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Study Shows Wait Times for Treatment at VAMCs Have Increased for Veterans with Colorectal Cancer


BACKGROUND:
VA currently treats about 3% of cancers in the U.S., of which 11% are colon or rectal malignancies; yet, to date, no study has evaluated colorectal cancer wait times for Veterans being treated at cancer-treating VAMCs. This study examined treatment times from diagnosis to first-course therapy for Veterans with colorectal cancers, and assessed factors associated with prolonged wait times. Using data from VA's Central Cancer Registry (1998-2008), investigators identified 17,487 Veterans with colon or rectal cancers who underwent surgical resection at one of 124 cancer-treating VAMCs. To evaluate changes in treatment trends over time, four time periods were created based on roughly equal numbers of patients: 1998-2000, 2001-2003, 2004-2006, and 2007-2008. In addition to treatment times, investigators examined tumor characteristics (e.g., grade), surgical extent (e.g., total colectomy), and chemotherapy use. Patient demographics also were assessed.

FINDINGS:

  • For Veterans with colorectal cancers, wait times for treatment at VAMCs have significantly increased over time. For colon cancer, the median time to treatment increased by 68% over the study period, while the median time to treatment for rectal cancer increased by 74%.
  • Among Veterans undergoing resection for colon cancer, the overall median time to treatment was 27 days, which increased from 19 (1998-2000) to 32 median days (2007-2008). Among Veterans with rectal cancer undergoing resection, the overall median time to treatment was 39 days, which increased from 27 (1998-2000) to 47 median days (2007-2008).
  • The strongest factors associated with prolonged time to colectomy (>45 days) were patient age >75 years, year of diagnosis (2007-2008), treatment at a high-volume VAMC, and diagnosis and treatment at different facilities vs. the same VAMC. Predictors for prolonged time to first course of therapy for Veterans with rectal cancer were similar.
  • Compared to Veterans with colon cancer, Veterans with rectal cancer had substantially longer wait times across every tumor, treatment, and hospital characteristic. The authors suggest this may be a result of the multi-modality diagnostic and treatment planning requirements for this type of cancer.

LIMITATIONS:

  • This was a retrospective observational study, thus investigators were only able to detect associations and were unable to control for unmeasured confounding factors.
  • This study did not evaluate whether or not prolonged wait times influenced short-term or long-term outcomes.
  • Data are 5 years old and may not reflect most recent efforts to reduce waiting times in CRC.

AUTHOR/FUNDING INFORMATION:
Dr. Bentrem was supported by an HSR&D Career Development Award; he and Dr. Gordon are part of HSR&D's Center for Management of Complex Chronic Care in Hines, IL.


PubMed Logo Merkow R, Bilimoria K, Sherman K, McCarter M, Gordon H, and Bentrem D. Efficiency of Colorectal Cancer Care among Veterans: Analysis of Treatment Wait Times for 124 Veterans Affairs Medical Centers. Journal of Oncology Practice July 2013;9(4):e154-163.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.