Surgical Outcome Research| Volume 154, ISSUE 3, P421-428, September 2013

Is timing to delivery of treatment a reliable measure of quality of care for patients with colorectal adenocarcinoma?


      Among patients with colorectal adenocarcinoma, patient race has been associated with differences in colorectal cancer survival. Survival disparities between ethnic groups may be related to treatment delays, treating hospital, or other patient factors. We hypothesized that prolonged interval to delivery of cancer therapy negatively impacts survival.

      Study Design

      We designed a retrospective cohort study using tumor registry and clinical database information from two academically affiliated hospitals. We examined factors associated with interval to treatment and associations between interval and overall survival.


      Among 592 patients treated by a cohort of physicians, we found no differences in cancer stage related to race or treating hospital. Interval to treatment differed between different hospitals (29 vs 16 days; P < .0001); yet, there were no differences in overall survival related to treatment interval, treating hospital, race, or insurance status. Tumor grade and tumor stage were associated with decreased overall survival.


      Differences exist related to the timing of definitive care for patients in this series; however, these differences do not translate directly into differences in overall survival. We must deliver quality health care in an efficient and timely manner; however, the metric of interval to treatment may not measure reliably the quality of care received.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Cancer Society
        Cancer facts and figures 2009.
        American Cancer Society, Chicago2009
        • Polite B.N.
        • Dignam J.J.
        • Olopade O.I.
        Colorectal cancer and race: understanding the differences in outcomes between African Americans and whites.
        Med Clin N Am. 2005; 89: 771-793
        • Doubeni C.A.
        • Field T.S.
        • Buist D.S.
        • Korner E.J.
        • Bigelow C.
        • Lamerato L.
        • et al.
        Racial differences in tumor stage and survival for colorectal cancer in an insured population.
        Cancer. 2007; 109: 612-620
        • Alexander D.D.
        • Waterbor J.
        • Hughes T.
        • Funkhouser E.
        • Grizzle W.
        • Manne U.
        African-American and Caucasian disparities in colorectal cancer mortality and survival by data source: an epidemiologic review.
        Cancer Biomark. 2007; 3: 301-313
        • Chien C.
        • Morimoto L.M.
        • Tom J.
        • Li C.I.
        Differences in colorectal carcinoma stage and survival by race and ethnicity.
        Cancer. 2005; 104: 629-639
        • Greenberg C.C.
        • Weeks J.C.
        • Stain S.C.
        Disparities in oncologic surgery.
        World J Surg. 2008; 32: 522-528
        • Fenton J.J.
        • Tancredi D.J.
        • Green P.
        • Franks P.
        • Baldwin L.M.
        Persistent racial and ethnic disparities in up-to-date colorectal cancer testing in medicare enrollees.
        J Am Geriatr Soc. 2009; 57: 412-418
        • Gray K.D.
        • Ballard B.R.
        • Washington M.K.
        • Belue R.
        • Grady W.M.
        • Chapman W.C.
        • et al.
        Do adverse histopathologic findings in colorectal cancer patients explain disparate outcomes?.
        J Natl Med Assoc. 2006; 98: 348-351
        • Brim H.
        • Mokarram P.
        • Naghibalhossaini F.
        • Saberi-Firoozi M.
        • Al-Mandhari M.
        • Al-Mawaly K.
        • et al.
        Impact of BRAF, MLH1 on the incidence of microsatellite instability high colorectal cancer in populations based study.
        Mol Cancer. 2008; 7: 68
        • Ashktorab H.
        • Smoot D.T.
        • Farzanmehr H.
        • Fidelia-Lambert M.
        • Momen B.
        • Hylind L.
        • et al.
        Clinicopathological features and microsatellite instability (MSI) in colorectal cancers from African Americans.
        Int J Cancer. 2005; 116: 914-919
        • Hayanga A.J.
        • Waljee A.K.
        • Kaiser H.E.
        • Chang D.C.
        • Morris A.M.
        Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: a county-level data analysis.
        Arch Surg. 2009; 144: 532-535
        • Compton C.C.
        • Greene F.L.
        The staging of colorectal cancer: 2004 and beyond.
        CA Cancer J Clin. 2004; 54: 295-308
        • Wudel Jr., L.J.
        • Chapman W.C.
        • Shyr Y.
        • Davidson M.
        • Jeyakumar A.
        • Rogers Jr., S.O.
        • et al.
        Disparate outcomes in patients with colorectal cancer: effect of race on long-term survival.
        Arch Surg. 2002; 137 (discussion 554-6): 550-554
        • Jerant A.F.
        • Fenton J.J.
        • Franks P.
        Determinants of racial/ethnic colorectal cancer screening disparities.
        Arch Intern Med. 2008; 168: 1317-1324
        • Yorio J.T.
        • Xie Y.
        • Yan J.
        • Gerber D.E.
        Lung cancer diagnostic and treatment intervals in the United States: a health care disparity?.
        J Thorac Oncol. 2009; 4: 1322-1330
        • Bedell M.B.
        • Wood M.E.
        • Lezotte D.C.
        • Sedlacek S.M.
        • Orleans M.M.
        Delay in diagnosis and treatment of breast cancer: implications for education.
        J Cancer Educ. 1995; 10: 223-228
        • Brazda A.
        • Estroff J.
        • Euhus D.
        • Leitch A.M.
        • Huth J.
        • Andrews V.
        Delays in time to treatment and survival impact in breast cancer.
        Ann Surg Oncol. 2010; 17: 291-296