Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System.
OBJECTIVE
The goals of this study are to evaluate determinants of the time in the medical system until a colorectal cancer diagnosis and to explore characteristics associated with stage at diagnosis.


METHODS
We examined medical records and survey data for 468 patients with colorectal cancer at 15 Veterans Affairs medical centers. Patients were classified as screen-detected, bleeding-detected, or other (resulting from the evaluation of another medical concern). Patients who presented emergently with obstruction or perforation were excluded. We used Cox proportional hazards models to determine predictors of time in the medical system until diagnosis. Logistic regression models were used to determine predictors of stage at diagnosis.


RESULTS
We excluded 21 subjects who presented emergently, leaving 447 subjects; the mean age was 67 years and 98% were male, 66% Caucasian, and 43% stage I or II. Diagnosis was by screening for 39%, bleeding symptoms for 27%, and other for 34%. The median times to diagnosis were 73-91 days and were not significantly different by diagnostic category. In the multivariable model for time to diagnosis, older age, having comorbidities, and Atlantic region were associated with a longer time to diagnosis. In the multivariable model for stage-at-diagnosis, only the diagnostic category was associated with stage; the screen-detected category was associated with decreased risk of late-stage cancer.


CONCLUSIONS
Our results point to several factors associated with a longer time from the initial clinical event until diagnosis. This increased time in the health care system did not clearly translate into more advanced disease at diagnosis.
Fisher
Deborah A
DA
Health Services Research and Development, Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton Street 152, Durham, NC 27705, USA. Fishe034@mc.duke.edu
Zullig
Leah L
LL
Grambow
Steven C
SC
Abbott
David H
DH
Sandler
Robert S
RS
Fletcher
Robert H
RH
El-Serag
Hashem B
HB
Provenzale
Dawn
D
D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs