The following research abstract has been accepted for presentation at the spring meeting of the
British Columbia Surgical Society, May 2011.

Out-of-Hospital Lower GI Diagnostic Centre Reduces Time To
Treatment of Colorectal Cancer

DN Sousa, ME Pezim.  Pezim Clinic, Vancouver, BC, Canada.

Background: While it is accepted that early treatment of Colorectal Cancer (CRC) yields better results, wait times for hospital-based GI consultation and endoscopy continue to rise.  The development of a purpose-built out-of-hospital lower GI diagnostic centre may help reduce time to diagnosis and treatment of CRC in British Columbia.

Purpose: To assess the impact of an out-of-hospital lower GI diagnostic centre (the Clinic) on the diagnosis and management of an initial group of patients with CRC.

Method: Records of patients diagnosed at the Clinic with CRC from July 2001 to May 2010 were examined with particular emphasis on time to consultation, time to diagnosis, diagnostic method and time to treatment.

Results: CRC was diagnosed in 187 patients (123 rectal, 64 colon), at a rate of one case per ten Clinic days (every 5 days in 2005).  Patients presented with a wide range of symptoms, rectal bleeding and change in stool the most common.  87% had no family history of CRC.  74 (40%) patients were diagnosed immediately at the Clinic by either digital examination (DRE) or proctoscopy.  In 82% of those diagnosed immediately, the referring physician had not detected an abnormality, including 28 of 41 (68%) patients with a positive DRE.  Only 12 (6%) of the 187 had undergone proctoscopy by the referring physician.  35 (19%) had completed fecal occult blood studies prior to referral, 14% of these being falsely negative.  Median wait time from referral to Clinic consultation for routine patients was 11 calendar days (ave 14), and 6 days (ave 5) for ‘urgent’ patients.  Nearly a third of urgent patients (31%) were seen on the same or next day.  The Canadian national wait time in 2008 was 90 days.  Within 3 weeks of primary care referral, 85% of patients had undergone initial Clinic consultation.  97% were seen within the month.  The median time required from initial Clinic consultation to diagnosis was 6 days.  An endoscopic procedure was required to diagnose the majority (74%) of CRCs – proctoscopy 32 (17%), flexible sigmoidoscopy 64 (36%), colonoscopy 38 (21%).  Flexible sigmoidoscopy alone would have diagnosed 79% of all CRC patients in this group.  Following diagnosis, 49% of patients had their initial treatment planning session within 2 weeks.  While overall time from referral to treatment was reduced in Clinic patients, time from diagnosis to treatment was not.  Final pathological staging was available for over half of cases and was not obviously different from Canadian norms.

Conclusion: Specialist consultation and endoscopy is required to distinguish CRC patients from the larger group of patients presenting similarly.  Delay in specialist consultation and endoscopy is the most significant cause of delay in diagnosis and treatment of CRC.  A purpose-built out-of-hospital diagnostic centre can significantly reduce overall time to treatment by reducing time to diagnosis.

© Pezim Clinic, Vancouver, British Columbia, Canada