Management pathway for patients with cervical cancer in the Auckland region 2003-2007

Introduction: This review was performed to describe the patient pathway and timelines involved in the treatment of FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IVA cervical cancer in a New Zealand cancer centre. Methods: Retrospective audit of women with a new diagnosis of FIGO Stage IB1-IVA cervical cancer in the Auckland/Northland regions between 2003 and 2007. Results: Two hundred and seven patients were identified. Median time from referral to first specialist assessment (FSA) was 10 days, from FSA to decision to treat (DTT) 50 days and from DTT to start of treatment 26 days. Overall median time from referral to start of treatment was 97 days. There was no difference in median time from referral to DTT for patients treated with primary surgery (48 days) or radiotherapy (47 days). On univariate analysis, factors associated with reduced time from referral to start of treatment were less socioeconomic deprivation (P = 0.001), shorter time to completion of radiological investigations (P < 0.0005) and private FSA (P < 0.0005). Only private FSA remained significant on multivariate analysis. The greatest delay in the pathway was between FSA and DTT, encompassing presentation at multidisciplinary meeting, examination under anaesthetic and obtaining radiological investigations. Median overall treatment time (OTT) for patients treated with definitive radiotherapy was 56 days and was increased by a median of 3 days where there were delays accessing operating theatre time for brachytherapy insertions. Conclusion: Overall patient pathway and radiotherapy OTT were longer than optimal, and areas of delay potentially amenable to modification were identified.