Colleen Webber1,2, Jennifer A Flemming1,2,3,4, Richard Birtwhistle1,3,5, Mark Rosenberg1,6, Patti A Groome1,2,3. 1. Department of Public Health Sciences, Queen's University, Kingston, ON, Canada. 2. Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada. 3. ICES, Ontario, Canada. 4. Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, ON, Canada. 5. Department of Family Medicine, Queen's University, Kingston, ON, Canada. 6. Department of Geography, Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND: Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of the CRC diagnostic interval. METHODS: This is a cross-sectional study of CRC patients diagnosed in Ontario, Canada, in 2008-2012. We used administrative health data to characterise colonoscopist density, private colonoscopy clinic access, distance to the closest colonoscopist and the diagnostic interval, defined as the time from patients' first cancer-related healthcare encounter to their cancer diagnosis date. We used multivariable quantile regression to evaluate the association between colonoscopy availability and the diagnostic interval, modelling the median and 90th percentile. RESULTS: The median diagnostic interval was 84 days (90th percentile 323 days). The diagnostic interval was longer in patients residing in areas with lower colonoscopists density or private clinic access (adjusted median difference = 9 and 19 days, respectively), with evidence of effect modification by symptom status. Increased distance to a colonoscopist was associated with a longer diagnostic interval in asymptomatic patients, but a shorter diagnostic interval in symptomatic patients (adjusted median difference = 29 and -25 days, respectively). CONCLUSIONS: This study demonstrated that reduced colonoscopy resource availability is associated with longer diagnostic intervals for CRC patients.
BACKGROUND: Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of the CRC diagnostic interval. METHODS: This is a cross-sectional study of CRCpatients diagnosed in Ontario, Canada, in 2008-2012. We used administrative health data to characterise colonoscopist density, private colonoscopy clinic access, distance to the closest colonoscopist and the diagnostic interval, defined as the time from patients' first cancer-related healthcare encounter to their cancer diagnosis date. We used multivariable quantile regression to evaluate the association between colonoscopy availability and the diagnostic interval, modelling the median and 90th percentile. RESULTS: The median diagnostic interval was 84 days (90th percentile 323 days). The diagnostic interval was longer in patients residing in areas with lower colonoscopists density or private clinic access (adjusted median difference = 9 and 19 days, respectively), with evidence of effect modification by symptom status. Increased distance to a colonoscopist was associated with a longer diagnostic interval in asymptomatic patients, but a shorter diagnostic interval in symptomatic patients (adjusted median difference = 29 and -25 days, respectively). CONCLUSIONS: This study demonstrated that reduced colonoscopy resource availability is associated with longer diagnostic intervals for CRCpatients.
Authors: Colleen Webber; Michael Brundage; Timothy P Hanna; Christopher M Booth; Erin Kennedy; Weidong Kong; Yingwei Peng; Marlo Whitehead; Patti A Groome Journal: BMJ Open Date: 2022-09-19 Impact factor: 3.006
Authors: Matthew Castelo; Colin Sue-Chue-Lam; Lawrence Paszat; Teruko Kishibe; Adena S Scheer; Bettina E Hansen; Nancy N Baxter Journal: PLoS One Date: 2022-09-12 Impact factor: 3.752