Time to operative care for breast cancer in the Cape Metro West region

Abstract

Background: Time from diagnosis to operative care is a quality indicator in breast cancer (BCA) care. The recommended time from diagnosis to definitive treatment in South Africa (SA) is 31 days. The primary objective of this study was to determine the time to operative care (TOC) for BCA patients attending a multidisciplinary breast clinic at a tertiary hospital in Cape Town, SA.

Methods: This was a retrospective review of women with BCA reviewed by the BCA multidisciplinary unit at Groote Schuur Hospital, SA, from 1 January 2018 to 31 December 2019.

Results: Of 563 women who underwent BCA operations, 370 (65.7%) had surgery as the primary treatment modality. The median TOC for those who had surgery first was 86 days (IQR: 63–109). Of the 370 who had surgery first, 20 (5.4%) were operated on within the recommended 31 days. TOC at the district hospital was 35.1 days shorter (p < 0.001), and at the regional hospital, it was 16.3 days (p = 0.008) shorter than at the tertiary hospital after controlling for age, district, and stage of cancer.

Conclusions: A low proportion of women with BCA had definitive surgery within the 31-day recommended waiting period. Decentralisation of operative care allowed faster access to surgery at district hospitals for women who did not need sentinel node biopsy or advanced anaesthesia care. Identifying additional resources needed to decrease TOC for BCA patients could improve access to timeous surgical care.