A paradox explained? Patients with delayed diagnosis of symptomatic colorectal cancer have good prognosis

Rupassara, K. S.; Ponnusamy, Shanthi; Withanage, N.D.; Milewski, P. J.

doi:10.1111/j.1463-1318.2006.00958.x

Cited by 55 publications

(53 citation statements)

References 14 publications

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“…The staging of the tumours and the proportions with left-or right-sided tumours or with emergency admissions are also similar. The finding of no relationship between the duration of symptoms and staging or mortality -even with our robust methods of identifying the duration -matches previous reports (Stubbs and Long, 1986;Barillari et al, 1989;Kyle et al, 1991;Mulcahy and O'Donoghue, 1997;Majumdar et al, 1999;Roncoroni et al, 1999;Kiran and Glass, 2002;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004;Bharucha et al, 2005;Khattak et al, 2006;Rupassara et al, 2006). It is likely that two effects are cancelling each other out: inherent biological features of the tumour and ease of diagnosis.…”

Section: Comparison Of Findings With Previous Literaturesupporting

confidence: 86%

“…There is a clear relationship between the staging of the cancer and mortality (Mulcahy and O'Donoghue, 1997;Roncoroni et al, 1999;Ponz de Leon et al, 2000;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004). Conversely, most studies have shown no relationship between the duration of symptoms and staging or mortality (Stubbs and Long, 1986;Barillari et al, 1989;Kyle et al, 1991;Mulcahy and O'Donoghue, 1997;Majumdar et al, 1999;Roncoroni et al, 1999;Kiran and Glass, 2002;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004;Bharucha et al, 2005;Khattak et al, 2006;Rupassara et al, 2006). Some have reported an inverse relationship, with a shorter duration of symptoms being associated with both worse staging and worse prognosis (Mulcahy and O'Donoghue, 1997;Olsson et al, 2004;Rupassara et al, 2006).…”

mentioning

confidence: 99%

“…Conversely, most studies have shown no relationship between the duration of symptoms and staging or mortality (Stubbs and Long, 1986;Barillari et al, 1989;Kyle et al, 1991;Mulcahy and O'Donoghue, 1997;Majumdar et al, 1999;Roncoroni et al, 1999;Kiran and Glass, 2002;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004;Bharucha et al, 2005;Khattak et al, 2006;Rupassara et al, 2006). Some have reported an inverse relationship, with a shorter duration of symptoms being associated with both worse staging and worse prognosis (Mulcahy and O'Donoghue, 1997;Olsson et al, 2004;Rupassara et al, 2006). Once emergency admissions, which generally have a shorter duration of symptoms, are corrected for, this inverse relationship disappears (Mulcahy and O'Donoghue, 1997;Olsson et al, 2004;Rupassara et al, 2006).…”

mentioning

confidence: 99%

“…Some have reported an inverse relationship, with a shorter duration of symptoms being associated with both worse staging and worse prognosis (Mulcahy and O'Donoghue, 1997;Olsson et al, 2004;Rupassara et al, 2006). Once emergency admissions, which generally have a shorter duration of symptoms, are corrected for, this inverse relationship disappears (Mulcahy and O'Donoghue, 1997;Olsson et al, 2004;Rupassara et al, 2006). Only two previous studies have examined the relationship between the first symptom of the cancer and mortality (Gonzalez-Hermoso et al, 2004;Korsgaard et al, 2006).…”

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confidence: 99%

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The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

Stapley¹,

et al. 2006

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The association between the staging of colorectal cancer and mortality is well known. Much less researched is the relationship between the duration of symptoms and outcome, and whether particular initial symptoms carry a different prognosis. We performed a cohort study of 349 patients with primary colorectal cancer in whom all their prediagnostic symptoms and investigation results were known. Survival data for 3 -8 years after diagnosis were taken from the cancer registry. Six features were studied: rectal bleeding, abdominal pain, diarrhoea, constipation, weight loss, and anaemia. Two of these were significantly associated with different staging and mortality. Rectal bleeding as an initial symptom was associated with less advanced staging (odds ratio from one Duke's stage to the next 0.50, 95% confidence interval 0.31, 0.79; P ¼ 0.003) and with reduced mortality (Cox's proportional hazard ratio (HR) 0.56 (0.41, 0.79); P ¼ 0.001. Mild anaemia, with a haemoglobin of 10.0 -12.9 g dl À1 , was associated with more advanced staging (odds ratio 2.2 (1.2, 4.3); P ¼ 0.021) and worse mortality (HR 1.5 (0.98, 2.3): P ¼ 0.064). When corrected for emergency admission, sex, and the site of the tumour, the HR for mild anaemia was 1.7 (1.1, 2.6); P ¼ 0.015. No relationship was found between the duration of symptoms and staging or mortality.

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Section: Comparison Of Findings With Previous Literaturesupporting

confidence: 86%

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confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

Stapley¹,

et al. 2006

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“…[7][8][9][10] For the rest of this review, I concentrate upon activity between B and D, so from first presentation to referral for definitive investigation and take most of my examples from the four commonest cancers, breast, prostate, lung, and colorectal.…”

Section: Introductionmentioning

confidence: 99%

Cancer diagnosis in primary care

2010

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Around a quarter of those in the developed world die of cancer. Most cancers present to primary care with symptoms, even when there is a screening test for the particular cancer. However, the symptoms of cancer are also symptoms of benign disease, and the GP has to judge whether cancer is a possible explanation. Very little research examined this process until relatively recently. This review paper examines the process of primary care diagnosis, especially the selection of patients for rapid investigation. It concentrates on the four commonest UK cancers: breast, lung, colon, and prostate as these have been the subject of most recent studies.

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Analysis of Time to Treatment and Survival Among Adults Younger Than 50 Years of Age With Colorectal Cancer in Canada

et al. 2023

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ImportanceColorectal cancer (CRC) is uncommon in adults younger than 50 years of age, so this population may experience delays to treatment that contribute to advanced stage and poor survival.ObjectiveTo investigate whether there is an association between time from presentation to treatment and survival in younger adults with CRC.Design, Setting, and ParticipantsThis retrospective cohort study used linked population-based data in Ontario, Canada. Participants included patients with CRC aged younger than 50 years who were diagnosed in Ontario between 2007 and 2018. Analysis was performed between December 2019 and December 2022.ExposureAdministrative and billing codes were used to identify the number of days between the date of first presentation and treatment initiation (overall interval).Main Outcomes and MeasuresThe associations between increasing overall interval, overall survival (OS), and cause-specific survival (CSS) were explored with restricted cubic spline regression. Multivariable Cox proportional hazards models were also fit for OS and CSS, adjusted for confounders. Analyses were repeated in a subset of patients with lower urgency, defined as those who did not present emergently, did not have metastatic disease, did not have cross-sectional imaging or endoscopy within 14 days of first presentation, and had an overall interval of at least 28 days duration.ResultsAmong 5026 patients included, the median (IQR) age was 44.0 years (40.0-47.0 years); 2412 (48.0%) were female; 1266 (25.2%) had metastatic disease and 1570 (31.2%) had rectal cancer. The lower-urgency subset consisted of 2548 patients. The median (IQR) overall interval was 108 days (55-214 days) (15.4 weeks [7.9-30.6 weeks]). Patients with metastatic CRC had shorter median (IQR) overall intervals (83 days [39-183 days]) compared with those with less advanced disease. Five-year overall survival was 69.8% (95% CI, 68.4%-71.1%). Spline regression showed younger patients with shorter overall intervals (&lt;108 days) had worse OS and CSS with no significant adverse outcomes of longer overall intervals. In adjusted Cox models, overall intervals longer than 18 weeks were not associated with significantly worse OS or CSS compared with those waiting 12 to 18 weeks (OS: HR, 0.83 [95% CI, 0.67-1.03]; CSS: HR, 0.90 [95% CI, 0.69-1.18]). Results were similar in the subset of lower-urgency patients, and when stratified by stage.Conclusions and relevanceIn this cohort study of 5026 patients with CRC aged younger than 50 years of age in Ontario, time from presentation to treatment was not associated with advanced disease or poor survival. These results suggest that targeting postpresentation intervals may not translate to improved outcomes on a population level.

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A paradox explained? Patients with delayed diagnosis of symptomatic colorectal cancer have good prognosis

Cited by 55 publications

References 14 publications

The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

Cancer diagnosis in primary care

Analysis of Time to Treatment and Survival Among Adults Younger Than 50 Years of Age With Colorectal Cancer in Canada

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