Original Contribution Efficiency of Colorectal Cancer Care Among Veterans: Analysis of Treatment Wait Times at Veterans Affairs Medical Centers

Purpose: Timeliness of cancer treatment is an important aspect of health care quality. Veterans Affairs Medical Centers (VAMCs) are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon and rectal cancers and assess factors associated with pro-longed wait times. Methods: From the VA Central Cancer Registry, patients who underwent colon or rectal resection for cancer from 1998 to 2008 were identified. Time from diagnosis to definitive can-cer-directed therapy was measured, and multivariable regres-sion methods were used to determine predictors of prolonged wait times for colon ( 45 days) and rectal ( 60 days) cancers. Results: From124VAMCs,14,097patientsunderwentcolectomy, and3,390underwent rectal resection for cancer. For coloncancer, the median time to treatment increasedby68%over time (P .001). From 2007 to 2008, themedian time to colectomywas 32 days. Predictors of prolonged wait times included age 55 years (v 55 years), time period (2007 to 2008 v 1998 to 2000), black race (v white), marriage status (married vunmarried), high-volumecenter status (v low volume), and treatment at adifferent hospital (vsamehospital as initial diagnosis; all P .05). For rectal cancer, the overall median time to first-course treatment increased by 74 % (P .001). From 2007 to 2008, the me-dian time to proctectomywas47days. Similar predictors of prolonged wait times were identified for rectal cancer. Conclusion: Time to first treatment has increased for pa-tients with colon and rectal cancers at VAMCs. Patient, tumor, and hospital factors are associated with prolonged time to treatment