A Moderate Delay in Diagnosis (Dx) of Colorectal Cancer (CRC) Does Not Adversely Affect Outcome

Abstract

A Moderate Delay in Diagnosis (Dx) of Colorectal Cancer (CRC) Does Not Adversely Affect Outcome Jennifer Chennat, Stephen J. Sontag, Thomas G. Schnell, Jack Leya Introduction: Delay in Dx of CRC is a major fear in the GI community and a major factor in litigation against endoscopists. In July 2001, the Hines VA GI Section chose C-scope as the sole method to accomplish the objective: the prevention of death from CRC. To achieve this goal, it was necessary to eliminate the delay in performing procedures. We adopted a strictly regulated policy in which inappropriate, unnecessary, or unlikely-to-benefit procedures were denied and consult requests returned for a variety of reasons. This policy successfully led to a mandatory waiting time for asymptomatic C-scope screening of only 5 days. By necessity and intention, however, the policy for some patients resulted in delay of the requested procedure. Reasons for delay include (1) the need for more clinical information, (2) lack of required lab data, (3) safety concerns due to co-morbid conditions, (4) our request for outside hospital records, (5) and too short interval from previous procedure. Our C-Scope Screening Database provides the opportunity to determine whether our policy’s built-in delay adversely affects outcome of CRC. Methods: The electronic database records of pts with CRC diagnosed through our VA program since July 2001 were examined in detail. 48 separate variables were considered, including dates of the following: birth, previous procedures, first Hines clinic enrollment, FOBTs (if given), C-scope requests, nurse prep clinic, C-scope performed (CRC Dx date), surgery (if done), and death. Most importantly, we carefully examined all progress notes, including the extensive notes written on every pt by the nurse practitioner and preventive health provider searching for any hint of GI symptoms that may have been recorded. In addition, the location, TNM class and Stage of CRC were recorded. CRC Stage 0,1,2 was considered Good Prognosis (GPC); Stage 3,4 was considered Poor Prognosis (PPC); HGD (Ca-in-situ or intramucosal) was Stage 0. Results: During the program’s 4 years, 356 pts with CRC were diagnosed: 30% were PPC. There was no age difference at Dx of CRC between the GPC group and the PPC group (66.8 vs 68.9; P Z NS). In symptomatic pts, the time from the earliest hint of GI symptoms to Dx of CRC was similar in both groups (10 months vs 7 months; P Z NS). The time from the first consult sent to Dx of CRC was statistically shorter in the PPG (3 months vs 4 months; P Z 0.0002). The 24 Pts who had a O1 year delay in Dx were similar in outcome as those who had no delay, belonging equally to the PPG and the GPC Abstracts