISTRATIVE DATA TO DETERMINE TIME TO DIAGNOSIS AND TREATMENT OF LYMPHOMA: A POPULATION BASED STUDY

Abstract

Introduction: The province of Manitoba (MB) has a goal of reducing time from suspicion of cancer to treatment to a target of 60 days. Most patients with suspicious symptoms present to primary care and referral is after diagnosis is confirmed. Time from suspicion to diagnosis, (diagnostic delay [DD]), is hypothesized to be inadequately captured in cancer centre records and we aimed to refine a method to identify milestones starting from initial health care contact to obtain baseline measures of delay. Methods: This study examined DD, treatment delay (TD) and system delay (SD) in patients (>17) diagnosed with B-cell lymphomas from 2005 to 2010 using administrative data (MB Cancer Registry, MB Health billing and Hospital Abstract data) and chart review of a random subset of patients. A triangulated data approach, using an iterative consultative process, identified events likely related to subsequent lymphoma diagnosis and milestones. By linking to referring provider, date of high suspicion (HS) was identified and intervals were calculated for DD, TD and SD. SD from the chart review and the algorithm was compared with quintile regression. Cumulative incidence curves of SD were generated assessing patient factors (age, gender, lymphoma subtype, stage, socioeconomic status) and system factors (route of HS, treatment type, continuity of care, region of residence). The difference between variables was tested using the log rank test with significance defined as p value < 0.0001), route of HS (ER first presentation, p < 0.0001), first treatment type (chemotherapy shorter than radiation, p = 0.02) influenced SD whereas gender, socioeconomic status, place of residence, and continuity of primary care did not. Conclusions: SD was long with some patients vastly exceeding acceptable time frames. DD accounted for two thirds of SD. This interval is underestimated by chart review, our methodology more reliably identifies HS and allows study on a population basis. To reduce SD a clinical pathway with goal timelines and emphasis on aggressive subtypes/presentations has been developed and disseminated. This serves to direct process improvement and as a reference for clinicians and further research design. Figure 1 Cumulative Time from High Suspicion (HS) to Treatment by Lymphoma Category.