Open Access

ARTICLE

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

Michael Jewett¹, Ricardo Rendon², George Dranitsaris³, Darrel Drachenberg⁴, Simon Tanguay⁵, Bryan Donnelly⁶, Neil Fleshner¹

1 University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
2 Dalhousie University, QE II Health Sciences Centre, Halifax, Nova Scotia, Canada
3 Outcomes Research Consultant, Toronto, Ontario, Canada
4 University of Manitoba, Manitoba Prostate Centre, Winnipeg, Manitoba, Canada
5 McGill University, Montreal General Hospital, Montreal, Quebec, Canada
6 University of Calgary, Rockyview General Hospital, Calgary, Alberta, Canada
Address correspondence to Dr. Michael Jewett, University Health Network, 610 University Ave, Toronto, Ontario M5G 2M9 Canada

Canadian Journal of Urology 2006, 13(Suppl.3), 54-61.

Abstract

Background: Prolonged surgical wait times have significant effects on a patient's psychological well-being and a negative impact on quality of life but the effect on long-term cancer control is controversial. We conducted a systematic review of the renal cancer literature to examine the best available evidence addressing the following key questions:
• What is the reported time interval for renal cancer patients from the initial surgical consultation until the day of renal 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 PubMed, Embase, the Cochrane Database and Google Scholar from January 1965 to October 2005 was conducted for published studies and international guidelines/consensus documents that evaluated surgical wait times for renal cancer. Data extracted from eligible studies included median or mean time to renal cancer surgery from diagnosis or referral, and key patient outcomes, such as survival rate or adjusted hazard ratios (HR).
Results: Only three studies evaluating wait times for renal cancer surgery were identified. Differences in study data availability, method of analysis and wait time definitions precluded statistical pooling of the findings. Wait times from various points of patient contact ranged from a median delay of 26 days (diagnosis to radical surgery, i.e., nephrectomy) to 82 days (general practitioner referral to radical surgery). One study reported a mean of 23.6 days between referral for surgery to hospital admission for nephrectomy. In the Canadian epidemiological study, which focused on all types of urological cancer, median wait time was 64 days from referral to surgery. This was in contrast to national and international guidelines, which recommended a maximum waiting time between 2 and 4 weeks for all cancer surgeries. There were no epidemiological studies evaluating the association between surgical delay and clinical outcomes such as overall survival.
Conclusions: In Canada, it appears that current wait times for urological surgeries, such as for renal cancer, are beyond the threshold recommended by national and international expert bodies. Then again, the association between surgical delay and overall survival appears to be unexplored. Research in this area is urgently needed. Notwithstanding, the surgical wait times (SWAT) initiative was developed to provide the necessary guidance and recommendations on these issues to the federal and provincial governments. Through a partnership of the key stakeholders, it is the vision of SWAT to ultimately improve the care and quality of life of renal cancer patients and their families.

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