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

BACKGROUND: Although 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 healthcar...

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Autores principales: Sikdar, Khokan C., Dickinson, James, Winget, Marcy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376684/
https://www.ncbi.nlm.nih.gov/pubmed/28056946
http://dx.doi.org/10.1186/s12913-016-1944-y
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author Sikdar, Khokan C.
Dickinson, James
Winget, Marcy
author_facet Sikdar, Khokan C.
Dickinson, James
Winget, Marcy
author_sort Sikdar, Khokan C.
collection PubMed
description BACKGROUND: Although 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. METHODS: All 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. RESULTS: 9626 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. CONCLUSION: A 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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spelling pubmed-53766842017-04-07 Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study Sikdar, Khokan C. Dickinson, James Winget, Marcy BMC Health Serv Res Research Article BACKGROUND: Although 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. METHODS: All 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. RESULTS: 9626 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. CONCLUSION: A 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. BioMed Central 2017-01-05 /pmc/articles/PMC5376684/ /pubmed/28056946 http://dx.doi.org/10.1186/s12913-016-1944-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Sikdar, Khokan C.
Dickinson, James
Winget, Marcy
Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
title Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
title_full Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
title_fullStr Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
title_full_unstemmed Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
title_short Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
title_sort factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376684/
https://www.ncbi.nlm.nih.gov/pubmed/28056946
http://dx.doi.org/10.1186/s12913-016-1944-y
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