A prospective study on the impact of waiting times for radiotherapy for cervical cancer at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Background.  Radiotherapy plays a vital role in the management of cervical cancer.  However, due to high patient load and limited resources, waiting lists are unacceptably long.  This is a highly curable malignancy that often occurs in economically active, relatively young women.  Thus, the impact of treatment delays on society is disproportionately large when compared to many other malignancies.  Delays also impact negatively on the health care system and places further stress on an already burdened department.  This prospective study aimed to evaluate the potential impact of radiotherapy delays.

Patients and methods.  Eighty-one patients requiring radical radiotherapy for cervical cancer were selected.  Patients were re-evaluated every four weeks while waiting, and again at simulation.

Results.  Median delay from first consultation to simulation was 55 days.  Longer delays were not statistically correlated to tumour progression.  Most of the upstaging occurred around 40 to 65 days.  One in four patients received blood transfusions and required hospital admission.  Four patients needed haemostatic brachytherapy for bleeding. 

Conclusion.  A relationship between time waited and disease progression could not be proven.  However, numbers were small and statistical tests were likely underpowered.  The study does, however, highlight unacceptably long delays for radiotherapy and a wait of less than 40 days is recommended.