Do diagnostic and treatment delays for colorectal cancer increase risk of death?
- 443 Downloads
Using 1998–2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death.
We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days). Cases (CRC deaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors.
Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancer patients with the longest diagnostic delays (8–12 months vs. 14–59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08–1.58), but not CRC-specific death. Colon cancer patients with the shortest treatment delays (<1 vs. 1–2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01–1.49), but not CRC-specific death. Among rectal cancer patients, delays were not associated with risk of all-cause or CRC-specific death.
Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.
KeywordsColorectal cancer Delayed diagnosis Time factors Outcomes Survival SEER-medicare
We gratefully acknowledge James Struthers for his data management and programming services. We thank Margie Olsen, PhD and Jean Wang, MD for their assistance and helpful advice and Leah Akers and Chris Davenport for their help with medical coding. We also thank the Center for Administrative Data Research of the Institute of Clinical and Translational Sciences and the Alvin J. Siteman Cancer’s Health Behavior, Communications, and Outreach Core at the Washington University School of Medicine. This work was supported by grants from the National Cancer Institute (CA112159); the National Center for Research Resources Washington University-ICTS (KL2 RR024994); and the Health Behavior, Communication and Outreach Core; the Core is supported in part by the National Cancer Institute Cancer Center Support Grant (P30 CA91842) to the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. NOD was supported by grants DK-56260, HL-38180, and DDRCC DK-52574. This study used the linked SEER-Medicare database. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. Contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.
- 1.American Cancer Society Cancer Facts and Figures (2012) http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf. Accessed on 27 July 2012
- 4.Centers for Disease Control and Prevention (CDC) (2011) Vital signs: colorectal cancer screening, incidence, and mortality—United States, 2002–2010. MMWR Morb Mortal Wkly Rep 60(26):884–889Google Scholar
- 8.Terhaar sive Droste JS, Oort FA, van der Hulst RW, Coupe VM, Craanen ME, Meijer GA, Morsink LM, Visser O, van Wanrooij RL, Mulder CJ (2010) Does delay in diagnosing colorectal cancer in symptomatic patients affect tumor stage and survival? A population-based observational study. BMC Cancer 10:332Google Scholar
- 17.Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8):IV-3-18Google Scholar
- 18.Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BKe (eds)SEER cancer statistics review, 1975–2007, National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web site, 2010
- 28.Hu C, Xing Y, Cormier JN, Chang GJ (2009) The validity of cause of death coding within the Surveillance, Epidemiology, and End Results (SEER) Registry. J Clin Oncol 27(15s):6544Google Scholar
- 31.Taylor M, Turner D, Latosinsky S, Noseworthy T (2005) Determining acceptable waiting times for the surgical treatment of solid organ malignancies—a systematic review. http://www.cancercare.mb.ca/cancercare_resources/EPI/pdfs/CIHR_WaitTime_Report2_111005.pdf. Accessed 17 Nov 2011. Toward Canadian benchmarks for health services wait times? Evidence, application and research priorities (Report 2)
- 33.Jellema P, van der Windt DA, Bruinvels DJ, Mallen CD, van Weyenberg SJ, Mulder CJ, de Vet HC Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis. BMJ 340:c1269Google Scholar
- 35.Fisher DA, Grubber JM, Castor JM Coffman CJ (2010) Ascertainment of colonoscopy indication using administrative data. Dig Dis Sci 55(6):1721–1725Google Scholar
- 36.American Medical Association (2001) Physicians’ current procedural terminology CPT 2002. American Medical Association, ChicagoGoogle Scholar
- 42.National Cancer Institute SEER-Medicare: Calculation of comorbidity weights. http://healthservices.cancer.gov/seermedicare/program/comorbidity.html. Accessed on 18 July 2011
- 44.Iacus SM, King G, Porro G (2011) Multivariate matching methods that are monotonic imbalance bounding. Avail at http://gking.harvard.edu/files/abs/cem-math-abs.shtml. J Am Stat Assoc 106:345–361Google Scholar
- 45.Iacus SM, King G, Porro G (2011) Causal inference without balance checking: coarsened exact matching. Avail at http://gking.harvard.edu/files/abs/cem-plus-abs.shtml
- 46.Institute of Medicine Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DC. Available at http://books.nap.edu/catalog.php?record_id=10027
- 47.Patwardhan MB, Samsa GP, McCrory DC, Fisher DA, Mantyh CR, Morse MA, Prosnitz RG, Cline KE, Gray RN (2006) Cancer care quality measures: diagnosis and treatment of colorectal cancer. Evidence report/technology assessment no. 138. (Prepared by the Duke Evidence based Practice Center under Contract No. 290-02-0025.) AHRQ Publication No. 06-E002. Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar
- 48.Department of Health (2000) Referral guidelines for suspected cancer. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4014421.pdf. Accessed 30 Nov 2011
- 49.Department of Health The NHS cancer plan. http://www.thh.nhs.uk/documents/_Departments/Cancer/NHSCancerPlan.pdf Accessed 29 Nov 2011
- 51.Singh H, De Coster C, Shu E, Fradette K, Latosinsky S, Pitz M, Cheang M, Turner D (2010) Wait times from presentation to treatment for colorectal cancer: a population-based study. Can J Gastroenterol 24 (1):33–39Google Scholar
- 53.Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, Woolf SH, Glick SN, Ganiats TG, Bond JH, Rosen L, Zapka JG, Olsen SJ, Giardiello FM, Sisk JE, Van Antwerp R, Brown-Davis C, Marciniak DA, Mayer RJ (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112(2):594–642PubMedCrossRefGoogle Scholar
- 60.Hu CY, Delclos GL, Chan W, Du XL (2010) Assessing the initiation and completion of adjuvant chemotherapy in a large nationwide and population-based cohort of elderly patients with stage-III colon cancer. Med Oncol 28(4):1062–1074Google Scholar