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. 2010 Jan;24(1):33-9.
doi: 10.1155/2010/692151.

Wait times from presentation to treatment for colorectal cancer: a population-based study

H Singh  1 , C De Coster, E Shu, K Fradette, S Latosinsky, M Pitz, M Cheang, D Turner
Affiliations

Wait times from presentation to treatment for colorectal cancer: a population-based study

H Singh et al. Can J Gastroenterol. 2010 Jan.

Abstract
in English, French

Background: The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada.

Objective: To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC).

Methods: Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living's administrative databases, a patient's first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT.

Results: The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT.

Conclusions: The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.

HISTORIQUE :: Le temps d’attente entre le diagnostic de cancer et le traitement a récemment suscité l’intérêt dans les soins du cancer au Canada.

OBJECTIF :: Examiner les tendances des temps d’attente entre la présentation du patient et le traitement (temps d’attente global dans le système de santé [TAG]) pour le cancer colorectal (CCR).

MÉTHODOLOGIE :: On a retracé les patients ayant des adénocarcinomes colorectaux, diagnostiqués entre 2001 et 2005, et leurs premiers traitements définitifs dans le registre manitobain du cancer (Winnipeg, Manitoba) fondé sur la population. En liant les bases de données administratives de Santé Manitoba, on a repéré la première exploration gastro-intestinale des patients (imagerie radiologique abdominale, endoscopie gastro-intestinale basse ou recherche de sang occulte dans les selles) avant le diagnostic de CCR. Le contact de référence avec le système de santé était évalué à compter de la date de visite chez le médecin qui avait demandé la première exploration gastroentérologique. Le TAG était défini comme le délai entre le contact de référence et le diagnostic de CCR. L’analyse de régression multivariée de Cox a permis de déterminer les prédicteurs indépendants de TAG.

RÉSULTATS :: On a évalué le TAG pour 2 552 cas de CCR pendant les cinq ans à l’étude. Le TAG médian est passé de 61 jours en 2001 à 95 jours en 2005 (P<0,001). La majeure partie de l’augmentation était causée par le temps d’attente avant le diagnostic (médiane de 44 jours en 2001 par rapport à 64 jours en 2005 [P<0,001]). L’année de diagnostic, un âge plus avancé, un lieu de résidence en milieu urbain et le diagnostic dans un établissement d’enseignement étaient des facteurs indépendants de TAG.

CONCLUSIONS :: Le TAG entre la présentation et le traitement de CCR au Manitoba a augmenté régulièrement de 2001 à 2005, surtout à cause de délais avant le diagnostic.

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Figures

Figure 1)
Figure 1)
Time to diagnosis (diagnostic delay) was calculated as the time from the index contact to the date of colorectal cancer (CRC) diagnosis. The overall wait time was calculated as the time from index contact to the first treatment for colorectal cancer (see text for the description of data sources). CT Computed tomography; FOBT Fecal occult blood test; GI Gastrointestinal; MD Physician; US Ultrasound
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