271 Higher Charlson-Deyo Score May Result in Delay to Colonoscopy in Veterans Subsequently Diagnosed With Colorectal Cancer

Abstract

INTRODUCTION: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy has been shown to be associated with increased risk of CRC. 1 Currently, the Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The compounding effects of an aging population, physician shortage, and increased military personnel entering the VAHS can increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. METHODS: We retrospectively reviewed records of 600 patients referred for colonoscopy between January 1999 and January 2009 and were subsequently diagnosed with CRC. Patients were excluded if a prior CRC diagnosis had been established. The final study cohort consisted of 530 patients. Using Chi square and Fisher's testing, we examined the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Further logistic regression analysis adjusted for age, race, CRC location and C/D score. RESULTS: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, P = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, P = 0.47, OR = 1.37, P = 0.48). CONCLUSION: Patients with a C/D score ≥2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.