Efficiency of colorectal cancer care among veterans: analysis of treatment wait times at Veterans Affairs Medical Centers.
OBJECTIVE
Timeliness of cancer treatment is an important aspect of health care quality. Veterans Affairs Medical Centers (VAMCs) are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon and rectal cancers and assess factors associated with prolonged wait times.


METHODS
From the VA Central Cancer Registry, patients who underwent colon or rectal resection for cancer from 1998 to 2008 were identified. Time from diagnosis to definitive cancer-directed therapy was measured, and multivariable regression methods were used to determine predictors of prolonged wait times for colon (≥ 45 days) and rectal (≥ 60 days) cancers.


RESULTS
From 124 VAMCs, 14,097 patients underwent colectomy, and 3,390 underwent rectal resection for cancer. For colon cancer, the median time to treatment increased by 68% over time (P < .001). From 2007 to 2008, the median time to colectomy was 32 days. Predictors of prolonged wait times included age ≥ 55 years (v < 55 years), time period (2007 to 2008 v 1998 to 2000), black race (v white), marriage status (married v unmarried), high-volume center status (v low volume), and treatment at a different hospital (v same hospital as initial diagnosis; all P < .05). For rectal cancer, the overall median time to first-course treatment increased by 74% (P < .001). From 2007 to 2008, the median time to proctectomy was 47 days. Similar predictors of prolonged wait times were identified for rectal cancer.


CONCLUSIONS
Time to first treatment has increased for patients with colon and rectal cancers at VAMCs. Patient, tumor, and hospital factors are associated with prolonged time to treatment.
Feinberg School of Medicine, Northwestern University; Jesse Brown Veterans Affairs (VA) Medical Center; VA Center for Management of Complex Chronic Care; University of Illinois at Chicago College of Medicine, Chicago, IL; University of Colorado Denver, Anschutz Medical Campus, Aurora; and Denver VA Medical Center, Denver, CO.
Ryan P
RP
Merkow
Karl Y
KY
Bilimoria
Karen L
KL
Sherman
Martin D
MD
McCarter
Howard S
HS
Gordon
David J
DJ
Bentrem
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D003695:Delivery of Health Care / Q000592:standards*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D062606:Tertiary Care Centers / Q000592:standards*; D013997:Time Factors; D061665:Time-to-Treatment; D014728:Veterans