Table 2.
Predictors of Treatment Delay From Diagnosis to First-Course Therapy Among Patients With Colon and Rectal Cancers Undergoing Surgical Resection at VA Hospitals (1998 to 2008)*
| Characteristic | Colon Cancer |
Rectal Cancer |
||||||
|---|---|---|---|---|---|---|---|---|
| Unadjusted |
Adjusted |
Unadjusted |
Adjusted |
|||||
| OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | |
| Age, years | ||||||||
| < 55 | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| 55 to 64 | 1.47 | 1.24 to 1.73 | 1.43 | 1.20 to 1.70 | 1.45 | 1.12 to 1.89 | 1.46 | 1.10 to 1.94 |
| 65 to 74 | 1.35 | 1.14 to 1.59 | 1.50 | 1.27 to 1.79 | 1.20 | 0.92 to 1.57 | 1.42 | 1.06 to 1.91 |
| ≥ 75 | 1.43 | 1.22 to 1.68 | 1.60 | 1.35 to 1.90 | 1.28 | 0.97 to 1.69 | 1.54 | 1.13 to 2.09 |
| Year of diagnosis | ||||||||
| 1998 to 2000 | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| 2001 to 2003 | 1.35 | 1.19 to 1.52 | 1.35 | 1.19 to 1.53 | 1.69 | 1.33 to 2.16 | 1.72 | 1.32 to 2.22 |
| 2004 to 2006 | 2.10 | 1.87 to 2.36 | 2.14 | 1.89 to 2.42 | 2.73 | 2.16 to 3.46 | 2.90 | 2.25 to 3.74 |
| 2007 to 2008 | 2.40 | 2.12 to 2.71 | 2.55 | 2.34 to 2.92 | 2.86 | 2.22 to 3.67 | 3.14 | 2.39 to 4.13 |
| Race | ||||||||
| White | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| Black | 1.14 | 1.03 to 1.26 | 1.16 | 1.03 to 1.30 | 1.10 | 0.87 to 1.39 | 1.16 | 0.89 to 1.51 |
| Hispanic | 1.08 | 0.91 to 1.29 | 0.94 | 0.74 to 1.20 | 0.81 | 0.56 to 1.17 | 0.74 | 0.47 to 1.16 |
| Other | 1.24 | 0.96 to 1.59 | 1.24 | 0.95 to 1.63 | 1.32 | 0.83 to 2.10 | 1.22 | 0.73 to 2.05 |
| Married (v unmarried) | 0.88 | 0.81 to 0.94 | 0.87 | 0.80 to 0.94 | 0.79 | 0.68 to 0.92 | 0.78 | 0.66 to 0.92 |
| AJCC Stage | ||||||||
| I | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| II | 0.52 | 0.47 to 0.57 | 0.52 | 0.47 to 0.58 | 0.71 | 0.59 to 0.85 | 0.72 | 0.58 to 0.89 |
| III | 0.50 | 0.45 to 0.54 | 0.51 | 0.46 to 0.56 | 0.69 | 0.58 to 0.83 | 0.69 | 0.56 to 0.84 |
| Tumor histology | ||||||||
| Adenocarcinoma | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| Mucinous | 0.74 | 0.63 to 0.86 | 0.79 | 0.68 to 0.93 | 0.81 | 0.58 to 1.13 | 0.75 | 0.52 to 1.09 |
| Other | 1.76 | 1.18 to 2.60 | 1.29 | 0.84 to 1.99 | 1.78 | 0.88 to 3.60 | 1.36 | 0.62 to 1.97 |
| Grade | ||||||||
| Low | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| Intermediate | 0.83 | 0.73 to 0.94 | 0.92 | 0.80 to 1.06 | 1.01 | 0.76 to 1.33 | 1.13 | 0.83 to 1.55 |
| High | 0.61 | 0.51 to 0.72 | 0.72 | 0.60 to 0.86 | 1.11 | 0.78 to 1.57 | 1.28 | 0.87 to 1.89 |
| Neoadjuvant CRT | — | — | 1.04 | 0.89 to 1.22 | 0.82 | 0.68 to 1.00 | ||
| Location of diagnosis and treatment | ||||||||
| Same hospital | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| Different hospitals | 1.50 | 1.32 to 1.69 | 1.53 | 1.34 to 1.75 | 1.80 | 1.48 to 2.19 | 1.84 | 1.48 to 2.29 |
| Surgical extent | ||||||||
| Hemicolectomy | 1.0† | 1.0† | — | — | ||||
| Total colectomy | 1.08 | 0.88 to 1.32 | 1.13 | 0.91 to 1.40 | — | — | ||
| Sigmoid colectomy | 1.13 | 0.97 to 1.30 | 1.17 | 1.01 to 1.37 | — | — | ||
| Total proctocolectomy | — | — | 1.29 | 0.88 to 1.90 | 1.36 | 0.89 to 2.09 | ||
| Proctectomy | — | — | 1.0† | 1.0† | ||||
| APR | — | — | 0.90 | 0.74 to 1.09 | 0.99 | 0.80 to 1.22 | ||
| Pelvic exenteration | — | — | 0.84 | 0.46 to 1.55 | 1.03 | 0.53 to 1.99 | ||
| Hospital surgical volume, patient cases per year‡ | ||||||||
| < 25 | 1.0† | 1.0† | 1.0† | 1.0† | ||||
| 25 to 50 | 1.25 | 1.13 to 1.39 | 1.40 | 1.13 to 1.73 | 1.37 | 1.10 to 1.71 | 1.37 | 0.97 to 1.92 |
| > 50 | 1.43 | 1.27 to 1.62 | 1.59 | 1.14 to 2.20 | 1.57 | 1.22 to 2.03 | 1.63 | 1.01 to 2.64 |
Abbreviations: AJCC, American Joint Committee on Cancer; APR, abdominoperineal resection; CRT, chemoradiotherapy; OR, odds ratio; VA, Veterans Affairs.
*
Delay for colon cancer, ≥ 45 days; rectal cancer, ≥ 60 days.
†
Referent.
‡
Average annual hospital-level colorectal surgical case volume.