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Roder D, Karapetis CS, Olver I, Keefe D, Padbury R, Moore J, Joshi R, Wattchow D, Worthley DL, Miller CL, Holden C, Buckley E, Powell K, Buranyi-Trevarton D, Fusco K, Price T. Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival. BMJ Open 2019; 9:e031421. [PMID: 31575579 PMCID: PMC6797269 DOI: 10.1136/bmjopen-2019-031421] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
- David Roder
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | | | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothy Keefe
- South Australian Cancer Service, South Australia Department of Health, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Padbury
- Medical Oncology, Flinders University, Adelaide, South Australia, Australia
- Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - James Moore
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Cancer Research and Clinical Trials, Adelaide Oncology and Haematology, North Adelaide, South Australlia, Australia
| | - David Wattchow
- Medical Oncology, Flinders University, Adelaide, South Australia, Australia
- Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Dan L Worthley
- Gastrointestinal Cancer Biology, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Caroline Louise Miller
- Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carol Holden
- Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Powell
- Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Dianne Buranyi-Trevarton
- South Australian Cancer Service, South Australia Department of Health, Adelaide, South Australia, Australia
| | - Kellie Fusco
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Timothy Price
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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