Do Delays in Diagnostic Colonoscopy Affect Colorectal Cancer Outcomes?
The demand for colonoscopy has increased, but limited capacity requires informed decision-making regarding setting screening priorities for colorectal cancer (CRC). Very few studies have addressed the issue of lag time between referral for colonoscopy and CRC diagnosis. Investigators in this retrospective cohort study of veterans with newly diagnosed CRC examined the lag time between referral and diagnosis of CRC – and the lag time between diagnosis and treatment. They also examined the relationship between these two lag periods with CRC stage at the time of diagnosis and survival rates. Veterans included in this study (n=289) were diagnosed with CRC between 1/00 and 6/05 at one VAMC in Houston, TX.
Findings show no meaningful association between mortality in veterans with CRC and lag times between referral for colonoscopy and CRC diagnosis for periods up to two-three months. In this study cohort, there was a 41-day median lag time between referral and diagnosis in veterans with CRC. Veterans with symptoms, abnormal labs or imaging studies had the shortest lag time between referral and diagnosis, as well as the most advanced cancer stage and shortest survival rates. The longest survival rates were found among veterans whose CRC was detected through CRC screening, mostly fecal occult blood tests.
Wattacheril J, Kramer J, Richardson P, Havemann B, Green L, Le A, and El-Serag H. Lagtimes in diagnosis and treatment of colorectal cancer: Determinants and association with cancer stage and survival. Alimentary Pharmacology & Therapeutics November 1, 2008;28(9):1166-1174.
Dr. El-Serag is part of HSR&D’s Houston Center for Quality of Care and Utilization Studies.