Delays in treatment for colorectal cancer patients in an NCI-designated cancer center serving a Hispanic majority community.

Abstract

178 Background: Timeliness of cancer treatment is an important aspect of health care quality. Colorectal cancer (CRC) care requires the coordinated multidisciplinary effort of various aspects of the health care system, which can lead to delays between initial diagnoses to definitive therapy. Little is known about the time from diagnosis to cancer-directed treatment, neither about the factors that cause delays or its effect on patient outcomes. Delays to curative surgery beyond 12 weeks are associated with increased mortality in CRC. Longer time to adjuvant chemotherapy is associated with worse survival among patients with resected CRC. The objective of our study is to identify delays in initiation of CRC treatment and its causative factors. Methods: We retrospectively reviewed the medical records of colorectal cancer patients who were either initially diagnosed or had initial surgical resection at University Hospital and had further treatment at Cancer Therapy and Research Center, between 7/1/2010 and 12/22/2014. Data were collected on patient and disease characteristics, treatment timelines and outcomes, till pre-specified data cut-off date of 8/1/16. Results: Of 256 patients treated for CRC, 59 % were males, 59 % Hispanic, and 34 % were uninsured. Most had non-metastatic disease (70%). 72 % were still alive at the time of data cut-off. The median time from diagnosis to treatment (TDT) was 21 days, with 60 % between 0-30 days and 59 % between 31-89 days. Median time from first treatment to first progression or recurrence was 12 months (range 0.9- 42 mos.). Median overall survival (OS) was 17 months (0.1- 51 months). There were no statistically significant difference between the progression or recurrence free survival and OS in patients with TDT <30 days, 30-89 days and >90 days. Compared to non-Hispanics, Hispanic patients were more likely to have a TDT of 31-89 days (31% vs 37%, p= 0.0003) and >/= 90 days (3% vs 7%, p= 0.0001). Conclusions: Hispanic patients were more likely to have a longer time from diagnosis to treatment compared to non-Hispanic patients. The various factors for such disparities in health care quality and their effect on survival needs to be explored further.