Objectives/purpose
This study aimed to examine the alignment of colorectal cancer (CRC) care with Optimal Care Pathway (OCP) time-to-action points and explore associations with patient characteristics, five-year survival, and healthcare costs. Particular focus was given to priority populations, including those from socioeconomically disadvantaged and geographically remote areas.
Sample and setting
A retrospective cohort study was conducted using linked data from the Victorian Cancer Registry and the Victorian Admitted Episodes Dataset. The sample included 26,392 patients diagnosed with CRC (ICD C18–20) in Victoria between January 2009 and December 2022.
Procedures
OCP alignment was operationalised using treatment timeframes outlined in the CRC OCP. Logistic regression models examined associations between OCP alignment, demographic and clinical variables, and five-year survival. Generalised linear models were used to assess differences in hospital costs.
Results
Patients diagnosed at Stage II or III were significantly more likely to receive OCP-aligned care. Those from higher socioeconomic areas had increased odds of OCP alignment and improved survival. Alignment with OCP was associated with 39% lower odds of death (OR 0.61, p < 0.001). A clear socioeconomic gradient in survival was observed, with individuals in the highest SEIFA quintile experiencing a 30% reduction in odds of death compared to the most disadvantaged group. OCP-aligned patients incurred higher hospital costs, particularly for supportive services including allied health, imaging, nursing, and pathology, with average total costs $2,598 higher than for non-aligned patients (p = 0.011).
Conclusion and clinical implications
While OCP-aligned care is associated with improved survival, it disproportionately benefits socioeconomically advantaged groups. Implementation efforts must address these disparities to ensure equitable access to high-quality, guideline-concordant care. Future research should explore barriers to timely treatment and assess the cost-effectiveness of OCP implementation to guide policy and practice.