Impact of Wait Times on Survival for Women With Uterine Cancer

ABSTRACT Women diagnosed with early-stage uterine cancer (without spread) have a 5-year survival rate of 96%; the rate drops to 16% if this cancer is diagnosed after the cancer has spread more distantly. It has been suggested that a timely hysterectomy after diagnosis of uterine cancer may improve survival, but there are no data to support this suggestion. The aim of this study was to investigate whether a longer wait time from diagnosis of uterine cancer to definitive surgery by hysterectomy is associated with poorer overall survival. Data were obtained from the Ontario Cancer Registry for all women who had a histopathologic diagnosis of uterine cancer followed by a hysterectomy between 2000 and 2009. Survival time was estimated with the Kaplan-Meier method, and the prognostic effect on survival of individual factors was evaluated using univariate Cox proportional hazards regression. Wait time was then added to the optimal multivariate model to evaluate whether it remained a significant variable after adjusting for all other factors. Nine thousand four hundred seventeen women were included in the final study population; 51.9% underwent surgery by a gynecologist, and 69.9% of the tumors were endometrioid adenocarcinoma. The 5-year overall survival rates for patients with wait times of 0.1 to 2, 2.1 to 6, 6.1 to 12, and more than 12 weeks were 71.1%, 81.8%, 79.5%, and 71.9%, respectively. Multivariate analysis showed that wait time was an independent prognostic variable for overall survival (P < 0.001) after adjusting for other specified variables. Wait times of 2 weeks or less were adversely prognostic for survival in the multivariate model, and women with wait times of more than 12 weeks had worse survival than those with wait times of 2.1 to 12.0 weeks. This study provides the first data from a large population-based cohort that demonstrates that delay from a diagnosis of uterine cancer to definitive surgery has a negative impact on overall survival.