Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study

Abstract

OBJECTIVES: To investigate key patient clinical and demographic characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer (CRC) patients. This will add to the little published research examining the pathway following CRC diagnosis and prior to surgery. DESIGN: Retrospective cohort analysis of linked data. SETTING: A population-based sample of people diagnosed August 2004 to December 2007 in New South Wales, Australia. PARTICIPANTS: 569 CRC patients, of whom 407 (72%, 95% CI 68% to 75%) had colonoscopy followed by surgery. PRIMARY OUTCOME MEASURES: Time between colonoscopy and surgery, and whether the surgery took place in a specialist cancer centre. RESULTS: Among the 407 eligible patients analysed, the median time from colonoscopy to surgery was 19 days (IQR 12-29 days). After adjusting for key demographic and clinical characteristics such as age and disease stage, the time was longer for rectal cancer patients and those reporting fair/poor health, although differences in medians were <5 days. 24% (95% CI 20% to 28%) had surgery in a specialist cancer centre, which was more common among people resident in metropolitan areas (37% vs 14% for others, adjusted p=0.001) and those without private health insurance (30% vs 21% for others, adjusted p=0.03). CONCLUSIONS: There do not appear to be systemic issues affecting time from colonoscopy to surgery related to patients' socio-demographic characteristics. However, patients with private insurance and those living in rural areas may be less likely to receive optimal specialist treatment. A more systematic approach might be needed to ensure cancer patients are treated in specialist cancer centres, particularly patients requiring more specialised treatment