Treatment delays of colon cancer in a safety-net hospital system.
BACKGROUND
Disparities in colon cancer survival have been reported to result from advanced stage at diagnosis and delayed therapy. We hypothesized that delays in treatment among medically underserved patients occur as a result of system-level barriers in a safety-net hospital system.


METHODS
Retrospective review and analysis of colon cancer patients treated in a large safety-net hospital system between May 2008 and May 2012. Data were collected on demographics, stage at diagnosis, time to surgery, time to adjuvant chemotherapy, and vital status. Regression analyses were performed to determine predictors of delays and failure to receive therapy.


RESULTS
Of 248 patients treated for colon cancer, 56% (n = 140) had advanced disease at the time of presentation; furthermore, 29.1% of all colectomies for colon cancer were performed on an urgent or emergent basis. Thirty-six patients with stage III and IV disease did not receive chemotherapy (26%). Race, age, gender, and hospice care did not predict receipt of chemotherapy or delays to treatment. Patients with stage I colon cancer had a significantly longer interval between diagnosis and elective surgery when compared with patients with stage II, III, and IV colon cancer, with only 10% (n = 3) undergoing resection sooner than 6 wk after diagnosis.


CONCLUSIONS
One in three patients diagnosed with colon cancer in a large safety-net hospital system require urgent or emergent surgery, and one in two present with advanced disease. Reducing disparities should focus on earlier diagnosis of colon cancer and improving access to surgical specialists.
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas. Electronic address: stefanos.g.millas@uth.tmc.edu.
Stefanos G
SG
Millas
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Zeinab M
ZM
Alawadi
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Curtis J
CJ
Wray
Department of Surgery, Baylor College of Medicine, Houston, Texas.
Eric J
EJ
Silberfein
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Richard J
RJ
Escamilla
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Burzeen E
BE
Karanjawala
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Tien C
TC
Ko
Department of Surgery, University of Texas Medical School, LBJ General Hospital, Houston, Texas.
Lillian S
LS
Kao
D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D003110:Colonic Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D013997:Time Factors
Colon cancer; Disparities; Safety-net hospital system; Treatment delay