Delay in the presentation of colorectal carcinoma: a review of causation

Carter, S.; Winslet, MC

doi:10.1007/s003840050127

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…It is encouraging to note that most of these papers have been published since 1990; almost half in the last decade. Furthermore, we identified considerably more evidence than previous narrative and systematic reviews conducted as part of evidence-based guidelines (Carter and Winslet, 1998;Scottish Intercollegiate Guidelines Network, 2003).…”

Section: Discussionmentioning

confidence: 97%

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

et al. 2007

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Colorectal cancer is a major global health problem, with survival varying according to stage at diagnosis. Delayed diagnosis can result from patient, practitioner or hospital delay. This paper reports the results of a review of the factors influencing pre-hospital delay -the time between a patient first noticing a cancer symptom and presenting to primary care or between first presentation and referral to secondary care. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Fifty-four studies were included. Patients' non-recognition of symptom seriousness increased delay, as did symptom denial. Patient delay was greater for rectal than colon cancers and the presence of more serious symptoms, such as pain, reduced delay. There appears to be no relationship between delay and patients' age, sex or socioeconomic status. Initial misdiagnosis, inadequate examination and inaccurate investigations increased practitioner delay. Use of referral guidelines may reduce delay, although evidence is currently limited. No intervention studies were identified. If delayed diagnosis is to be reduced, there must be increased recognition of the significance of symptoms among patients, and development and evaluation of interventions that are designed to ensure appropriate diagnosis and examination by practitioners.

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Section: Discussionmentioning

confidence: 97%

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

et al. 2007

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“…Our data showed there was a relatively short delay in both colon cancer (82 days) and rectal cancer (114 days). However, this result should be objectively evaluated because the interval might be affected by various factors (patient, practitioner or hospital), and patients with a high awareness of health may consult a physician much earlier than those without. Unfortunately, the Chinese patients were found to have a low awareness of CRC, which leads to a delayed consultation with their doctors.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing diagnosis of colorectal cancer: A hospital‐based survey in China

Deng

Gao

et al. 2012

J of Digest Diseases

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Objective To investigate the diagnostic status of colorectal cancer (CRC) and the influence of early diagnosis and cancer stage in a tertiary care hospital in China. Methods Face‐to‐face interviews were conducted in 364 consecutive CRC patients who had never participated in CRC screening. Initial symptoms, diagnosis and treatment delay were determined using a questionnaire. Factors influencing diagnostic status were analyzed using univariate analysis and logistic regression model. Results A total of 307 patients were enrolled, in which 128 were with colon cancer and 179 with rectal cancer. The duration of diagnosis delay was significant longer than that of treatment delay. Unlike rectal cancer, colon cancer was likely to be treated at an advanced stage with a short interval between symptom onset and treatment. Colon cancer patients with a history of biliary tract or gallbladder stones, aged ≥ 50 years and with abdominal mass or intestinal obstruction as the initial symptom were diagnosed and treated much earlier. In rectal cancer, women and non‐smokers were diagnosed and treated quickly. Factors correlated with early cancer stage were found in colon cancer, including bloody stool as the initial symptom (OR = 2.63, 95% CI 1.08–6.25, P = 0.034) and a history of appendectomy (OR = 4.00, 95% CI 1.15–14.29, P = 0.029). Conclusions The factors contributing to early cancer detection were identified but their clinical value is limited. Diagnosis by symptoms suggesting CRC needs to be improved and CRC screening should be vigorously promoted.

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“…Deciding to seek medical advice can be a complex decision in light of such an uncertain situation. According to Carter and Winslet (1998), there are many reasons why a patient may not actually call a physician: the symptom is not deemed serious enough, it is too unpleasant or embarrassing, a wait-and-see policy is adopted, investigation is feared, the cause is already known, a serious underlying condition is suspected, there may be an association with a dietary indiscretion, a lack of faith in physicians, or a lack of time to consult a physician. According to Hackett and his colleagues (Hackett, Cassem, & Raker, 1973), what eventually sent patients to seek medical assistance was pain, incapacity, fear, advice from a friend or relative, or attending a routine medical check-up.…”

Section: Discussionmentioning

confidence: 99%

Women’s experiences with ovarian cancer: Reflections on being diagnosed

Fitch¹,

Deane²,

Howell³

et al. 2003

CONJ

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The purpose of this qualitative study was to describe the perspectives of women living with ovarian cancer about their experiences with diagnosis, treatment, and follow-up care. A convenience sample of 18 women was interviewed using an openended interview guide. This paper will focus on their perspectives during the peri-diagnostic period.Most of the women in this study experienced changes in their bodies -bloating, weight gain around their middles, indigestion, bowel changes, and abdominal pain. The vagueness of the symptoms and lack of awareness by the women and, in the women's opinion, health care professionals caused delays in diagnosis and initial investigations of other body systems. The symptoms were often dismissed by the women as being related to normal body changes such as childbirth, menopause, or stress responses. It was often not until the women's symptoms became severe or included pain that referrals were made to relevant specialists. At this point, many of the women were physically and emotionally spent, leaving them vulnerable and in a weakened state for confronting the diagnosis and coping with the difficult course of treatment. Clearly, the subtle, nebulous nature of the symptoms confounded the diagnosis of ovarian cancer for these women, resulting in patient delays and physician delays.Implications emerge from this work for better screening tests as well as public, patient, and health professional education about the warning signs and symptoms of ovarian cancer.

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Delay in the presentation of colorectal carcinoma: a review of causation

Cited by 18 publications

References 21 publications

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

Factors influencing diagnosis of colorectal cancer: A hospital‐based survey in China

Women’s experiences with ovarian cancer: Reflections on being diagnosed

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