title: Lagtimes in diagnosis and treatment of colorectal cancer: determinants and association with cancer stage and survival.
abstract: BACKGROUND
  Lagtimes to diagnostic colonoscopy have been used as practice performance measures.
  
  
  OBJECTIVE
  To evaluate the duration, determinants and outcomes of lagtimes between referral for endoscopic evaluation and colorectal cancer (CRC) diagnosis.
  
  
  METHODS
  We examined the medical records of 289 patients with CRC and evaluated lagtimes, their potential determinants and their association with CRC stage at diagnosis as well as overall survival.
  
  
  RESULTS
  Median lag between referral and CRC diagnosis was 41 days (41.5% > 60 days, 30.1% > 90 days). The only significant predictor of lagtime was the initiating event for referral: abnormal symptom, laboratory test or imaging study was associated with shortest and presence of family history was associated with longest lagtimes respectively. Longer lagtimes were associated with lower mortality risk, but this was completely explained by earlier CRC stage. An analysis restricted to 100 patients referred for abnormal CRC screening tests found no association between duration of lag and CRC stage or mortality.
  
  
  CONCLUSIONS
  There seems to be no meaningful association between mortality in patients with CRC and lagtimes between referral for colonoscopy and CRC diagnosis for periods up to 2-3 months. On the contrary, longer lagtimes were inversely associated with CRC stage at the time of diagnosis.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wattacheril
authors.forename: J R
authors.initials: JR
authors.lastname: Kramer
authors.forename: P
authors.initials: P
authors.lastname: Richardson
authors.forename: B D
authors.initials: BD
authors.lastname: Havemann
authors.forename: L K
authors.initials: LK
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Le
authors.forename: H B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States