title: Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study.
abstract: Although it is well-known that early detection of colorectal cancer (CRC) is important for optimal patient survival, the relationship of patient and health system factors with delayed diagnosis are unclear. The purpose of this study was to identify the demographic, clinical and healthcare factors related to mode of CRC detection and length of the diagnostic interval.
  
  
  
  All residents of Alberta, Canada diagnosed with first-ever incident CRC in years 2004-2010 were identified from the Alberta Cancer Registry. Population-based administrative health datasets, including hospital discharge abstract, ambulatory care classification system and physician billing data, were used to identify healthcare services related to CRC diagnosis. The time to diagnosis was defined as the time from the first CRC-related healthcare visit to the date of CRC diagnosis. Mode of CRC detection was classified into three groups: urgent, screen-detected and symptomatic. Quantile regression was performed to assess factors associated with time to diagnosis.
  
  
  
  9626 patients were included in the study; 25% of patients presented as urgent, 32% were screen-detected and 43% were symptomatic. The median time to diagnosis for urgent, screen-detected and symptomatic patients were 6 days (interquartile range (IQR) 2-14 days), 74 days (IQR 36-183 days), 84 days (IQR 39-223 days), respectively. Time to diagnosis was greater than 6 months for 27% of non-urgent patients. Healthcare factors had the largest impact on time to diagnosis: 3 or more visits to a GP increased the median by 140 days whereas 2 or more visits to a GI-specialist increased it by 108 days compared to 0-1 visits to a GP or GI-specialist, respectively.
  
  
  
  A large proportion of CRC patients required urgent work-up or had to wait more than 6 months for diagnosis. Actions are needed to reduce the frequency of urgent presentation as well as improve the timeliness of diagnosis. Findings suggest a need to improve coordination of care across multiple providers.
authors.affiliation: Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, G 214 HSC, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. khokan.sikdar@ucalgary.ca.
authors.forename: Khokan C
authors.initials: KC
authors.lastname: Sikdar
authors.affiliation: Departments of Family Medicine and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Dickinson
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA, 94305, USA.
authors.forename: Marcy
authors.initials: M
authors.lastname: Winget
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D014850:Waiting Lists
keywords: Administrative data; Colorectal cancer; Diagnostic delay; Primary health care; Wait time