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Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study
  1. David Goldsbury1,
  2. Mark Fort Harris2,
  3. Shane Pascoe2,
  4. Ian Olver3,
  5. Michael Barton4,
  6. Allan Spigelman5,
  7. Dianne O'Connell1
  1. 1Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia
  2. 2UNSW Research Centre for Primary Health Care and Equity, Sydney, Australia
  3. 3Cancer Council Australia, Sydney, Australia
  4. 4Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Health Service, Sydney, Australia
  5. 5UNSW St Vincent's Clinical School, Sydney, Australia
  1. Correspondence to Dr David Goldsbury; davidg{at}nswcc.org.au

Abstract

Objectives 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.

Design Retrospective cohort analysis of linked data.

Setting A population-based sample of people diagnosed August 2004 to December 2007 in New South Wales, Australia.

Participants 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.

Results 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).

Conclusions 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.

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Footnotes

  • To cite: Goldsbury D, Harris MF, Pascoe S, et al. Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study. BMJ Open 2012;2:e001070. doi:10.1136/bmjopen-2012-001070

  • Contributors DO and MFH contributed to conception and study design, participated in its coordination, advised on the data analysis and helped to draft the manuscript. DG assisted with obtaining the data and data management, undertook the analysis and drafted the manuscript. SP, IO, MB and AS contributed to conception and study design, participated in its coordination and helped to draft the manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by Cancer Australia (2007; Priority-driven Collaborative Cancer Research Scheme [510348]).

  • Competing interests None.

  • Ethics approval Ethical approval was provided by the University of New South Wales Human Research Ethics Committee and the New South Wales Population and Health Services Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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