To investigate key patient clinical and demographic characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer (CRC) patients. This will add to the little published research examining the pathway following CRC diagnosis and prior to surgery.
Retrospective cohort analysis of linked data.
A population-based sample of people diagnosed August 2004 to December 2007 in New South Wales, Australia.
569 CRC patients, of whom 407 (72%, 95% CI 68% to 75%) had colonoscopy followed by surgery.
Primary outcome measures
Time between colonoscopy and surgery, and whether the surgery took place in a specialist cancer centre.
Among the 407 eligible patients analysed, the median time from colonoscopy to surgery was 19 days (IQR 12–29 days). After adjusting for key demographic and clinical characteristics such as age and disease stage, the time was longer for rectal cancer patients and those reporting fair/poor health, although differences in medians were <5 days. 24% (95% CI 20% to 28%) had surgery in a specialist cancer centre, which was more common among people resident in metropolitan areas (37% vs 14% for others, adjusted p=0.001) and those without private health insurance (30% vs 21% for others, adjusted p=0.03).
There do not appear to be systemic issues affecting time from colonoscopy to surgery related to patients' socio-demographic characteristics. However, patients with private insurance and those living in rural areas may be less likely to receive optimal specialist treatment. A more systematic approach might be needed to ensure cancer patients are treated in specialist cancer centres, particularly patients requiring more specialised treatment.
Investigate key patient clinical and demographic characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer patients in New South Wales, Australia.
Most existing research has focused on delay prior to diagnosis, and little is known about factors associated with referral to specialist treatment following diagnosis.
Rectal cancer cases had slightly longer time to surgery than colon cancer cases.
Treatment in a specialist cancer centre was associated more with patient access than disease characteristics.
We need to ensure that those with the greatest need, such as those with rectal cancer, have access to timely and specialist treatment.
Strengths and limitations of this study
This is one of the first studies to examine the pathway following colorectal cancer diagnosis and prior to surgery, with a relatively large population-based sample of patients.
Surgery was the only treatment we could reliably analyse.
Surgeon specialties were not known so specialist centres were identified as institutions with radiotherapy facilities.
We cannot determine the exact reason for longer time to treatment and it might actually be a positive, possibly reflecting referral to a specialist surgeon or preoperative radiotherapy.