Summary

Cancer is a major cause of premature death and the second most common cause of death overall in Australia. Cancers of the bowel, breast and lung are among the most frequent causes of potentially preventable death in people younger than 75 years. Timely interventions such as surgery can prevent deaths occurring from these three types of cancer.

This is the second report from the National Health Performance Authority (the Authority) on cancer surgery waiting times at public hospitals across Australia. The report presents waiting times for surgery for malignant bowel, breast and lung cancers.

Waiting times for surgery is a measure of access to treatment that can help maintain quality of life or be potentially life-saving. Without timely surgery, cancers may progress and patients with early-stage disease may face a reduced opportunity for cure.

In Australia, planned (or elective) cancer surgeries are prioritised using the same waiting list system as other planned surgeries. The patients covered in this report were assigned to planned surgery waiting lists by surgeons as urgent or semi- urgent cases. Urgent cases are expected to be completed within 30 days, while semi-urgent cases are meant to be completed within 90 days.

Most patients waiting for bowel, breast or lung cancer surgery in most hospitals are listed as urgent. However, there are some hospitals where the proportion of patients assigned as semi-urgent is much higher. As such, the Authority focuses both on reporting the time within which half of patients received their surgery (median waiting times) and the time until the vast majority of patients (at least 90%) received their surgery at each hospital.

Importantly, there is no agreed definition of poor performance in relation to waiting times for cancer surgery. Therefore, the Authority makes no determination that any hospital is performing either well or poorly. Instead, the information in this report is intended to help clinicians, hospital managers, and system managers see what is possible at similar hospitals and support sharing of successful strategies to manage surgery waiting lists.

Key findings

In 2012–13, a total of 32,665 patients received surgery for malignant bowel, breast or lung cancer in Australia. Of these, 13,697 patients received planned surgery for malignant bowel, breast or lung cancer at a public hospital. The remaining patients received their surgery at a private hospital or had emergency cancer surgery.

The vast majority (92%) of patients received their planned surgery within 30 days and almost all (97%) received their surgery within 45 days.

However, there were 1,028 patients nationally who waited longer than 30 days and 346 patients who waited longer than 45 days.

  • Bowel cancer: 564 patients waited longer than 30 days; 216 of these patients waited longer than 45 days
  • Breast cancer: 357 patients waited longer than 30 days; 102 of these patients waited longer than 45 days
  • Lung cancer: 107 patients waited longer than 30 days; 28 of these patients waited longer than 45 days.

This report focuses on the 12,927 patients who received their surgery for malignant bowel, breast or lung cancer at one of Australia’s major or large public hospitals that performed 10 or more surgeries in 2012–13. For information on the hospitals where the remaining 770 patients received their surgery, see the Appendix. For information on waiting times performance for all hospitals, visit the AIHW website.

Waiting times across metropolitan and regional hospitals

In 2012–13, patients in metropolitan and regional areas of Australia experienced, on average, similar median waiting times for malignant bowel, breast and lung cancer surgeries. More specifically, the median waiting time for these surgeries (the time it took for 50% of patients to receive their surgery) was similar across major metropolitan, major regional and large hospitals.

Looking at results by hospital, most hospitals provided timely surgery for malignant bowel, breast and lung cancer in 2012–13. However, there was a small group of major and large hospitals where some patients faced longer waits. At some hospitals, it took between 45 and 90 days for the vast majority of patients to receive their surgery.

What is malignant cancer?

In this report, the term ‘malignant’ refers to those cancers that have the ability to progress to a more serious disease and spread to surrounding tissue or other organs, if left untreated.

Malignant bowel cancer surgery at major and large public hospitals

In 2012–13, a total of 89 major and large hospitals performed at least 10 surgeries for malignant bowel cancer.

The time within which half of patients received their bowel cancer surgery (median waiting time) was similar across major and large hospitals.

The median waiting time was 15 days at major metropolitan hospitals, 16 days at major regional hospitals and 12 days at large hospitals (Figure 2b).

The time within which the vast majority of patients (at least 90%) received their surgery was also similar across hospitals. Of the 89 hospitals, 56 completed at least 90% of surgeries within 30 days and this rose to 82 of 89 hospitals having completed at least 90% of surgeries within 45 days. However, there were seven hospitals that took longer than 45 days to complete at least 90% of bowel cancer surgeries (Figure 2c).

Malignant breast cancer surgery at major and large public hospitals

In 2012–13, a total of 86 major and large hospitals performed at least 10 surgeries for malignant breast cancer.

The time within which half of patients received their breast cancer surgery (median waiting time) was similar across major and large hospitals.

The median waiting time was 12 days at major metropolitan hospitals, 14 days at major regional hospitals and 12 days at large hospitals (Figure 3b).

The time within which the vast majority of patients received their surgery was also similar across hospitals. Of the 86 hospitals, 79 completed at least 90% of surgeries within 30 days and this rose to 85 of 86 hospitals by 45 days. Only one hospital took longer than 45 days to complete at least 90% of its breast cancer surgeries (Figure 3c).

Malignant lung cancer surgery at major hospitals

In 2012–13, a total of 29 major hospitals performed at least 10 surgeries for malignant lung cancer.

The time within which half of patients received their lung cancer surgery (median waiting time) at a major hospital was 13 days (Figure 4b).

The time within which the vast majority of patients received their surgery was similar across hospitals. Of the 29 hospitals, 20 completed at least 90% of surgeries within 30 days and this rose to 27 of 29 hospitals having completed at least 90% of surgeries within 45 days. Two hospitals took longer than 45 days to complete at least 90% of their lung cancer surgeries (Figure 4c).

Changes in cancer surgery waiting times from 2011–12 to 2012–13

With the release of this report, two years of comparable data are now available on waiting times for surgery for malignant bowel, breast and lung cancer at Australian public hospitals. These reports measure the time from being placed on a waiting list until being admitted to hospital for planned surgery. As there are no data collected on the time to get onto the waiting list, the reports do not measure this period.

In 2011–12 and 2012–13, the median waiting time for these surgeries was similar across metropolitan and regional hospitals. Both years of data indicate that the vast majority of patients waited no longer than 30 days for their surgery. In 2011–12, a total of 91% of 12,699 patients received their cancer surgery within 30 days and this rose to 97% of patients by 45 days. In 2012–13, a total of 92% of 13,697 patients received their cancer surgery within 30 days and 97% by 45 days.

At a hospital level, the variation within peer groups was similar to that shown in the last report. There were only small changes in median waiting times from 2011–12 to 2012–13. Nearly all hospitals completed most of their surgeries within 45 days in both 2011–12 and 2012–13.

In 2012–13, the percentage of patients who received surgery within 45 days compared to 2011–12 was as follows:

Percentage of patients receiving surgery in 45 days

Malignant cancer type 2011-2012 2012-13
Bowel cancer 94% 95%
Breast cancer 99% 99%
Lung cancer 96% 97%

However, some hospitals took longer than 45 days to complete at least 90% of surgeries and a small number took between 76 days and 90 days to complete 90% of malignant bowel cancer surgeries. These hospitals were Princess Alexandra Hospital (Qld) and Royal Hobart (Tas).*

* One hospital also fell into the 76 to 90 days to complete 90% of surgeries category for malignant lung cancer surgeries. However, the percentage of patients assigned to waiting lists as semi-urgent at this hospital was much higher than other hospitals in its peer group. This may affect interpretation of information about waiting times for cancer surgery at this hospital.