Wait times up 78 percent at VA for colorectal cancer procedures

August 26, 2013

A study published in the August print issue of the Journal of Oncology Practice shows that from 1998-2008, wait times for colorectal cancer operations at Veterans Administration hospitals increased from 19 to 32 days. But researchers think longer waits may be a reflection of several unmeasured variables including more careful care, staffing, and patient conditions or preferences.

"Some of it is purely staffing – we don't have enough surgeons or nurses or anesthetists or O.R. time to meet the need," says Martin McCarter, MD, investigator at the University of Colorado Cancer Center and at the University of Colorado Hospital. "But some of this increase in for procedures at the VA may be due to an increased focus on quality and outcomes. Better care takes time."

The study used data from 17,487 patients listed in the VA Central Cancer Registry. McCarter and colleagues including first author Ryan Merkow, MD, former surgery resident at UCH, compared the time between diagnosis and definitive, cancer-directed therapy such as or rectal resection in 1998 and 2008. During this 10-year period, the median time from diagnosis to treatment increased from 19 to 32 days. At high-volume centers, increases were even more pronounced, jumping 14 days for the treatment of and nearly 30 days for the treatment of rectal cancer.

"What's missing in this study are any cancer-related outcomes – what's the effect of these longer wait times on survival or quality of life?" says McCarter. Reframed, the question is whether more careful care is worth the wait – is it better to treat quickly in the days after diagnosis or to adopt the more modern, more careful approach that can push back treatment?

"For example, perhaps more VA doctors are taking into account a patient's comorbidities – maybe someone has lung or in addition to cancer. And it can take a few days or even a few weeks to bring specialists for these other conditions onboard," McCarter says. McCarter points out that this question of the influence of time-to-treatment on outcomes is a larger question in the overall strategy of cancer care. "Although everybody assumes it's best to treat cancer as soon as possible, by the time they're detected, most tumors have been growing for years. It may be that a two-week delay before treatment makes no difference and that taking time to better plan care is a worthwhile trade," McCarter says.

The study also shows that patient, tumor and hospital factors influence time to treatment. Specifically, patients over age 55 were treated slightly more quickly than younger ones, and more advanced tumors were treated more quickly than less advanced ones – both findings match the intuitive need to treat a more dangerous tumor efficiently. But then married (vs. unmarried) and white (vs. black) patients treated at low-volume (vs. high-volume) centers, and at the same hospital at which they were diagnosed also saw shorter wait times between diagnosis and treatment. Some of these factors may reflect other unmeasured influences such as a patient's desire for a second opinion before committing to surgery.

"VA's across the country realize that timeliness of care is an important issue. There's tremendous pressure to move people efficiently through the system. For example, wait times for an elective hernia repair may be up to 9 months because cancer patients take priority over elective or more benign situations and there just aren't enough resources to go around," McCarter says.

"The challenge for the future is to have our cake and eat it too – to have quality along with the efficiency of shorter wait times," McCarter says.

Explore further: African Americans experience longer delays between diagnosis and treatment of prostate cancer

More information: jop.ascopubs.org/content/early … 2012.000738.abstract

Related Stories

African Americans experience longer delays between diagnosis and treatment of prostate cancer

May 28, 2013
Among men with prostate cancer, African Americans experience longer treatment delays after being diagnosed than Caucasians. That is the finding of an analysis published early online in CANCER, a peer-reviewed journal of the ...

African Americans experience longer delay between prostate cancer diagnosis and treatment

April 1, 2013
African American men on average wait a week longer than their Caucasian counterparts between the initial diagnosis of prostate cancer and treatment, according to University of North Carolina researchers.

Danish health care fast track program reduces cancer patients' treatment, diagnosis wait time

January 26, 2012
In Denmark, implementing a national fast track system for cancer patients reduced the waiting time between a patient's initial meeting with a health care provider and their first treatment by four weeks when comparing 2010 ...

Difference in breast cancer survival between black and white women has not changed substantially

July 23, 2013
In an analysis of 5-year survival rates among black and white women diagnosed with breast cancer between 1991 and 2005, black women continued to have a lower rate of survival, with most of the difference related to factors ...

Moffitt Cancer Center expert standardizing guidelines for penile cancer treatment

August 7, 2013
Penile cancer is rare, with an average of 1,200 new cases per year in the United States, but it can be debilitating and lethal. Without evidenced-based treatment approaches, outcomes have varied widely. Philippe E. Spiess, ...

Delaying treatment for advanced breast cancer more than 60 days has 'profound effect', researchers find

November 22, 2012
(Medical Xpress)—Results from a new study conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) show ...

Recommended for you

Shooting the achilles heel of nervous system cancers

July 20, 2017
Virtually all cancer treatments used today also damage normal cells, causing the toxic side effects associated with cancer treatment. A cooperative research team led by researchers at Dartmouth's Norris Cotton Cancer Center ...

Molecular changes with age in normal breast tissue are linked to cancer-related changes

July 20, 2017
Several known factors are associated with a higher risk of breast cancer including increasing age, being overweight after menopause, alcohol intake, and family history. However, the underlying biologic mechanisms through ...

Immune-cell numbers predict response to combination immunotherapy in melanoma

July 20, 2017
Whether a melanoma patient will better respond to a single immunotherapy drug or two in combination depends on the abundance of certain white blood cells within their tumors, according to a new study conducted by UC San Francisco ...

Discovery could lead to better results for patients undergoing radiation

July 19, 2017
More than half of cancer patients undergo radiotherapy, in which high doses of radiation are aimed at diseased tissue to kill cancer cells. But due to a phenomenon known as radiation-induced bystander effect (RIBE), in which ...

Definitive genomic study reveals alterations driving most medulloblastoma brain tumors

July 19, 2017
The most comprehensive analysis yet of medulloblastoma has identified genomic changes responsible for more than 75 percent of the brain tumors, including two new suspected cancer genes that were found exclusively in the least ...

Novel CRISPR-Cas9 screening enables discovery of new targets to aid cancer immunotherapy

July 19, 2017
A novel screening method developed by a team at Dana-Farber/Boston Children's Cancer and Blood Disorders Center—using CRISPR-Cas9 genome editing technology to test the function of thousands of tumor genes in mice—has ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.