Impact on patient care time and tumor stage of a program for fast diagnosis and treatment of colorectal cancer

Abstract

To evaluate the effectiveness of a fast track diagnosis and treatment program for colorectal cancer (CRC) in reducing the diagnosis to treatment interval (DTI) and tumor stage. To analyze the association between DTI and tumor stage. A quasi-experimental study with a control group was conducted, and 156 incident cases of CRC referred through a preferential pathway between July 2005 and December 2008 in a tertiary hospital were included, after excluding those treated urgently, treated by endoscopic polypectomy only or having periodic colonoscopies. A control group of 156 patients was randomly selected from all the patients referred through habitual pathways, frequency matched by tumor location, age and year of entry. Data was analyzed with multivariate linear and logistic regression. Mean DTI was 39.20 days (95% CI: 36.21-42.42) for fast track patients and 63.40 days (95% CI: 57.08-70.41) for controls (p < 0.001), and this difference persisted after multivariate analysis. The odds of having a DTI longer than 30 days was 4.79 (95% CI: 2.19-10.51) higher for controls. There were no significant differences in tumor stage according to the pathway followed. Independently of the track followed, a DTI longer than 30 days was associated with advanced tumor stages for colon cancer, while it was associated with low stages for rectal cancer. The PDTR strategy is effective in reducing DTI and may reduce patients' and relatives' anxiety. However, it is far from reaching the DTI recommended. The achieved reduction of the delay has no impact on tumor stage.