Examining patterns of and reasons for delays to treatment in colon cancer

Autor: Jiyue Qin, Jacob B Schriner, Adam Kopp, Haejin In, Patricia Friedmann, Vanessa Arientyl, Ali Kalam
Rok vydání: 2021
Předmět:
Zdroj: Journal of Clinical Oncology. 39:52-52
ISSN: 1527-7755
0732-183X
Popis: 52 Background: Delays in colon cancer (CC) treatment can impact patient outcomes. Detailed examination into the patterns and reasons for delay in the diagnostic and pre-treatment work up are understudied, hindering the development of strategies to improve timeliness of care. Methods: CC patients diagnosed at an urban academic institution in 2018 were investigated. Chart review yielded presentation location, diagnostic-work up, treatment and patient characteristics. Time between presentation to the healthcare provider to treatment initiation of ≥ 60 days was considered a delay (Total_Delay). Total time further examined as 3 phases: presentation to diagnosis (PtoD), diagnosis to staging completion (DtoS), and staging completion to treatment (StoT). Delays for each phase was defined as ≥ 30 days. Total_Lt60d vs non-Total_Ge60d were compared. A logistic regression model was used to calculate odds ratio (OR) and 95% confidence intervals (CI) to identify associations with Total_Ge60d. Results: Among 121 CC patients, the median time and interquartile range (IQR) between presentation and treatment initiation was 29 (IQR 8, 53) days. Total_Delay occurred in 21% of patients. The median time between presentation and treatment and interquartile range (IQR) for Total_Delay was 106 (IQR 82, 162) and 16 (IQR 6, 39) for non-Total_Delay. Age, sex, race, and comorbidities were similar between Total_Delay and non-Total_Delay. Total_Delay patients were generally more functionally independent (92% vs 74%, p < .06), presented to locations other than the emergency department (64% vs 42%, p < .075) and were less likely to have hospital admission work-up (20% vs 60%, p < .001) compared to non-Total_Delay. The logistic model showed that Total_Delay is associated with non-hospital work-up (OR 8.3, 95% CI 1.9-45.3), adjusting for comorbidities, symptoms, functional status, cancer severity, and insurance. Delays similarly occurred in all three phases for Total_Delay patients; 48% had delay during PtoD, 60% during DtoS, and 48% during StoT. The most common reason for delay by phase was the following; in the PtoD phase, 5 of 11 (46%) was due to obtaining endoscopy, in DtoS and StoT, 6 of 15 (40%) and 5 of 11 (46%), respectively, was in getting outpatient specialty appointments. Delays due to patient factors (PtoD 18%, DtoS 27%, StoT 28%) were less frequent. Conclusions: Delays to treatment for CC are largely driven by health systems delays. Bundling of diagnostic evaluation and pre-treatment that mimics work-up during a hospital admission may overcome delays in cancer care.
Databáze: OpenAIRE
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