title: Guidelines-based diagnostic process does increase hospital delay in a cohort of colorectal cancer patients: a population-based study.
abstract: This is an investigation of factors determining hospital delay until treatment in an unrestricted population of colorectal cancer patients in the western part of the Netherlands. All patients with newly diagnosed colon (n=2146) and rectal carcinoma (n=1036) in the period 2006-2008 were included in analyses of inhospital delay (first hospital visit until first treatment >35 days). One-third of all patients were also available for analyses of prehospital delay (enrollment until first hospital visit >7 days). Patient, tumour and process factors predicting delay were examined in logistic regression models. The median prehospital and inhospital time intervals were 2 days [(p25-p75) 0-16] and 32 days (17-49), respectively, for colon cancer patients and 7 days (1-21) and 43 days (33-60) for rectal cancer patients. After adjustment for patient and tumour factors, colon and rectal cancer patients with first hospital visit before histological confirmation of cancer, complete diagnostic assessment or discussed in a multidisciplinary meeting had a higher probability of increased inhospital delay. Furthermore, first hospital visit before histological confirmation of cancer was associated with decreased prehospital delay in colon and rectal cancer patients. A guidelines-based diagnostic process (considered high quality of care) and multidisciplinary collaboration were associated with increased hospital delay in colorectal cancer patients.
authors.affiliation: aComprehensive Cancer Centre the Netherlands (IKNL), Utrecht bHaga Hospital, Department of Surgery cRadiotherapy Centre West, The Hague dDiaconessenhuis, Department of Internal Medicine Departments of eClinical Oncology fSurgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Lydia G M
authors.initials: LG
authors.lastname: van der Geest
authors.forename: Marloes A G
authors.initials: MA
authors.lastname: Elferink
authors.forename: Willem Hans
authors.initials: WH
authors.lastname: Steup
authors.forename: Anne M C
authors.initials: AM
authors.lastname: Witte
authors.forename: Johan W R
authors.initials: JW
authors.lastname: Nortier
authors.forename: Rob A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: Henk
authors.initials: H
authors.lastname: Struikmans
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003953:Diagnosis-Related Groups; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*