Timeliness of Cancer Treatment: Delays from referral to first treatment experienced by patients referred urgently with high suspicion of a new cancer in the New Zealand Health System

Abstract

Cancer affects millions of people around the world and is the leading cause of death in New Zealand (NZ). Timely care is a key aspect of improving the quality of a health system as it impacts both experiences and outcomes of cancer patients. This thesis aimed to review the literature around the inequalities in timeliness of cancer care in health systems similar to NZ, and to investigate inequalities in cancer patients' time from referral to first treatment in NZ. Conceptual models of patient delay demonstrate that people with different contributing factors such as demographics may have different duration of time intervals between events such as diagnosis and treatment, creating inequalities and inequities in the timeliness of care. The literature review conducted showed that there are widespread inequalities in the timely receipt of cancer care in the UK, Canada and NZ, particularly in areas such as gender, age, ethnicity, co-morbidities and deprivation. However, research from NZ is limited, with most existing literature only focusing on individual cancers and a very limited range of factors that impact on timeliness. A secondary analysis of NZ patients referred urgently with a high suspicion of a new cancer was conducted using a retrospective longitudinal design. Negative binomial regression and binary logistic regression were used to investigate the inequalities in the number of days from referral to first treatment, and the percentage of those meeting the government's 62-day indicator respectively against the predictor variables of age, sex, ethnicity, regional cancer network, deprivation, access to services, tumour stream and referral year. This was done for the total sample, and the specific tumour streams of breast, gynaecological, lower gastrointestinal, lung and skin. Results found inequalities present in the provision of cancer care in NZ for all investigated variables, with older age groups, females, indigenous and ethnic minority groups, highly deprived, those living further away from services and diagnosed with either gynaecological or head and neck cancers facing significant delays to first treatment. Patients referred in 2017 faced reduced delays compared to those referred in 2015. Some of the inequalities found are inequities, as they are unfair and unjust. The government, District Health Boards and the entire population can work towards decreasing these differences in cancer care. However, further research needs to be conducted, including investigating variables previously found to be associated with delay but not investigated in this study, and working with service end users (staff and patients) to make sense of the differences found and creating solutions to improve the state of cancer care in NZ.