A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis

Abstract

Background: Administrative wait times reflect the time from the decision to treat until surgery; however, this does not reflect the total time a patient actually waits for treatment. Several factors may prolong the wait for colon cancer surgery. We sought to analyze the time from the date of surgical consultation to the date of surgery and any events within this time frame that may extend wait times. Methods:We retrospectively reviewed the cases of all adult patients in Ontario aged 18-80 years with diagnosed colon cancer who did not receive neoadjuvant therapy and underwent resection electively between Jan. 1, 2002, and Dec. 31, 2009. Wait times were measured from the date of surgical consultation to the date of surgery. We chose a wait time of 28 days, reflecting local administrative targets, as a comparative benchmark. We performed univariate and multivariate analyses to identify variables contributing to a waits longer than 28 days. Variables were analyzed in continuous linear and logistic regression models. Results:We included 10 223 patients in our study. The median wait time from initial surgical consultation to resection was 31 (range 0-182) days. Age older than 65 years had a negative impact on wait time. Preoperative services, including computed tomography, cardiac consultation, echocardiography, multigated acquisition scan, magnetic resonance imaging, colonoscopy and cardiac catheterization also significantly increased wait times. Wait times were longer in rural hospitals. Conclusion:Preoperative services significantly increased wait times between initial surgical consultation and surgery.Contexte : Au plan administratif, les temps d'attente sont le reflet de l'intervalle entre la prise de décision de traiter et la chirurgie elle-même. Toutefois, cette mesure ne tient pas toujours compte du temps total d'attente d'un patient pour son traitement. Plusieurs facteurs peuvent prolonger l'attente dans le cas d'une chirurgie pour le cancer du côlon. Nous avons voulu mesurer le temps écoulé entre la date de la consultation en chirurgie et la date de la chirurgie, et tout événement à l'intérieur de cet intervalle susceptible de prolonger les délais.Méthodes : Nous avons passé en revue de façon rétrospective le cas de tous les patients adultes ontariens âgés de 18 à 80 ans porteurs d'un diagnostic de cancer du côlon qui n'ont pas reçu de traitement néo-adjuvant et qui ont subi une résection non urgente entre le 1er janvier 2002 et le 31 décembre 2009. Les temps d'attente ont été mesurés entre la date de la consultation en chirurgie et la date de la chirurgie elle-même. Nous avons choisi un temps d'attente de 28 jours qui reflète les objectifs administratifs locaux comme valeur comparative. Nous avons effectué des analyses univariées et multivariées pour faire ressortir les facteurs qui contribuent à des périodes d'attente de plus de 28 jours. Les variables ont été analysées selon des modèles de régression linéaire et logistique continue.Résultats : Nous avons inclus 10 223 patients dans notre étude. Le temps d...

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

“…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).…”

“…A systematic review collating studies to 2003 found rural residence was associated with longer time from first symptom to presentation and PCP referral for colorectal cancer (16). However, more recent research from Scotland and Canada is equivocal (17)(18)(19)(20). In Australia, only two studies report diagnostic intervals for rural patients with colorectal and breast cancer (11,21,22).…”

Barriers to colonoscopy in remote northern Canada: an analysis of cancellations

“…Studies in other regions, have shown Indigenous individuals to experience disparities in access to colonoscopy when compared to non-Indigenous residents [11,12]. To date, studies have found rural residents experience delays in colonoscopy access in Ontario (Canada) and Western Australia [13,14]. However, no studies have assessed colonoscopy access in northern Canada or specifically the impact of cancellations on access to care.…”

Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada

“…The second leading cause of cancer death in North America, its prognosis can be excellent with early diagnosis and treatment [ 14 – 17 ]. Colon cancer screening and investigative technologies as well as surgical and systemic treatments that matter in terms of survival have proliferated in Canada [ 18 – 22 ] and the USA [ 23 – 30 ] with moderate to strong inverse socioeconomic associations in the USA, but modest to nil or null ones in Canada. Community PCP supply has been associated with earlier diagnosis as well as better treatment and survival in both countries [ 13 , 31 , 32 ].…”