Surgical Outcome ResearchIs timing to delivery of treatment a reliable measure of quality of care for patients with colorectal adenocarcinoma?
Section snippets
Rationale and specific aims
Our overall aim was to demonstrate whether interval to treatment delivery was associated with differences in survival in a cohort of patients with colorectal adenocarcinoma. We hypothesized that differences in interval to treatment delivery may be influenced by patient factors, physician factors, and health care system factors. We hypothesized that the most powerful factor impacting interval to treatment would be the health care system delivering treatment. To isolate the impact of interval to
Methods
We conducted a retrospective review of all patients diagnosed with colon and rectal carcinoma at the main campus of UT Southwestern Medical Center in Dallas, Texas. Patients were treated at either Parkland Health and Hospital Systems (county) or University Hospital-St. Paul (university) from January 1, 2000, to October 31, 2008. Patients identified in tumor registry databases at each institution as having primary colorectal carcinoma were included in the study population. Patients diagnosed
Aim 1: To identify a single cohort of patients from two affiliated hospitals diagnosed and non-emergently treated within the hospital system
At the county and university hospitals, 1,181 patients were treated for colorectal cancer during the 8-year study period. Figure 1, A illustrates the process of inclusion and exclusion from the study. The most common reason for exclusion (69% of excluded cases) was the patient being diagnosed outside the health system. Emergency cases comprised 29% (n = 60) of excluded patients in the county hospital population and 21% (n = 79) in the university hospital population. Our final study population
Discussion
Previous studies have documented disparate outcomes for patients with colorectal cancer13; however, factors that contribute to these observed differences have yet to be determined. Studies looking at differences in screening and tumor biology/histology have failed to demonstrate substantial differences to account for these differences in outcomes.7, 8, 14 In the present study, we compare patients treated at two affiliated hospitals in which patients were cared for by overlapping physician
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Cited by (20)
Surgical Cancer Care in Safety-Net Hospitals: a Systematic Review
2023, Journal of Gastrointestinal SurgeryImpact of delay to surgery on survival in stage I-III colon cancer
2020, European Journal of Surgical OncologyCitation Excerpt :Studies looking at the impact of delays to surgery are limited and conflicting. Several recent studies have not revealed a significant association between a prolonged interval to CC resection and long-term survival [12–15]. However, other large-scale population-based studies showed ambiguous results [16,17].
Impact of therapeutic delay in colorectal cancer on overall survival and cancer recurrence – is there a safe timeframe for prehabilitation?
2019, European Journal of Surgical OncologyCitation Excerpt :Multiple studies regarding this therapeutic delay show different results. A number of studies demonstrated that delayed treatment is not significantly associated with survival or oncologic outcome [2–4]. Others showed a negative association between time to treatment and survival in case of rectal cancer but not for colonic cancer [5–7].
Association between the time to surgery and survival among patients with colon cancer: A population-based study
2017, European Journal of Surgical OncologyCitation Excerpt :After adjusting for relevant confounders, there was no association between a delay to surgery and the outcomes of death or metastatic recurrence. Finally, a case series including 592 cases of colorectal cancer from 2000 to 2008 in two academic hospitals also found no difference in survival with a longer TTS.12 Our data also supports this previous work as well and greatly adds to the growing literature as we evaluated treatment delay at the population level in a well characterized contemporary cohort.
Treatment delays of colon cancer in a safety-net hospital system
2015, Journal of Surgical ResearchCitation Excerpt :There are limited data on whether short delays, on the order of days to weeks, impact colon cancer-associated outcomes and when the time between diagnosis and treatment becomes excessive. Roland et al.[7] compared patients with CRC treated at two academically affiliated hospitals, one a county hospital (Parkland Health and Hospital System) and the other a private University Hospital (University Hospital-St. Paul). Although the authors were able to identify an increased time to treatment of nonemergent CRC in the county hospital (16 versus 29 d), there were no differences in observed overall survival; the median survival in patients treated within 16 d was 4.5 y compared with 5.1 y in patients treated beyond this interval.