Poster Presentation COSA 2015 ASM

Evaluating a direct access colonoscopy program for suspected colorectal cancer. (#334)

Sheryl Sim 1 , Penny Allen 2 , Lavinia Tan 3 , Lucy Gately 4 , Patricia Banks 1 , Adrian Lee 2 , Garry Hamilton 2
  1. Peter MacCallum Cancer Centre/North West Regional Hospital, Burnie, TAS, Australia
  2. University of Tasmania, Burnie, Tasmania
  3. Barwon Health, Geelong, Victoria
  4. The Alfred Hospital, Prahran, Victoria, Australia

Aim:
Direct access colonoscopy (DAC) is a system that allows general practitioners to refer directly for a colonoscopy without a prior specialist clinic review and has been shown to significantly reduce waiting times to diagnosis and treatment 1. In July 2010, a DAC program was introduced to North West Regional Tasmania. The aim of this study was to determine if the DAC program improved time from referral to diagnosis and definitive colorectal cancer treatment.

Methods:
All pathological diagnoses of colorectal cancer from 2009 to 2012 (pre-DAC from 1/1/2009 to 30/6/10 and post DAC 1/1/11 to 30/6/12)were obtained from North West Regional Pathology, the sole pathology provider in the region. Data including time to scope, time to treatment, and demographics, were retrieved from paper records for analysis of differences between standard referrals (SR), Emergency Department (ED)/Inpatient referrals and DACs

Results:
206 colorectal cases were identified (118 SR, 26 DAC, 47 ED/inpatient and 15 referrals from unknown pathway). The gender distribution, mean age and number of presenting symptoms were equally balanced in the 3 groups. The majority of faecal occult blood (FOB) positive patients were referred through SR rather than DAC (73% vs 23%). Mean time to scope was not significantly improved with DAC [7 (SD 5.6) vs 9 (SD 8.9) weeks; p=0.21]. Mean time to definitive treatment (surgery or chemoradiotherapy) was not significantly improved with DAC [ 11 (SD 9.8) vs 11 (SD 9.4) weeks, p=0.88]. When rectal cancer cases requiring neoadjuvant chemoRT were excluded, the difference in mean time to surgery was not significant.

Conclusions:
DAC failed to improve time to diagnosis and definitive treatment. With unforeseen low numbers of patients in DAC, this study may not have been sufficiently powered to detect a difference. More patients, particularly the FOB positive patients should have been considered for DAC. Mean waiting times for the DAC group were longer than expected. Further work to educate general practitioners about the direct access program and ways to reduce time to diagnosis and treatment are needed.