Open Access

ARTICLE

Does prolonging the time to testicular cancer surgery impact long-term cancer control: a systematic review of the literature

David Bell¹, Christopher Morash², George Dranitsaris³, Jonathan Izawa⁴, Thomas Short⁵, Laurence H. Klotz⁶, Neil Fleshner⁷

1 Dalhousie University, Halifax, Nova Scotia, Canada
2 University of Ottawa, Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada
3 Outcomes Research Consultant, Toronto, Ontario, Canada
4 University of Western Ontario, London Regional Health Sciences Centre, London, Ontario, Canada
5 Carlo Fidani Peel Regional Cancer Centre at Credit Valley Hospital, Ontario, Canada
6 University of Toronto, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada
7 University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
Address correspondence to Dr. David Bell, 5991 Spring Garden Road, Suite 620, Halifax, Nova Scotia B3H 1Y6 Canada

Canadian Journal of Urology 2006, 13(Suppl.3), 30-36.

Abstract

Background: The wait times for urological cancer surgeries in Canada are beyond those recommended by the Canadian Association of Surgical Oncology. Prolonged wait times have a negative impact on patient quality of life but the effect on long-term cancer control is controversial. We conducted a systematic review of the testicular cancer literature to examine the best available evidence addressing the following key questions:
• What is the reported time interval for testicular cancer patients from the decision to operate until the day of testicular cancer surgery?
• Are there recommendations/guidelines in the urological cancer literature and, if so, how do the Canadian times compare?
• Is there a known association between duration of wait time beyond the recommended standard and clinical outcome (i.e. recurrence-free survival, overall survival)?
Methods: A structured literature search of Medline, PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects, Healthstar and Google Scholar from January 1980 to September 2005 was conducted for published epidemiological studies and international guidelines/consensus documents that evaluated surgical wait times for testicular cancer. Data extracted from eligible studies included median time to diagnosis and to testicular cancer surgery.
Results: Five studies evaluating different components of wait times (e.g. delay in diagnosis, delay in orchiectomy) in testicular cancer patients were identified, four of which measured the impact of prolonged delays on relapse-free and overall survival. Differences in study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings. In one study from the United Kingdom, median wait time was 30 days from general practitioner referral to surgery and 4 days from diagnosis to surgery. No Canadian studies specific to testicular cancer were identified. The association between surgical delay and clinical outcomes remained controversial where only one of five epidemiological studies reported an association between treatment delay and relapse-free and overall survival.
Conclusions: Even though the association between surgical delay and disease related clinical outcomes remains controversial, there is an ongoing concern that the psychological impact of prolonged waiting for urological cancer surgery could negatively impact patient outcomes. Additional research is needed to identify the current wait times for testicular cancer in Canada and to develop guidelines and recommendations on what appropriate wait times should be. To address these important issues, the surgical wait times (SWAT) initiative is mandated to provide the necessary guidance and recommendations to the federal and provincial governments. Through a partnership between the key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of cancer patients.

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