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Epidemiology

Factors associated with the melanoma diagnostic interval in Ontario, Canada: a population-based study

British Journal of Cancer volume 130, pages 483–495 (2024)Cite this article

Subjects

Abstract

Background

Protracted times to diagnosis of cancer can lead to increased patient anxiety, and in some cases, disease progression and worse outcomes. This study assessed the time to diagnosis for melanoma, and its variability, according to patient-, disease-, and system-level factors.

Methods

This is a descriptive, cross-sectional study in Ontario, Canada from 2007–2019. We used administrative health data to measure the diagnostic interval (DI)–and its two subintervals–the primary care subinterval (PCI) and specialist care subinterval (SCI). Multivariable quantile regression was used.

Results

There were 33,371 melanoma patients. The median DI was 36 days (interquartile range [IQR]: 8–85 days), median PCI 22 days (IQR: 6–54 days), and median SCI 6 days (IQR: 1–42 days). Increasing comorbidity was associated with increasing DI. Residents in the most deprived neighbourhoods and those in rural areas experienced shorter DIs and PCIs, but no differences in SCI. There was substantial variation in the DI and SCI across health regions, but limited differences in the PCI. Finally, patients with a history of non-melanoma skin cancer, and those previously established with a dermatologist experienced significantly longer DI, PCI, and SCI.

Discussion

This study found variability in the melanoma DI, notably by system-level factors.

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Fig. 1: Cohort creation flowchart.

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Data availability

The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca).

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Acknowledgements

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study also received funding from the Canadian Institutes of Health Research (CIHR) Doctoral Award. This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from © Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by: Canadian Institute for Health Information (CIHI), MOH, Ontario Health (OH), and Toronto Community Health Profiles. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. We thank the Toronto Community Health Profiles Partnership for providing access to the Ontario Marginalisation Index.

Funding

The authors received no specific funding for this work. MEM is supported by a Canadian Institutes of Health Research Doctoral Award.

Author information

Author notes

  1. These authors contributed equally: Yuka Asai, Hugh Langley, Nicole J. Look Hong, Frances C. Wright.

  2. These authors jointly supervised this work: Timothy P. Hanna, Patti A. Groome.

Authors and Affiliations

  1. Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada

    Meaghan E. Mavor, Timothy P. Hanna & Patti A. Groome

  2. Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, ON, Canada

    Meaghan E. Mavor, Timothy P. Hanna & Patti A. Groome

  3. Department of Oncology, Queen’s University, Kingston, ON, Canada

    Timothy P. Hanna & Hugh Langley

  4. ICES at Queen’s University, Kingston, ON, Canada

    Timothy P. Hanna & Paul Nguyen

  5. Division of Dermatology, Department of Medicine, Queen’s University, Kingston, ON, Canada

    Yuka Asai

  6. South East Regional Cancer Program, Kingston, ON, Canada

    Hugh Langley

  7. Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Nicole J. Look Hong & Frances C. Wright

  8. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Nicole J. Look Hong & Frances C. Wright

  9. Surgical Oncology Program, Cancer Care Ontario – Ontario Health, Toronto, ON, Canada

    Frances C. Wright

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Contributions

MEM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. TPH and PAG contributed equally to this work as co-senior authors. MEM: conceptualisation, design, statistical analyses, interpretation, original draft, revision, review. YA: clinical expertise, interpretation, review. HL: clinical expertise, interpretation, review. NJLH: clinical expertise, interpretation, review. PN: cohort creation, data processing, review. FCW: clinical expertise, interpretation, review. TPH: conceptualisation, design, supervision, interpretation, revision. PAG: conceptualisation, design, supervision, interpretation, revision.

Corresponding author

Correspondence to Meaghan E. Mavor.

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The authors declare no competing interests.

Ethics approval

This project has been approved by the Health Sciences Research Ethics Board at Queen’s University. Participant consent has been waived as the research falls under Article 5.5A of the Tri-Council Policy Statement 2 (TCPS 2).

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Mavor, M.E., Hanna, T.P., Asai, Y. et al. Factors associated with the melanoma diagnostic interval in Ontario, Canada: a population-based study. Br J Cancer 130, 483–495 (2024). https://doi.org/10.1038/s41416-023-02518-1

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