Waiting times in the colorectal cancer treatment pathway in a Sri Lankan cohort: data from a specialised tertiary care setting

Abstract

INTRODUCTION Colorectal cancer (CRC) is the third most prevalent cancer in Sri Lanka, with rising incidence rates over the past decade. Timely intervention is essential for favourable outcomes, but prolonged waiting times remain a significant healthcare challenge globally. This study examines the time intervals between key steps in the CRC diagnostic and treatment pathway to identify potential areas for reducing delays. METHODS A cohort of 108 patients with suspected CRC symptoms, presenting to the University Surgical Unit at North Colombo Teaching Hospital from 2017 to 2024, was analysed. Data were collected on time intervals between: [1] symptom onset to primary care visit, [2] General Practitioner (GP) referral to specialist consultation, [3] specialist consultation to colonoscopy, [4] colonoscopy to imaging or neoadjuvant chemo-radiotherapy (NCRT), and [5] colonoscopy to surgery. Median times for each interval were calculated. RESULTS Of the 108 patients (36.1% male, median age 63), the median time from symptom onset to GPvisit was 11 weeks. Patients referred by GPs waited a median of 3 weeks for specialist consultation. Two-thirds underwent colonoscopy within 2 weeks of specialist consultation, with 78% completing it within 4 weeks. For patients not requiring NCRT, the median time from colonoscopy to surgery was 3.86 weeks; for those requiring NCRT, it was 12.86 weeks. CONCLUSIONS Waiting times for colonoscopy and curative surgery are within the accepted universal standards for colorectal cancer management, in this cohort. The delay in patient presentation to primary care was notably longer than physician-related delays. Early specialist referral for bowel symptoms may reduce time to diagnosis and treatment, aligning colonoscopy-to-treatment intervals with international standards.