Study Examines Possible Determinants of Colorectal Cancer Diagnostic Delays among Veterans
When diagnosed at an early, localized stage, the five-year survival rate for individuals with colorectal cancer (CRC) is 90%. Thus, diagnostic delay is important because it could be related to poorer patient outcomes. This study sought to determine predictors of medical system delay and to evaluate characteristics associated with stage at diagnosis, including time to diagnosis. Time to diagnosis was defined as the time from the first relevant medical visit or abnormal test date to tissue diagnosis. Using data from the VA team (15 VA sites) of a multi-center observational study, along with additional VA administrative data, investigators identified 468 Veterans with CRC. Veterans were classified as receiving diagnosis of CRC in one of three ways: 1) screen-detected (positive FOBT, barium enema, sigmoidoscopy, or colonoscopy), 2) bleeding-detected (any symptoms related to GI bleeding), or 3) other (diagnosis resulting from the evaluation of another medical concern).
Findings suggest that there is variation within the VA healthcare system regarding the time from initial clinical event until the diagnosis of CRC. The median times from initial event to diagnosis were 91 days for screen-detected cancers, 74 days for bleeding-detected cancers, and 73 days for "other." The CRC stage was III or IV for 57% of the study participants. Compared to screen-detected, bleeding detected and other diagnostic categories were associated with an increased risk of late-stage disease at diagnosis. Older age and any comorbidity level (compared to no comorbidities) were associated with a longer time to diagnosis. The South and West-Midwest regions were associated with a shorter time to diagnosis compared to the Atlantic region.
The authors note that potential barriers to a timely diagnosis for older Veterans are not necessarily a reflection of problems within the VA system, but are likely an issue in non-VA populations as well. They also note that the finding that screen-detected cancers are more likely to be confirmed in an earlier stage confirms the real-world effectiveness found in the trials and studies of screening efficacy.
Fisher D, Zullig L, Grambow S, et al. Determinants of Medical System Delay in the Diagnosis of Colorectal Cancer within the Veterans Affairs Health System. Digestive Diseases and Sciences March 18, 2010;e-pub ahead of print.
This study was partly funded by VA (CRS 02-164). Dr. Fisher is supported by an HSR&D Career Development Transition Award. Drs. Fisher, Zullig, and Grambow are part of HSR&D's Center for Health Services Research in Primary Care located in Durham, NC.