Age at death and the effect of lead‐time bias in patients with colorectal cancer: a 10‐year follow‐up

Abstract

Aim Studies addressing the benefit of early intervention are prone to lead-time bias, which results in an artificial improvement in cancer-specific mortality. We have previously compared the age at death for patients with colorectal cancer presenting on an emergency or elective basis. In this study, we aimed to repeat the analysis with a minimum follow-up of 10 years.Method A nonscreen-detected cohort of patients presenting with colorectal cancer to three Lanarkshire Hospitals between 2000 and 2006 were entered into a prospective database, with analysis performed on 28 November 2016. The following data were collected: age at death, presentation type (emergency/elective), operative intent (palliative/curative) and Dukes stage. Results are presented as [mean (95% confidence intervals)]. Statistical analysis was undertaken using Student's t-test and multivariate analysis performed using Cox proportional hazard models.Results One thousand six hundred and thirty-six patients were identified. Elective patients presented younger than emergency patients [67.9 (67.3-68.5) vs 70.9 (69.6-72.2) years; P < 0.0001]. Overall mortality was 71.1% at time of analysis; no difference was seen in the mean age at death between emergency and elective presentation [73.5 (72.4-74.8) vs 73.6 (72.3-74.9) years; P = 0.841].Conclusion Current early detection strategies to diagnose colorectal cancer may improve cancer-specific survival by increasing lead-time bias. However, in our cohort of symptomatic patients, treatment on an elective or emergency basis does not influence overall survival. These data suggest that in selected patients, particularly where there is comorbidity, it may be reasonable to adopt a more expectant approach to investigate and treat colorectal symptoms.

The diagnostic accuracy of the faecal immunohistochemical test in identifying significant bowel disease in a symptomatic population

“…The impact that increased usage of the FIT as a triage tool is having on overall life expectancy of patients needs further research, particularly in the older population or in those with significant comorbidities, where lead-time bias needs to be considered [31].…”

“…Forty per cent of those diagnosed with CRC in this cohort had died by time of follow‐up and were more likely to die of non colorectal‐related causes than the rest of the cohort, which could indicate other medical co‐morbidities or the effect of age or frailty. The impact that increased usage of the FIT as a triage tool is having on overall life expectancy of patients needs further research, particularly in the older population or in those with significant co‐morbidities, where lead‐time bias needs to be considered [31].…”

What are the physical and mental health implications of duration of untreated psychosis?

“…LTB refers to the latency between the time in which an early diagnosis is established and the time in which a disorder would have been diagnosed without early detection or screening, which artificially increases the time before a poor outcome occurs. LTB has been observed in cancer research [3], affecting such essential outcome as mortality.…”

“…LTB refers to the latency between the time in which an early diagnosis is established and the time in which a disorder would have been diagnosed without early detection or screening, which artificially increases the time before a poor outcome occurs. LTB has been observed in cancer research [3], affecting such essential outcome as mortality. According to this scenario, efforts to carry out early detection and early intervention strategies would be mostly futile, which questions the need of primary and secondary prevention in the psychotic disorders field.…”