Cancer Causes & Control

, Volume 24, Issue 5, pp 961–977 | Cite as

Do diagnostic and treatment delays for colorectal cancer increase risk of death?

  • Sandi L. Pruitt
  • Amy Jo Harzke
  • Nicholas O. Davidson
  • Mario Schootman
Original paper



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.


Colorectal 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.

Supplementary material

10552_2013_172_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Sandi L. Pruitt
    • 1
    • 2
  • Amy Jo Harzke
    • 3
  • Nicholas O. Davidson
    • 4
    • 5
  • Mario Schootman
    • 4
    • 6
  1. 1.Department of Clinical SciencesUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Harold C. Simmons Comprehensive Cancer CenterDallasUSA
  3. 3.Correctional Managed CareUniversity of Texas Medical BranchGalvestonUSA
  4. 4.Alvin J. Siteman Cancer Center at Barnes-Jewish HospitalWashington University School of MedicineSaint LouisUSA
  5. 5.Division of Gastroenterology, Department of MedicineWashington University School of MedicineSaint LouisUSA
  6. 6.Division of Health Behavior Research, Department of MedicineWashington University School of MedicineSaint LouisUSA

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