title: Time to first treatment after colonoscopy in patients suffering from colon or rectum cancer in France.
abstract: BACKGROUND
  Time to treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays.
  
  
  OBJECTIVE
  To describe indicators of time to first treatment after colonoscopy in colon cancer (CC) and rectum cancer (RC) patients in France.
  
  
  METHODS
  Using the international classification of diseases and medical procedures codes, from national hospital discharge and long term illness databases we selected patients newly diagnosed for CC or RC in 2009-2010 who had undergone treatment.
  
  
  RESULTS
  We included 15 694 and 6 623 patients for CC and RC, respectively. Median times to surgery in patients with a surgical treatment pathway for CC and RC were 22 (Q1=14; Q3=34) and 97 (Q1=34; Q3=141) days, respectively. Median times to chemotherapy for patients with a non-surgical treatment pathway, for CC and RC were 36 (Q1=21; Q3=59) and 40 (Q1=27; Q3=59) days, respectively. The median time to radiotherapy in RC patients was 53 (Q1=39; Q3=78) days.Time to surgery as first treatment in RC patients (46 days) was twice as long as that in CC patients (22 days). Time to treatment was longer in most northern regions and in overseas districts, and shorter in southern regions, for both CC and RC.
  
  
  CONCLUSIONS
  The findings in this unprecedented study in France will inform decision-making policies on the future implementation of guidelines on timeframes for colorectal cancer treatment access.
authors.affiliation: Institut de veille sanitaire, département des maladies chroniques et traumatismes, 12, rue du Val d'Osne, 94414 Saint-Maurice, France. Electronic address: y.kudjawu@invs.sante.fr.
authors.forename: Yao Cyril
authors.initials: YC
authors.lastname: Kudjawu
authors.affiliation: Institut de veille sanitaire, direction scientifique et de la qualité, 12, rue du Val d'Osne, 94414 Saint-Maurice, France. Electronic address: d.eilstein@invs.sante.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eilstein
authors.affiliation: Institut de veille sanitaire, département des maladies chroniques et traumatismes, 12, rue du Val d'Osne, 94414 Saint-Maurice, France. Electronic address: e.decool@invs.sante.fr.
authors.forename: Elsa
authors.initials: E
authors.lastname: Decool
authors.affiliation: Institut de veille sanitaire, département des maladies chroniques et traumatismes, 12, rue du Val d'Osne, 94414 Saint-Maurice, France. Electronic address: f.demaria@invs.sante.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: De Maria
authors.affiliation: Institut de veille sanitaire, département des maladies chroniques et traumatismes, 12, rue du Val d'Osne, 94414 Saint-Maurice, France. Electronic address: n.beltzer@invs.sante.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Beltzer
authors.affiliation: Assistance Publique des Hôpitaux de Paris, Unité d'épidémiologie et de recherche clinique, Hôpital européen Georges Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France. Electronic address: gilles.chatellier@aphp.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
mesh_terms: D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Colon rectum cancer; Colonoscopy; Hospital discharge data; Time to treatment