An Assessment, with NICE Guidelines as a Benchmark, of Delay to Care in a Cohort of Colorectal Cancer Patients Seen in the Witwatersrand University Academic Complex

Abstract

Background: Colorectal cancer (CRC) in South Africa (S.A) is the second most common in women and the third in men. Worldwide it is the second most deadly cancer. As a subset, colon cancer is the fifth most deadly with an estimated 551,000 deaths in 2018. CRC makes up 5.8% of all cancer-related deaths globally. Despite this, there are no screening programmes in S.A, with a diagnosis being largely dependent on symptomatology. Additionally, there is no clear understanding of the significance of the outcome imposed by delay in referral and treatment. Unlike countries in Europe, South Africa has no guidelines defining cut-offs for acceptable delays in this context. Methods: A retrospective study was done on the delay in referral, diagnosis, and treatment of CRC patients. A cohort of patients in which surgery was the primary treatment that was presented to Witwatersrand Academic Hospitals was studied. Delays were benchmarked against fourteen days from primary contact to consultation with a specialist and consultation to treatment delay of more than 31 days. Definitive treatment delay was defined as the time from referral to the treatment centre and tumour resection of more than 62 days. Outcomes were evaluated by defining the 90-day mortality. Results: The median referral delay was 78 days, for treatment delay was 54 days and for definitive treatment delay was 175 days. Of the 587 patients analysed, 341 had therapeutic surgery, 17 demised within 90 days post-surgery. Longer delays and higher mortality rates were seen in the public sector and a lower socio-economic group of patients. Conclusion: The time parameters set out by the NHS and Europe were not met. There were greater delays seen in patients with lower socio-economic backgrounds and in those attending the public sector. The effect of delays on 90-day mortality is doubtful. Delays to care both outside of hospitals and in hospitals may be a point of investigation in future studies.