Currently submitted to: Interactive Journal of Medical Research
Date Submitted: Aug 17, 2019
Open Peer Review Period: Oct 22, 2019 - Dec 9, 2019
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Provider Delays Do Not Impact Short-term Outcomes in Colorectal Cancer Patients
The UK has lower all-cancer survival compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to longer diagnostic and treatment delays.
The present study aims to determine whether delays experienced by colorectal cancer (CRC) patients affect survival.
This observational study utilised a trust-wide cancer register to identify CRC patients diagnosed by positive histology. The effect of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences.
A total of 648 patients (57.9% male) were identified. In colon cancer patients, neither diagnostic nor treatment delays had an impact on overall mortality (χ2 (3) = 1.492, P=.68) and (χ2 (3) = 0.594, P=.90) respectively. Similarly, treatment delays did not impact outcomes in rectal cancer patients (χ2 (3) = 5.535, P=.14). In the initial cox regression analysis, rectal cancer patients with shorter diagnostic delays were less likely to die than those experiencing longer delays (HR: 0.165, 95% CI: 0.044 – 0.616, P=.007). However, this result was non-significant following sensitivity analysis.
Diagnostic and treatment delays had no impact on survival in this CRC patient cohort. The utility of the two-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect. Clinical Trial: NAD
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