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.

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.