title: Location and timing of care for colon cancer patients in the VA Health System.
abstract: BACKGROUND
  We sought to identify colon cancer patients within the Veterans Affairs (VA) system who experienced lengthy wait times for surgery or chemotherapy. We looked specifically at the relationship between location of treatment and timing of care.
  
  
  METHODS
  We performed a retrospective cohort study of 4635 patients diagnosed with colon cancer in the VA Health System during 2002-2010 and treated with surgery followed by chemotherapy. We used VA administrative databases, including the VA Outpatient Clinic, Patient Treatment, and Fee Basis inpatient and outpatient files. Time from diagnosis to surgery and time from surgery to initiation of chemotherapy were the primary outcome measures.
  
  
  RESULTS
  Patients who required referral to a hospital different from their home VA facility for surgery experienced delays in surgical intervention compared with patients treated at their home VA medical center. For patients referred outside of the VA system, this delay was almost 2 wk (13.5 d, P < 0.001). When these patients then went to another hospital for chemotherapy, they experienced further delays in care. Patients treated surgically outside the VA system who returned to the VA system for chemotherapy were more likely to initiate chemo >8 wk following surgery (OR 1.69, P = 0.01). The average adjusted time from surgery to chemotherapy for these patients compared with those treated wholly within the VA system was 11.4 d (P = 0.003).
  
  
  CONCLUSIONS
  VA patients who require treatment at multiple hospitals for colon cancer, especially those who require surgery outside of the VA system, are more likely to experience delays in care compared with patients treated at a single hospital.
authors.affiliation: Veterans Affairs Medical Center, Philadelphia, PA 19104, USA. ecp6z@yahoo.com
authors.forename: Emily Carter
authors.initials: EC
authors.lastname: Paulson
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Fu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000628:therapy*; D003107:Colorectal Surgery; D003131:Combined Modality Therapy; D004358:Drug Therapy; D005260:Female; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000706:statistics & numerical data*; D014850:Waiting Lists
keywords: Cancer treatment; Colonic neoplasms; Coordination of care; Veteran's Health Administration