Delay in Treatment of Colorectal Cancer: Multifactorial Problem

Abstract

The stage of a colorectal carcinoma represents the most important prognostic factor regarding the probability of survival. The primary objective of this study was to document the management of patients with colorectal carcinoma after onset of symptoms. Factors influencing the delay in definitive therapy should thus be determined. Anthropometric, social, and operative data were obtained by standardized questionnaires from 40 patients with colonic cancer and 30 patients with rectal cancer. The influence of delayed treatment on outcome was analyzed. A significant correlation was found for the time between onset of first symptoms and definitive surgical therapy with tumor stage (colon cancer: r = 0.52, p < 0.05; colorectal cancer: r = 0.62, p < 0.05). The time delay in rectal carcinoma patients averaged 224 days and in patients with colonic carcinoma 149 days. Social influences such as profession, type of education, marital status, and quality of health insurance had a significant influence on treatment delay, as did the clinical experience of the physician first contacted. The leading symptom in patients with rectal cancer was peranal hemorrhage, and in patients with colonic cancer it was abdominal pain. The main causes of iatrogenic delay were insufficient clinical investigation and a lack of awareness when typical first symptoms were present. Delayed treatment of colorectal cancer seems to be a multifactorial problem. Causes for such delay are found not only in the patients and their social environments but also in the type and quality of their medical care systems. Intensified education and earlier prevention are the major aims for patients and their physicians.

Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the ‘National Survey of NHS Patients: Cancer’

“…The GLM showed that the significant factors varied by cancer type. Looking at total delay, for colorectal, age, and marital status were the key factors in explaining the variation in delays; this strengthens the limited evidence base to date (Langenbach et al, 2003;Gonzalez-Hermoso et al, 2004;Robertson et al, 2004). For lung and ovarian cancer, none of the factors stood out as being important.…”

“…Similarly, there are conflicting findings from the colorectal literature, although this is more limited. One paper has reported faster time to treatment in patients aged 50 -74 years (Robertson et al, 2004), another has reported that age and gender were not associated with differences in delays (GonzalezHermoso et al, 2004); and another that marital status is one of several multifactorial reasons for delay (Langenbach et al, 2003).…”

Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer

“…-13 days (Sainsbury et al, 1999) 11 days (Jones et al, 1992) 9 days (urgent referrals) (Spurgeon et al, 2000) 14 days (nonurgent referrals) (Spurgeon et al, 2000) 13 days (Nosarti et al, 2000) -1/3 experience total pre-hospital delays of 412 weeks Provider delay of 1 Week (Thulesius et al, 2004) Colorectal -60 days (Aithal and Tanner, 1996) 27.5 days (Thongsuksai et al, 2000) 46 weeks (54%) (Robinson et al, 1986) 16.2 days (mean, rectum) (Holliday and Hardcastle, 1979) 12.7 days (mean, colon) (Holliday and Hardcastle, 1979) 20 -66%) 43 months (Graffner and Olsson, 1986) 47%46 weeks (Robinson et al, 1986) 15.3 days (mean, rectum) (Holliday and Hardcastle, 1979) 11.2 days (mean, colon) (Holliday and Hardcastle, 1979) 20 -34% 43 months (Holliday and Hardcastle, 1979) 16 days (Aithal and Tanner, 1996) 11 days (Jones et al, 1992) 13 days (urgent referrals) (Spurgeon et al, 2000) 27 days (nonurgent referrals) (Spurgeon et al, 2000) 15 days (Aithal and Tanner, 1996) 17 days (mean 52) (Potter and Wilson, 1999) Mean delay to treatment delay: 244 days (Rectal), 149 days (colon) (Langenbach et al, 2003) Lung 4.6 months (mean 5.8) (Myrdal et al, 2004) 189 days (Koyi et al, 2002) 109 days (Billing and Wells, 1996) 21 days (mean 43) (Koyi et al, 2002) 31 days (Jones et al, 1992) 33 days (mean 56) (Koyi et al, 2002) 7 days (Jones et al, 1992) 7 days (urgent referrals) …”

The “two-week wait” referral pathway allows prompt treatment but does not improve outcome for patients with oesophago-gastric cancer

“…[1] However, the evidence supporting a link between delay in diagnosis and poorer cancer outcome is weak. [14][15][16][17][18][19][20][21][22][23][24][25] The greatest number of studies examining diagnostic delays have been in patients with breast…”