Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis
Background Clinical delays may be important contributors to outcomes among younger adults (<50 years) with colorectal cancer (CRC). We aimed to describe delay intervals for younger adults with CRC using health administrative data to understand drivers of delay in this population.Methods This...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e001022.full |
| _version_ | 1811189060569399296 |
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| author | Nancy N Baxter Bettina E Hansen Matthew Castelo Lawrence Paszat Lena Nguyen Adena S Scheer Neil Faught |
| author_facet | Nancy N Baxter Bettina E Hansen Matthew Castelo Lawrence Paszat Lena Nguyen Adena S Scheer Neil Faught |
| author_sort | Nancy N Baxter |
| collection | DOAJ |
| description | Background Clinical delays may be important contributors to outcomes among younger adults (<50 years) with colorectal cancer (CRC). We aimed to describe delay intervals for younger adults with CRC using health administrative data to understand drivers of delay in this population.Methods This was a population-based study of adults <50 diagnosed with CRC in Ontario, Canada from 2003 to 2018. Using administrative code-based algorithms (including billing codes), we identified four time points along the pathway to treatment—first presentation with a CRC-related symptom, first investigation, diagnosis date and treatment start. Intervals between these time points were calculated. Multivariable quantile regression was performed to explore associations between patient and disease factors with the median length of each interval.Results 6853 patients aged 15–49 were diagnosed with CRC and met the inclusion criteria. Males comprised 52% of the cohort, the median age was 45 years (IQR 40–47), and 25% had stage IV disease. The median time from presentation to treatment start (overall interval) was 109 days (IQR 55–218). Time between presentation and first investigation was short (median 5 days), as was time between diagnosis and treatment start (median 23 days). The greatest component of delay occurred between first investigation and diagnosis (median 78 days). Women, patients with distal tumours, and patients with earlier stage disease had significantly longer overall intervals.Conclusions Some younger CRC patients experience prolonged times from presentation to treatment, and time between first investigation to diagnosis was an important contributor. Access to endoscopy may be a target for intervention. |
| first_indexed | 2024-04-11T14:29:30Z |
| format | Article |
| id | doaj.art-230e9e8b876b4d23a71ae4311519f653 |
| institution | Directory Open Access Journal |
| issn | 2054-4774 |
| language | English |
| last_indexed | 2024-04-11T14:29:30Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj.art-230e9e8b876b4d23a71ae4311519f6532022-12-22T04:18:42ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-11-019110.1136/bmjgast-2022-001022Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysisNancy N Baxter0Bettina E Hansen1Matthew Castelo2Lawrence Paszat3Lena Nguyen4Adena S Scheer5Neil Faught6The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia1 Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaDepartment of Surgery, Unity Health Toronto, Toronto, Ontario, CanadaInstitue of Clinical Evaluative Sciences, Toronto, Ontario, Canada.Medicine, University of Toronto, Toronto, Ontario, CanadaDepartment of Surgery, University of Toronto, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaBackground Clinical delays may be important contributors to outcomes among younger adults (<50 years) with colorectal cancer (CRC). We aimed to describe delay intervals for younger adults with CRC using health administrative data to understand drivers of delay in this population.Methods This was a population-based study of adults <50 diagnosed with CRC in Ontario, Canada from 2003 to 2018. Using administrative code-based algorithms (including billing codes), we identified four time points along the pathway to treatment—first presentation with a CRC-related symptom, first investigation, diagnosis date and treatment start. Intervals between these time points were calculated. Multivariable quantile regression was performed to explore associations between patient and disease factors with the median length of each interval.Results 6853 patients aged 15–49 were diagnosed with CRC and met the inclusion criteria. Males comprised 52% of the cohort, the median age was 45 years (IQR 40–47), and 25% had stage IV disease. The median time from presentation to treatment start (overall interval) was 109 days (IQR 55–218). Time between presentation and first investigation was short (median 5 days), as was time between diagnosis and treatment start (median 23 days). The greatest component of delay occurred between first investigation and diagnosis (median 78 days). Women, patients with distal tumours, and patients with earlier stage disease had significantly longer overall intervals.Conclusions Some younger CRC patients experience prolonged times from presentation to treatment, and time between first investigation to diagnosis was an important contributor. Access to endoscopy may be a target for intervention.https://bmjopengastro.bmj.com/content/9/1/e001022.full |
| spellingShingle | Nancy N Baxter Bettina E Hansen Matthew Castelo Lawrence Paszat Lena Nguyen Adena S Scheer Neil Faught Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis BMJ Open Gastroenterology |
| title | Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis |
| title_full | Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis |
| title_fullStr | Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis |
| title_full_unstemmed | Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis |
| title_short | Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis |
| title_sort | measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data a population based analysis |
| url | https://bmjopengastro.bmj.com/content/9/1/e001022.full |
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