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Health services research
Original research
Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival
  1. David Roder1,
  2. Christos Stelios Karapetis2,
  3. Ian Olver1,
  4. Dorothy Keefe3,4,
  5. Robert Padbury2,5,
  6. James Moore4,6,
  7. Rohit Joshi4,7,
  8. David Wattchow2,5,
  9. Dan L Worthley8,
  10. Caroline Louise Miller9,10,
  11. Carol Holden9,
  12. Elizabeth Buckley1,
  13. Kate Powell9,
  14. Dianne Buranyi-Trevarton3,
  15. Kellie Fusco1,
  16. Timothy Price4,11
  1. 1 Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
  2. 2 Medical Oncology, Flinders University, Adelaide, South Australia, Australia
  3. 3 South Australian Cancer Service, South Australia Department of Health, Adelaide, South Australia, Australia
  4. 4 Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
  5. 5 Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
  6. 6 Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  7. 7 Cancer Research and Clinical Trials, Adelaide Oncology and Haematology, North Adelaide, South Australlia, Australia
  8. 8 Gastrointestinal Cancer Biology, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  9. 9 Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  10. 10 School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
  11. 11 Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
  1. Correspondence to Professor David Roder; David.Roder{at}unisa.edu.au

Abstract

Objectives Some early studies indicated lower survival with longer time from diagnosis to cancer treatment, but others showed the reverse. We investigated time to treatment of colorectal cancer and associations with survival.

Setting and participants Clinical registry data for colorectal cancer cases diagnosed in 2000–2010 at four major public hospitals in South Australia and treated by surgery (n=1675), radiotherapy (n=616) and/or systemic therapy (n=1556).

Design A historic cohort design, with rank-order tests for ordinal clinical and sociodemographic predictors and multiple logistic regression for comparing time from diagnosis to treatment. Unadjusted Kaplan-Meier estimates and adjusted Cox proportional hazards regression were used to investigate disease-specific survival by time to treatment.

Outcome measures Time to treatment and survival from diagnosis to death from colorectal cancer.

Results Treatment (any type) commenced for 87% of surgical cases <60 days of diagnosis, with 80% having surgery within this period. Of those receiving radiotherapy, 59% began this treatment <60 days, and of those receiving systemic therapy, the corresponding proportion was 56%. Adjusted analyses showed treatment delay >60 days was more likely for rectal cancers, 2006–2010 diagnoses, residents of northern than other metropolitan regions and for surgery, younger ages <50 years and unexpectedly, those residing closer to metropolitan services. Adjusting for clinical and sociodemographic factors, and diagnostic year, better survival occurred in <2 years from diagnosis for time to treatment >30 days. Survival in the 3–10 years postdiagnosis generally did not differ by time to treatment, except for lower survival for any treatment >90 days for surgical cases.

Conclusions The lower survival <2 years from diagnosis for treatment <30 days of diagnosis is consistent with other studies attributed to preferencing more complicated cases for earlier care. Lower 3–10 years survival for surgical cases first treated >90 days from diagnosis is consistent with previously reported U-shaped relationships.

  • Oncology epidemiology
  • protocols & guidelines
  • quality in healthcare
  • public health
  • colorectal surgery

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-031421

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    Footnotes

    • Contributors Study concept: DR, TP; study design: DR TP, CSK, RP, JM; data acquisition: DB-T, KP; quality control of data: DB-T, KP, KF; data analysis: DR, KF; data interpretation: DR, CSK, IO, DK, RP, JM, RJ, DW, DLW, TP; report writing: DR, KF; review of report: DR, CSK, IO, DK, RP, JM, RJ, DW, DLW, TP, CLM, CH, EB. All authors read and approved the final manuscript.

    • Funding This study was undertaken with the financial support of Cancer Council’s Beast Cancer Project on behalf of its donors and the State Government through the Department of Health.

    • Competing interests DR reports grants from Cancer Council SA, during the conduct of the study.

    • Patient consent for publication Not required.

    • Ethics approval Research ethics approval was obtained from the South Australian Human Research Ethics Committee (HREC/14/SAH/145) and University of South Australia Research Ethics Committee.

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

    • Data availability statement Data may be obtained from a third party and are not publicly available.