According to GLOBOCAN, colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancerrelated death, with 1.85 million new cases diagnosed worldwide in 2018. [1,2] The incidence of CRC appears to be increasing in emerging low-and middle-income countries (LMICs) owing to socioepidemiological transitions, including dietary changes, with countries in sub-Saharan Africa (SSA) reporting a notable increase in colorectal, breast and prostate cancer. [3,4] South Africa (SA) is no exception-the incidence of CRC is increasing steadily, and it was the sixth leading cause of cancer-related death in 2018. [1] It is noteworthy that apart from increasing incidence, the average age of CRC patients at the time of diagnosis in SSA is ~10 years younger than that observed in high-income countries (HICs). [5,6] In addition, other non-communicable diseases (NCDs), including diabetes and respiratory and cardiovascular disease, are on the rise, with the prevalence in SA being reported as two to three times higher than in HICs. [7] While there are no published data on comorbidity with CRC from SSA, many CRC cohorts from HICs describe a considerable comorbidity burden that adversely affects short-(30-day) and long-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
BACKGROUND: Data on colorectal cancer (CRC) diagnosis to treatment interval (DTI), an index of quality assurance in high-income countries (HICs) is lacking in South Africa. This study aimed to determine DTIs and their impact on CRC survival in a South African cohort METHODS: Participants (n = 289) from the Colorectal Cancer in South Africa (CRCSA) cohort were identified for inclusion. The DTI was defined as the duration between the diagnosis and initial definitive treatment and categorised into approximate quartiles (Q1-4). The DTI quartiles were 0-14 days, 15-28 days, 29-70 days, and > 71 days. Overall survival (OS) was illustrated using the Kaplan-Meier method and compared between DTI groups using Cox proportional hazards (PH) regression. RESULTS: There was no significant impact of the DTI (as quartiles) on overall CRC survival. The median length of time between DTI in this cohort was 29 days. Significant associations were identified between the DTI and self-reported ethnicity (p-value = 0.025), the site of the malignancy (colon vs rectum) (p-value < 0.0001), multidisciplinary team (MDT) review (p-value = 0.015) and the initial treatm.ent modality (p-value < 0.0001). CONCLUSION: Prolonged DTIs did not significantly impact survival for those with CRC in the CRCSA cohort. Symptom to diagnosis time should be investigated as a determinant of survival.
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