Time to Endoscopy in Patients with Colorectal Cancer: Analysis of Wait-Times

Renée M Janssen, Oliver Takach, Estello Nap-Hill, Robert A Enns, Renée M Janssen, Oliver Takach, Estello Nap-Hill, Robert A Enns

Abstract

Objective. The Canadian Association of Gastroenterology Wait Time Consensus Group recommends that patients with symptoms associated with colorectal cancer (CRC) should have an endoscopic examination within 2 months. However, in a recent survey of Canadian gastroenterologists, wait-times for endoscopy were considerably longer than the current guidelines recommend. The purpose of this study was to evaluate wait-times for colonoscopy in patients who were subsequently found to have CRC through the Division of Gastroenterology at St. Paul's Hospital (SPH). Methods. This study was a retrospective chart review of outpatients seen for consultation and endoscopy ultimately diagnosed with CRC. Subjects were identified through the SPH pathology database for the inclusion period 2010 through 2013. Data collected included wait-times, subject characteristics, cancer characteristics, and outcomes. Results. 246 subjects met inclusion criteria for this study. The mean wait-time from primary care referral to first office visit was 63 days; the mean wait-time to first endoscopy was 94 days. Patients with symptoms waited a mean of 86 days to first endoscopy, considerably longer than the national recommended guideline of 60 days. There was no apparent effect of length of wait-time on node positivity or presence of distant metastases at the time of diagnosis. Conclusion. Wait-times for outpatient consultation and endoscopic evaluation at the St. Paul's Hospital Division of Gastroenterology exceed current guidelines.

Figures

Figure 1
Figure 1
A frequency histogram of wait-time in days from receipt of referral to endoscopy in all included subjects (N = 246) is shown in the figure. Wait-times are shown in 30-day intervals with the exception of the last bar (241–450 days). The 60-day benchmark appears as a vertical line at the 60-day mark. 102 of 246 subjects (41%) had their first endoscopic procedure within 60 days; wait-times ranged from 1 to 428 days.

References

    1. Canadian Cancer Society's Advisory. Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Canadian Cancer Society; 2013. .
    1. Wilschut J. A., Habbema J. D. F., Ramsey S. D., Boer R., Looman C. W. N., van Ballegooijen M. Increased risk of adenomas in individuals with a family history of colorectal cancer: results of a meta-analysis. Cancer Causes and Control. 2010;21(12):2287–2293. doi: 10.1007/s10552-010-9654-y.
    1. Paterson W. G., Depew W. T., Paré P., et al. Canadian consensus on medically acceptable wait times for digestive health care. Canadian Journal of Gastroenterology. 2006;20(6):411–423. doi: 10.1155/2006/343686.
    1. Singh H., De Coster C., Shu E., et al. Wait times from presentation to treatment for colorectal cancer: a population-based study. Canadian Journal of Gastroenterology. 2010;24(1):33–39. doi: 10.1155/2010/692151.
    1. Leddin D., Armstrong D., Borgaonkar M., et al. The 2012 SAGE wait times program: Survey of Access to Gastroenterology in Canada. Canadian Journal of Gastroenterology. 2013;27(2):83–89. doi: 10.1155/2013/143018.
    1. Duff S. E., Wood C., McCredie V., Levine E., Saunders M. P., O'Dwyer S. T. Waiting times for treatment of rectal cancer in North West England. Journal of the Royal Society of Medicine. 2004;97(3):117–118. doi: 10.1258/jrsm.97.3.117.
    1. Robertson R., Campbell N. C., Smith S., et al. Factors influencing time from presentation to treatment of colorectal and breast cancer in urban and rural areas. British Journal of Cancer. 2004;90(8):1479–1485. doi: 10.1038/sj.bjc.6601753.
    1. Gillis A., Dixon M., Smith A., Law C., Coburn N. G. A patient-centred approach toward surgical wait-times for colon cancer: a population-based analysis. Canadian Journal of Surgery. 2014;57(2):94–100. doi: 10.1503/cjs.026512.
    1. Arbman G., Nilsson E., Störgren-Fordell V., Sjödahl R. A short diagnostic delay is more important for rectal cancer than for colonic cancer. European Journal of Surgery. 1996;162(11):899–904.
    1. Korsgaard M., Pedersen L., Sørensen H. T., Laurberg S. Delay of treatment is associated with advanced stage of rectal cancer but not of colon cancer. Cancer Detection and Prevention. 2006;30(4):341–346. doi: 10.1016/j.cdp.2006.07.001.
    1. Ramos M., Esteva M., Cabeza E., Llobera J., Ruiz A. Lack of association between diagnostic and therapeutic delay and stage of colorectal cancer. European Journal of Cancer. 2008;44(4):510–521. doi: 10.1016/j.ejca.2008.01.011.
    1. Roncoroni L., Pietra N., Violi V., Sarli L., Choua O., Peracchia A. Delay in the diagnosis and outcome of colorectal cancer: a prospective study. European Journal of Surgical Oncology. 1999;25(2):173–178. doi: 10.1053/ejso.1998.0622.
    1. Korsgaard M., Pedersen L., Sørensen H. T., Laurberg S. Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark. Colorectal Disease. 2006;8(8):688–695. doi: 10.1111/j.1463-1318.2006.01014.x.
    1. Tomlinson C., Wong C., Au H.-J., Schiller D. Factors associated with delays to medical assessment and diagnosis for patients with colorectal cancer. Canadian Family Physician. 2012;58(9):e495–e501.

Source: PubMed

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