Colorectal Cancer Diagnosis Wait Time

  • Charts and Tables

    Charts and Tables

    Figure 3.3

    Median and 90th percentile wait times from abnormal fecal test result to follow-up colonoscopy, by province — first-round screening tests conducted in 2013 and 2014

    Data include colonoscopies performed within 180 days of abnormal fecal test results.
    Target: The Canadian Association of Gastroenterology recommends that colonoscopy be completed within 60 days of an abnormal fecal test.
    Data source: National Colorectal Cancer Screening Network.

    Data Table

    ProvinceMedian wait time (days)90th percentile wait time (days)
    BC92150
    AB65139
    SK61119
    MB56119
    NS83147
    PE88151
    NL37104

    Data include colonoscopies performed within 180 days of abnormal fecal test results.
    Target: The Canadian Association of Gastroenterology recommends that colonoscopy be completed within 60 days of an abnormal fecal test.
    Data source: National Colorectal Cancer Screening Network.

  • About this indicator

    About this indicator

    Key message

    Wait times from an abnormal fecal test result to follow-up colonoscopy are decreasing, but no provinces have achieved 90th percentile wait times within the 60 day target.

    Indicator definition

    The median and 90th percentile wait time between an abnormal fecal test result and a follow-up colonoscopy required to resolve the diagnosis among people screened by provincial colorectal cancer screening programs in 2013 and 2014. The results are reported by province.

    Target

    60 days from an abnormal fecal test result to follow-up colonoscopy, recommended by the Canadian Association of Gastroenterology.1

    Measured since

    The 2012 Cancer System Performance Report.

    Why measure this?

    Timely resolution of an abnormal fecal test result leads to a shortened period of uncertainty and less anxiety for people who turn out to have a negative diagnosis (no cancer) and to earlier detection and prompt initiation of treatment for people with a positive diagnosis (cancer), which could improve treatment outcomes. For example, early detection of colorectal cancers through screening using the guaiac fecal occult blood test and removal of polyps during follow-up colonoscopy—the recommended diagnostic test for follow-up of an abnormal fecal test result—has been shown to reduce colorectal cancer mortality.2 As a result, a wait time target based on pan-Canadian consensus on the medically acceptable wait time from abnormal fecal test to follow-up colonoscopy has been set.1

    What are the key findings?

    • In 2013 and 2014, 90th percentile wait times from an abnormal fecal test result to follow-up colonoscopy ranged from 104 days in Newfoundland and Labrador to 151 days in Prince Edward Island (seven provinces submitted data) (Figure 3.3). None of the provinces had 90th percentile wait times below the 60 day target.
    • From 2011–12 to 2013–14, 90th percentile wait times decreased for all provinces (Saskatchewan, Manitoba, Prince Edward Island and Newfoundland and Labrador) that reported data for the two time periods; the decrease ranged from four days in Prince Edward Island to 55 days in Newfoundland and Labrador (data not shown).

    Why do these findings matter?

    Although wait times are decreasing, many people with an abnormal fecal test result continue to wait several months for a follow-up colonoscopy needed to resolve the diagnosis. Timely resolution of an abnormal fecal test result can reduce the stress and anxiety patients and their families experience. As of 2012, all provinces had developed or were developing organized colorectal cancer screening programs. It is important to note, however, that colorectal cancer screening programs are still in the early stages of implementation in some provinces. Improvements may be seen as the programs mature. Improving colorectal cancer diagnosis wait times requires that many parts of the system involved in screening and diagnosis colorectal cancer work together at multiple levels to drive for efficient processes and minimize wait times.

    References

    1. Paterson WG, Depew WT, Pare P, Petrunia D, Switzer C, Veldhuyzen van Zanten SJ, et al. Canadian consensus on medically acceptable wait times for digestive health care. Can J Gastroenterol. 2006 Jun;20(6):411-23.
    2. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L. Cochrane Systematic Review of Colorectal Cancer Screening Using the Fecal Occult Blood Test (hemoccult): An Update. Am J Gastroenterol. 2008;103(6):1541-9.
  • Data specifications

    Data specifications

    Definition: The median and 90th percentile wait time (days) between an abnormal fecal test result and a follow-up colonoscopy required to resolve the diagnosis among people screened by provincial colorectal cancer screening programs

    Population: Individuals with an abnormal fecal test (from colorectal cancer screening) who went on to receive a colonoscopy within 180 days of the fecal test result

    Data source: National Colorectal Cancer Screening Network

    Measurement timeframe: 2013 – 2014 screening year

    Stratification variables: Province

    Provinces submitting data: BC, AB, SK, MB, NS, PE, NL

    Province-specific notes:

    • BC: Started colorectal screening program on November 15, 2013. The data were based on the period from November 15, 2013 to December 31, 2014.
    • AB: Multiple databases had been used to capture the follow-up colonoscopies, such as the National Ambulatory Care Reporting System (NACRS), the Discharge Abstract Database (DAD) and claims. The uptake rates were underestimated due to incomplete colonoscopy data, which was caused by delays between the time of colonoscopy and the time the colonoscopy was reported to the databases. In general, reporting delays for NACRS and DAD are at least 1.5 months; some clinics might have longer delay periods. The available physician claims data in the data warehouse covers until March 31, 2014.
    • PE: Some of the individuals with long waits for colonoscopy had used the FOBT kit after a recent colonoscopy. This is not in line with guidelines and results in skewed wait time results.

    Notes:

    1. Date of abnormal fecal test is the date the result is reported by the laboratory for each individual test; if there is more than one abnormal fecal test, the date of the first test is used.
    2. The colonoscopy may have been performed inside or outside of the screening program but only for individuals who had their fecal test performed in the screening program.
  • Related indicators