BACKGROUND: Using 1998-2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death. METHODS: We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days). Cases (CRC deaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors. RESULTS: Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancer patients with the longest diagnostic delays (8-12 months vs. 14-59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08-1.58), but not CRC-specific death. Colon cancer patients with the shortest treatment delays (<1 vs. 1-2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01-1.49), but not CRC-specific death. Among rectal cancer patients, delays were not associated with risk of all-cause or CRC-specific death. CONCLUSIONS: Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.
BACKGROUND: Using 1998-2005 SEER-Medicare data, we examined the effect of diagnostic and treatment delays on all-cause and colorectal cancer (CRC)-specific death among US adults aged ≥ 66 years with invasive colon or rectal cancer. We hypothesized that longer delays would be associated with a greater risk of death. METHODS: We defined diagnostic and treatment delays, respectively, as days between (1) initial medical consult for CRC symptoms and pathologically confirmed diagnosis (maximum: 365 days) and (2) pathologically confirmed diagnosis and treatment (maximum: 120 days). Cases (CRC deaths) and controls (deaths due to other causes or censored) were matched on survival time. Logistic regression analyses adjusted for sociodemographic, tumor, and treatment factors. RESULTS: Median diagnostic delays were 60 (colon) and 40 (rectal) days and treatment delays were 13 (colon) and 16 (rectal) days in 10,663 patients. Colon cancerpatients with the longest diagnostic delays (8-12 months vs. 14-59 days) had higher odds of all-cause (aOR: 1.31 CI: 1.08-1.58), but not CRC-specific death. Colon cancerpatients with the shortest treatment delays (<1 vs. 1-2 weeks) had higher odds of all-cause (aOR: 1.23 CI: 1.01-1.49), but not CRC-specific death. Among rectal cancerpatients, delays were not associated with risk of all-cause or CRC-specific death. CONCLUSIONS: Longer delays of up to 1 year after symptom onset and 120 days for treatment did not increase odds of CRC-specific death. There may be little clinical benefit in detecting and treating existing symptomatic disease earlier. Screening prior to symptom onset must remain the primary goal to reduce CRC incidence, morbidity, and mortality.
Authors: Anna P Schenck; Carrie N Klabunde; Joan L Warren; Sharon Peacock; William W Davis; Sarah T Hawley; Michael Pignone; David F Ransohoff Journal: Cancer Epidemiol Biomarkers Prev Date: 2007-10 Impact factor: 4.254
Authors: Petra Jellema; Daniëlle A W M van der Windt; David J Bruinvels; Christian D Mallen; Stijn J B van Weyenberg; Chris J Mulder; Henrica C W de Vet Journal: BMJ Date: 2010-03-31
Authors: Marko Simunovic; Eddy Rempel; Marc-Erick Thériault; Nancy N Baxter; Beth A Virnig; Neal J Meropol; Mark N Levine Journal: Can J Surg Date: 2009-08 Impact factor: 2.089
Authors: Eric E Seiber; Fabian Camacho; Muhammad Fazal Zeeshan; Teresa T Kern; Steven T Fleming Journal: J Rural Health Date: 2015-05-29 Impact factor: 4.333
Authors: Lindsey A Jones; Carol Estwing Ferrans; Blase N Polite; Katherine C Brewer; Ajay V Maker; Heather A Pauls; Garth H Rauscher Journal: Ann Epidemiol Date: 2017-10-13 Impact factor: 3.797
Authors: Rachel B Issaka; Li Li; Catherine Fedorenko; Cynthia W Ko; John M Inadomi; Scott D Ramsey Journal: J Racial Ethn Health Disparities Date: 2020-02-12
Authors: Charlotte J L Molenaar; Loes Janssen; Donald L van der Peet; Desmond C Winter; Rudi M H Roumen; Gerrit D Slooter Journal: World J Surg Date: 2021-04-03 Impact factor: 3.352
Authors: Antonieta Medina-Lara; Bogdan Grigore; Ruth Lewis; Jaime Peters; Sarah Price; Paolo Landa; Sophie Robinson; Richard Neal; William Hamilton; Anne E Spencer Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014
Authors: Munir Ahmad Abu-Helalah; Hussam Ahmad Alshraideh; Moh'd Da'na; Mo'tasem Al-Hanaqtah; Anas Abuseif; Kamal Arqoob; Abdelrahman Ajaj Journal: J Gastrointest Cancer Date: 2016-03
Authors: Chanpreet S Arhi; Elaine M Burns; Alex Bottle; George Bouras; Paul Aylin; Paul Ziprin; Ara Darzi Journal: Br J Gen Pract Date: 2020-06-25 Impact factor: 5.386
Authors: Saul N Weingart; Coral L Atoria; David Pfister; David Classen; Aileen Killen; Elizabeth Fortier; Andrew S Epstein; Christopher Anderson; Allison Lipitz-Snyderman Journal: J Patient Saf Date: 2021-12-01 Impact factor: 2.844