Timely access and quality of care in colorectal cancer: a population-based cohort study using administrative data

Porter, Geoffrey A.; Urquhart, Robin; Kendell, Cynthia; Bu, Jingyu; McConnell, Yarrow J.; Grunfeld, Eva

doi:10.1186/1756-0500-6-355

Cited by 11 publications

(9 citation statements)

References 17 publications

(17 reference statements)

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“…The two studies used similar methods to ours, however, an important difference is that we excluded urgent patients from the calculation of the diagnostic interval whereas the other two did not. If we include urgent patients, the median diagnostic interval was 55 days in our study with 37% of all patients diagnosed within 4 weeks, similar to 37.1% found by Porter et al [34]. A multicenter US study that included mainly male patients of Veteran Affairs hospitals reported a median diagnostic interval of 91 days for screen-detected and 74 days for symptom-detected CRC [33].…”

Section: Discussionsupporting

confidence: 84%

“…Two other population-based studies conducted in Canada that included slightly older patient cohorts, diagnosed in years 2001–2005, reported a median diagnostic interval of 44–64 days (depending on year of diagnosis) [12] and 44 days [34]. The two studies used similar methods to ours, however, an important difference is that we excluded urgent patients from the calculation of the diagnostic interval whereas the other two did not.…”

Section: Discussionmentioning

confidence: 94%

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Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

Sikdar

Dickinson

Winget

2017

BMC Health Serv Res

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BackgroundAlthough it is well-known that early detection of colorectal cancer (CRC) is important for optimal patient survival, the relationship of patient and health system factors with delayed diagnosis are unclear. The purpose of this study was to identify the demographic, clinical and healthcare factors related to mode of CRC detection and length of the diagnostic interval.MethodsAll residents of Alberta, Canada diagnosed with first-ever incident CRC in years 2004–2010 were identified from the Alberta Cancer Registry. Population-based administrative health datasets, including hospital discharge abstract, ambulatory care classification system and physician billing data, were used to identify healthcare services related to CRC diagnosis. The time to diagnosis was defined as the time from the first CRC-related healthcare visit to the date of CRC diagnosis. Mode of CRC detection was classified into three groups: urgent, screen-detected and symptomatic. Quantile regression was performed to assess factors associated with time to diagnosis.Results9626 patients were included in the study; 25% of patients presented as urgent, 32% were screen-detected and 43% were symptomatic. The median time to diagnosis for urgent, screen-detected and symptomatic patients were 6 days (interquartile range (IQR) 2–14 days), 74 days (IQR 36–183 days), 84 days (IQR 39–223 days), respectively. Time to diagnosis was greater than 6 months for 27% of non-urgent patients. Healthcare factors had the largest impact on time to diagnosis: 3 or more visits to a GP increased the median by 140 days whereas 2 or more visits to a GI-specialist increased it by 108 days compared to 0–1 visits to a GP or GI-specialist, respectively.ConclusionA large proportion of CRC patients required urgent work-up or had to wait more than 6 months for diagnosis. Actions are needed to reduce the frequency of urgent presentation as well as improve the timeliness of diagnosis. Findings suggest a need to improve coordination of care across multiple providers.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 94%

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

Sikdar

Dickinson

Winget

2017

BMC Health Serv Res

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“…Perhaps unsurprisingly, and as noted by others, findings from previous studies have been mixed (41). While in our study rural patients with colorectal cancer had a longer time from presentation to diagnosis and treatment (diagnostic and health system interval), Scottish and French studies found no such association (17,42) and a Canadian study found the opposite-rural patients had greater odds of being diagnosed within four weeks compared with urban patients (43). Some studies report longer intervals for rural patients than we found, such as longer median patient and diagnostic intervals in Western Australia (11), and treatment interval for rural colon cancer patients in Ontario (19).…”

Section: Discussionsupporting

confidence: 54%

Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer

Bergin

Emery

Bollard

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Longer cancer pathways may contribute to rural-urban survival disparities, but research in this area is lacking. We investigated time to diagnosis and treatment for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Population-based surveys (2013-2014) of patients (aged ≥40, approached within 6 months of diagnosis), primary care physicians (PCPs), and specialists were collected as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were examined: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment), and total interval (symptom/screening to treatment). Rural and urban intervals were compared using quantile regression including age, sex, insurance, and socioeconomic status. 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 PCPs, and 370 specialists participated. Compared with urban patients, patients with symptomatic colorectal cancer from rural areas had significantly longer total intervals at the 50th [18 days longer, 95% confidence interval (CI): 9-27], 75th (53, 95% CI: 47-59), and 90th percentiles (44, 95% CI: 40-48). These patients also had longer diagnostic and health system intervals (6-85 days longer). Breast cancer intervals were similar by area of residence, except the patient interval, which was shorter for rural patients with either cancer in the higher percentiles. Rural residence was associated with longer total intervals for colorectal but not breast cancer; with most disparities postpresentation. Interventions targeting time from presentation to diagnosis may help reduce colorectal cancer rural-urban disparities. .

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“…However, there may be disadvantages of rapid diagnosis or treatment commencement; Canadian studies show that patients with colorectal cancer who waited longer for diagnosis or treatment more often received higher-quality healthcare. 41 42 While we were unable to measure clinical aspects of quality of care, these findings indicate that relationships between timeliness, utilisation and care quality are complex.…”

Section: Discussionmentioning

confidence: 90%

Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis

Hayes

Adams

McCallum

et al. 2020

J Epidemiol Community Health

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BackgroundPoorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer.MethodsWe identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18–C20; n=35 142) diagnosed in the period 2001–2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile.Results48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60–69, 70–79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91).ConclusionsOlder patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.

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Timely access and quality of care in colorectal cancer: a population-based cohort study using administrative data

Cited by 11 publications

References 17 publications

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer

Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis

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