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. 2020 Jul 17;9(3):e15911.
doi: 10.2196/15911.

Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study

Ahmed Abdulaal  1 , Chanpreet Arhi  1 , Paul Ziprin  1
Affiliations

Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study

Ahmed Abdulaal et al. Interact J Med Res. .

Abstract

Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays.

Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival.

Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences.

Results: A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis.

Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

Keywords: cancer; colorectal; delay; surgery.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The algorithm used for patient inclusion. CRC: colorectal cancer; GI, gastrointestinal.
Figure 2
Figure 2
Representation of the delays and delay subdivisions considered for the analysis. T1: diagnostic delay; T1a: delay from referral based on symptoms to receipt of referral; T1b: referral delay; T1c: delay between hospital appointment and diagnosis; T2: treatment delay; T2a: delay between diagnosis and multidisciplinary team (MDT) meeting date; T2b: considered for those patients who received a surgical intervention; Ttotal: total delay from referral to surgery or treatment.
Figure 3
Figure 3
Kaplan-Meier plot illustrating the survival function by diagnostic delay quartile with time.
Figure 4
Figure 4
Kaplan-Meier plot illustrating the survival function by treatment delay quartile with time.
Figure 5
Figure 5
Kaplan-Meier plot illustrating the survival function by diagnostic delay quartile with time.
Figure 6
Figure 6
Kaplan-Meier plot illustrating the survival function by treatment delay quartile with time.
See this image and copyright information in PMC

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