Digestive Diseases and Sciences

, Volume 55, Issue 5, pp 1434–1441 | Cite as

Determinants of Medical System Delay in the Diagnosis of Colorectal Cancer Within the Veteran Affairs Health System

  • Deborah A. Fisher
  • Leah L. Zullig
  • Steven C. Grambow
  • David H. Abbott
  • Robert S. Sandler
  • Robert H. Fletcher
  • Hashem B. El-Serag
  • Dawn Provenzale
Original Article


Background and Aims

The goals of this study are to evaluate determinants of the time in the medical system until a colorectal cancer diagnosis and to explore characteristics associated with stage at diagnosis.


We examined medical records and survey data for 468 patients with colorectal cancer at 15 Veterans Affairs medical centers. Patients were classified as screen-detected, bleeding-detected, or other (resulting from the evaluation of another medical concern). Patients who presented emergently with obstruction or perforation were excluded. We used Cox proportional hazards models to determine predictors of time in the medical system until diagnosis. Logistic regression models were used to determine predictors of stage at diagnosis.


We excluded 21 subjects who presented emergently, leaving 447 subjects; the mean age was 67 years and 98% were male, 66% Caucasian, and 43% stage I or II. Diagnosis was by screening for 39%, bleeding symptoms for 27%, and other for 34%. The median times to diagnosis were 73–91 days and were not significantly different by diagnostic category. In the multivariable model for time to diagnosis, older age, having comorbidities, and Atlantic region were associated with a longer time to diagnosis. In the multivariable model for stage-at-diagnosis, only the diagnostic category was associated with stage; the screen-detected category was associated with decreased risk of late-stage cancer.


Our results point to several factors associated with a longer time from the initial clinical event until diagnosis. This increased time in the health care system did not clearly translate into more advanced disease at diagnosis.


Colorectal neoplasms Diagnosis Delay Screening 



The work of the CanCORS consortium was supported by grants from the National Cancer Institute to the Statistical Coordinating Center (U01 CA093344) and the NCI supported Primary Data Collection and Research Centers (Dana-Farber Cancer Institute/Cancer Research Network U01 CA093332, Harvard Medical School/Northern California Cancer Center. U01 CA093324, RAND/UCLA U01 CA093348, University of Alabama at Birmingham. U01 CA093329, University of Iowa U01 CA.01013, University of North Carolina. U01CA 093326) and by a Department of Veteran’s Affairs grant to the Durham VA Medical Center CRS 02-164. Dr. Fisher was supported in part by a VA Health Services Research and Development Career Development Transition Award (RCD 03-174). Dr. Provenzale was supported in part by an NIH K24 grant 5 K24 DK002926.


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Copyright information

© US Government 2010

Authors and Affiliations

  • Deborah A. Fisher
    • 1
    • 2
  • Leah L. Zullig
    • 1
  • Steven C. Grambow
    • 1
    • 3
  • David H. Abbott
    • 1
  • Robert S. Sandler
    • 4
  • Robert H. Fletcher
    • 5
  • Hashem B. El-Serag
    • 6
  • Dawn Provenzale
    • 1
    • 2
  1. 1.Health Services Research and Development, Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamUSA
  2. 2.Division of Gastroenterology, Department of MedicineDuke University Medical CenterDurhamUSA
  3. 3.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  4. 4.Division of Gastroenterology and HepatologyUniversity of North CarolinaChapel HillUSA
  5. 5.Professor Emeritus, Department of Population MedicineHarvard Medical SchoolChapel HillUSA
  6. 6.Department of Medicine, Section of Gastroenterology and HepatologyMichael E DeBakey VA Medical Center & Baylor College of MedicineHoustonUSA

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