Do diagnostic and treatment delays for colorectal cancer increase risk of death?

Sandi L. Pruitt, Amy Jo Harzke, Nicholas O. Davidson, Mario Schootman

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background Using 1998-2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death. Methods We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days).Cases(CRCdeaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors. Results Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancer patients with the longest diagnostic delays (8-12 months vs. 14-59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08-1.58), but not CRC-specific death. Colon cancer patients with the shortest treatment delays (<1 vs. 1-2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01-1.49), but not CRCspecific death. Among rectal cancer patients, delays were not associated with risk of all-cause or CRC-specific death. Conclusions Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.

Original languageEnglish (US)
Pages (from-to)961-977
Number of pages17
JournalCancer Causes and Control
Volume24
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Colorectal Neoplasms
Colonic Neoplasms
Rectal Neoplasms
Therapeutics
Colon
Medicare
Logistic Models
Regression Analysis
Morbidity
Survival
Mortality
Incidence
Neoplasms

Keywords

  • Colorectal cancer
  • Delayed diagnosis
  • Outcomes
  • SEER-medicare
  • Survival
  • Time factors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Do diagnostic and treatment delays for colorectal cancer increase risk of death? / Pruitt, Sandi L.; Harzke, Amy Jo; Davidson, Nicholas O.; Schootman, Mario.

In: Cancer Causes and Control, Vol. 24, No. 5, 05.2013, p. 961-977.

Research output: Contribution to journalArticle

Pruitt, Sandi L. ; Harzke, Amy Jo ; Davidson, Nicholas O. ; Schootman, Mario. / Do diagnostic and treatment delays for colorectal cancer increase risk of death?. In: Cancer Causes and Control. 2013 ; Vol. 24, No. 5. pp. 961-977.
@article{33932e3c228f43939813bac108fe28b5,
title = "Do diagnostic and treatment delays for colorectal cancer increase risk of death?",
abstract = "Background Using 1998-2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death. Methods We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days).Cases(CRCdeaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors. Results Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancer patients with the longest diagnostic delays (8-12 months vs. 14-59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08-1.58), but not CRC-specific death. Colon cancer patients with the shortest treatment delays (<1 vs. 1-2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01-1.49), but not CRCspecific death. Among rectal cancer patients, delays were not associated with risk of all-cause or CRC-specific death. Conclusions Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.",
keywords = "Colorectal cancer, Delayed diagnosis, Outcomes, SEER-medicare, Survival, Time factors",
author = "Pruitt, {Sandi L.} and Harzke, {Amy Jo} and Davidson, {Nicholas O.} and Mario Schootman",
year = "2013",
month = "5",
doi = "10.1007/s10552-013-0172-6",
language = "English (US)",
volume = "24",
pages = "961--977",
journal = "Cancer Causes and Control",
issn = "0957-5243",
publisher = "Springer Netherlands",
number = "5",

}

TY - JOUR

T1 - Do diagnostic and treatment delays for colorectal cancer increase risk of death?

AU - Pruitt, Sandi L.

AU - Harzke, Amy Jo

AU - Davidson, Nicholas O.

AU - Schootman, Mario

PY - 2013/5

Y1 - 2013/5

N2 - Background Using 1998-2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death. Methods We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days).Cases(CRCdeaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors. Results Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancer patients with the longest diagnostic delays (8-12 months vs. 14-59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08-1.58), but not CRC-specific death. Colon cancer patients with the shortest treatment delays (<1 vs. 1-2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01-1.49), but not CRCspecific death. Among rectal cancer patients, delays were not associated with risk of all-cause or CRC-specific death. Conclusions Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.

AB - Background Using 1998-2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death. Methods We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days).Cases(CRCdeaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors. Results Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancer patients with the longest diagnostic delays (8-12 months vs. 14-59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08-1.58), but not CRC-specific death. Colon cancer patients with the shortest treatment delays (<1 vs. 1-2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01-1.49), but not CRCspecific death. Among rectal cancer patients, delays were not associated with risk of all-cause or CRC-specific death. Conclusions Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.

KW - Colorectal cancer

KW - Delayed diagnosis

KW - Outcomes

KW - SEER-medicare

KW - Survival

KW - Time factors

UR - http://www.scopus.com/inward/record.url?scp=84892818493&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892818493&partnerID=8YFLogxK

U2 - 10.1007/s10552-013-0172-6

DO - 10.1007/s10552-013-0172-6

M3 - Article

VL - 24

SP - 961

EP - 977

JO - Cancer Causes and Control

JF - Cancer Causes and Control

SN - 0957-5243

IS - 5

ER -