Benefits of a Well-Structured Diagnostic Process in Colon Cancer

Abstract

Introduction: Preoperative work-up in colorectal cancer is comprehensive and can be time consuming. In our institution, the preoperative track for colorectal patients was reorganized in order to reduce the therapeutic delay and the number of outpatient clinic visits. We assessed the impact upon the patient outcomes. Methods: All consecutive patients with colon cancer who entered the reorganized preoperative track between January 2008 and December 2009 (n = 87) were retrospectively compared with a consecutively diagnosed traditionally evaluated patient group diagnosed between January 2005 and December 2006 (n = 108). Time between diagnostic procedures and surgery as well as needed number of preoperative outpatient department visits were calculated. All rectal malignancies, patients who received preoperative chemotherapy and/or radiotherapy and patients who underwent emergency procedures were excluded from analysis. Results: Time between colonoscopy and surgery was reduced from [median (25–75%)] 44 (34–54) to 27 (21–34) days, p < 0.001. The number of outpatient department visits declined from 6 (5–7) to 3 (3–4), p < 0.001. Time between first diagnostic test and colonoscopy was reduced from 44 (11–68) to 9 days (0–30), p < 0.001. Time between first diagnostic test and operation was reduced from 85.5 (56–120.5) to 42 days (28–62), p < 0.001. Before the reorganizations, 7% of colonoscopies were ordered by GPs and went up afterwards to 60%. Conclusion: Reorganization of traditional logistic routes for patients diagnosed with colon cancer reduces therapeutic delay and improves care. Moreover, the surgeon, gastroenterologist and oncologist can focus on the oncologic patient and his/her family instead of having to perform administrative tasks.

A differentiated approach to referrals from general practice to support early cancer diagnosis – the Danish three-legged strategy

“…Studies indicate that the strategy can be both effective and efficient. A Dutch study of direct access to colonoscopy for abdominal symptoms showed reduced time to diagnosis and more efficient use of tests ( Klemann et al , 2011 ). This is supported by studies from the United Kingdom ( Maruthachalam et al , 2005 ; Ahmed et al , 2013 ).…”

Variation in Direct Access to Tests to Investigate Cancer: A Survey of English General Practitioners

“…Direct access to imaging and endoscopy has been shown to improve care in a number of countries. For example, a Dutch study has demonstrated that direct access colonoscopy reduces diagnostic delay and specialist workload without markedly increasing the volume of procedures done [ 8 ]. A Danish study has shown that direct access to CT Thorax did not increase test use but significantly reduced specialist time per patient and with high staff acceptability [ 9 ].…”

Impact of therapeutic delay in colorectal cancer on overall survival and cancer recurrence – is there a safe timeframe for prehabilitation?

“…After this day patients are discussed in a multidisciplinary team. Afterwards a second outpatient clinic visit is planned with the colorectal surgeon to discuss the definitive plan of surgery [15]. Importance of such a fast and well-structured diagnostic process has been shown in several studies stating that a longer therapeutic delay causes more psychological distress in oncology patients [15e18].…”