Colorectal cancer diagnosis wait time

Definition:

1. Wait time between abnormal fecal tests to follow-up colonoscopy through organized colorectal cancer screening
   • The median and 90^th percentile wait time (days) between an abnormal fecal test result and a follow-up colonoscopy required to resolve the diagnosis
   • Percentage of fecal tests with follow-up colonoscopy within the target wait times (60 days) through organized colorectal cancer screening
2. Wait time between follow-up colonoscopy to definitive diagnosis
   • The median and 90^th percentile wait time (days) between a follow-up colonoscopy and definitive pathological diagnosis

Rationale for measurement: Monitoring and reporting on colorectal cancer diagnosis wait times across Canada can help to reveal where efforts need to be targeted to improve how various parts of the system involved in screening and diagnosing colorectal cancer work together to ensure prompt resolution of abnormal results.

Measurement timeframe: Screening year 2015

Population:

1. Wait time between abnormal fecal tests to follow-up colonoscopy
   • Individuals aged 50-74 with an abnormal fecal test in the measure timeframe who went on to receive a colonoscopy within 180 days of the fecal test result

2. Wait time between follow-up colonoscopy to definitive diagnosis
   • Individuals aged 50-74 who had a follow-up colonoscopy that is within the measurement timeframe and that is within 180 days of the abnormal fecal test result

Measure:

1. Wait time between abnormal fecal tests to follow-up colonoscopy through organized colorectal cancer screening
   • Median and 90^th percentile time interval (days) between an abnormal fecal test and a follow-up colonoscopy
   • Percentage of fecal tests with follow-up colonoscopy within the target wait times
     Denominator: Individuals aged 50-74 with an abnormal fecal test in the measure timeframe who went on to receive a colonoscopy within 180 days of the fecal test result.
     Numerator: Number of individuals who received follow-up colonoscopy within 60 days of abnormal fecal tests.

2. Wait time between follow-up colonoscopy to definitive diagnosis
   • Median and 90^th percentile time interval (days) from a follow-up colonoscopy to definitive pathological diagnosis.

Exclusion criteria:

1. Wait time between abnormal fecal tests to follow-up colonoscopy through organized colorectal cancer screening
   • Screens outside of the programmatic colorectal screening were excluded
   • Colonoscopies received longer than 180 days after abnormal fecal tests were excluded

2. Wait time between follow-up colonoscopy to definitive diagnosis
   • Screens outside of the programmatic colorectal screening were excluded
   • Colonoscopies received longer than 180 days after abnormal fecal tests were excluded
   • Screens if no specimen is sent to pathology diagnosis were excluded

Data availability:

1. Wait time between an abnormal fecal test result and a follow-up colonoscopy: AB, BC, ON, NB, SK, MB, NS, PE, NL
2. Wait time (days) between a follow-up colonoscopy and definitive pathological diagnosis: BC, NB, SK, MB, NS, PE, NL

Stratification: By province

Data source: Provincial cancer agencies and programs

Data retrieval date: July – September 2017

Variables details: Not applicable

Notes from jurisdictions:

• AB: Yes, Alberta follows guidelines on the calculation of wait times for a follow-up colonoscopy. We exclude the individuals from the analysis, who had colonoscopy done outside 180 days time-frame. In the database, we are unable to identify patients that experienced delayed follow-up testing by choice.
• NB: NB follows the guidelines on the calculation of wait times for a follow-up colonoscopy or colorectal cancer diagnosis. It does not exclude individuals from the analysis, who have chosen to delay their colonoscopy appointments. During this period, Colon Cancer Screening was only accessible to 11% of the province (half the population in Health Zone 2).
• NL: Outliers that do not fall within the 180 days due to patient initiated scheduling delays are excluded. The NL colon screening program follows the recommendations of the National Colorectal Cancer Screening Network that works to have a follow up colonoscopy 60 days following a positive FIT result.
• NS: We have not excluded any individuals from this analysis. Only follow-up colonoscopies performed within the screening program were included for analysis. Approximately 10% of FIT+ patients decline the services offered by the program.
• ON: Individuals who have chosen to delay their colonoscopy appointments were included in the calculation. Our calculation of wait times restricts to Ontario screen-eligible individuals, 50–74 years old, with an abnormal program FOBT result in 2015, who underwent colonoscopy within 180 days of the abnormal FOBT result. We exclude from our calculation the following individuals: a) those with a missing or invalid HIN, date of birth, sex or postal code, b) those with an invasive colorectal cancer before the abnormal FOBT date, and c) those with a total colectomy before the abnormal FOBT date.

Methodology notes:

1. Data were analyzed and provided by provincial breast cancer screening programs.
2. Considerations about wait time between abnormal fecal tests to follow-up colonoscopy through organized colorectal cancer screening
   • The date of the abnormal fecal test is the date that the result is reported by the laboratory for each individual.
   • The fecal test must be performed within the organized screening program, but the follow-up colonoscopy can be performed within or outside of the screening program.
   • Each individual is counted once regardless of the number of fecal tests performed. If an individual had multiple abnormal fecal tests in a given year(s), the first abnormal test date is selected.
   • If multiple follow-up colonoscopies are performed after the abnormal fecal test, count the first colonoscopy after the abnormal fecal test.
   • All colonoscopies are included regardless of whether they are complete (for whatever reason)
3. Consideration about wait time between follow-up colonoscopy to definitive diagnosis
   • The measurement timeframe refers to the date of the colonoscopy.
   • The date of definitive pathological diagnosis refers to the date of the initial pathological report after a colonoscopy that confirms the presence (or absence) of colorectal cancer or adenoma.
   • Include both complete and incomplete colonoscopies – as long as there is definitive diagnosis via a pathology report
   • The fecal test must be performed within the organized screening program, but the follow-up colonoscopy can be performed within or outside of the screening program.
   • Each individual is counted once regardless of the number of fecal tests performed. If an individual had multiple abnormal fecal tests in a given year(s), the first abnormal test date is selected.
   • If multiple follow-up colonoscopies are performed after the abnormal fecal test, count the first complete colonoscopy after the abnormal fecal test.

Changes to definition compared to previous years: Not applicable