title: Patterns of health care utilization preceding a colorectal cancer diagnosis are strong predictors of dying quickly following diagnosis.
abstract: BACKGROUND
  Understanding the predictors of a quick death following diagnosis may improve timely access to palliative care. The objective of this study was to explore whether factors in the 24 months prior to a colorectal cancer (CRC) diagnosis predict a quick death post-diagnosis.
  
  
  METHODS
  Data were from a longitudinal study of all adult persons diagnosed with CRC in Nova Scotia, Canada, from 01Jan2001-31Dec2005. This study included all persons who died of any cause by 31Dec2010, except those who died within 30 days of CRC surgery (n = 1885 decedents). Classification and regression tree models were used to explore predictors of time from diagnosis to death for the following time intervals: 2, 4, 6, 8, 12, and 26 weeks from diagnosis to death. All models were performed with and without stage at diagnosis as a predictor variable. Clinico-demographic and health service utilization data in the 24 months pre-diagnosis were provided via linked administrative databases.
  
  
  RESULTS
  The strongest, most consistent predictors of dying within 2, 4, 6, and 8 weeks of CRC diagnosis were related to health services utilization in the 24 months prior to diagnosis: i.e., number of specialist visits, number of days spent in hospital, and number of family physician visits. Stage at diagnosis was the strongest predictor of dying within 12 and 26 weeks of diagnosis.
  
  
  CONCLUSIONS
  Identifying potential predictors of a short timeframe between cancer diagnosis and death may aid in the development of strategies to facilitate timely and appropriate referral to palliative care upon a cancer diagnosis.
authors: Department of Surgery, Dalhousie University, Halifax, NS Canada ; Cancer Outcomes Research Program, Dalhousie University/Capital District Health Authority, Halifax, NS Canada.
authors: Robin
authors: R
authors: Urquhart
authors: School of Health Administration, Dalhousie University, Halifax, NS Canada.
authors: Grace
authors: G
authors: Johnston
authors: Department of Diagnostic Radiology, Dalhousie University, Halifax, NS Canada.
authors: Mohamed
authors: M
authors: Abdolell
authors: Department of Surgery, Dalhousie University, Halifax, NS Canada ; Cancer Outcomes Research Program, Dalhousie University/Capital District Health Authority, Halifax, NS Canada.
authors: Geoff A
authors: GA
authors: Porter
keywords: Delivery of health care; Diagnosis; Digestive system neoplasms; Palliative care