Factors influencing time from presentation to treatment of colorectal and breast cancer in urban and rural areas

Abstract

Stage at diagnosis and survival from cancer vary according to where people live, suggesting some may have delays in diagnosis. The aim of this study was to determine if time from presentation to treatment was longer for colorectal and breast cancer patients living further from cancer centres, and identify other important factors in delay. Data were collected on 1097 patients with breast and 1223 with colorectal cancer in north and northeast Scotland. Women with breast cancer who lived further from cancer centres were treated more quickly than those living closer to cancer centres (P ¼ 0.011). Multilevel modelling found that this was largely due to them receiving earlier treatment at hospitals other than cancer centres. Breast lump, change in skin contour, lymphadenopathy, more symptoms and signs, and increasing age predicted faster treatment. Screen detected cancers and private referrals were treated more quickly. For colorectal cancer, time to treatment was similar for people in rural and urban areas. Quicker treatment was associated with palpable rectal or abdominal masses, tenesmus, abdominal pain, frequent GP consultations, age between 50 and 74 years, tumours of the transverse colon, and iron medication at presentation. Delay was associated with past anxiety or depression. There was variation between general practices and treatment appeared quicker at practices with more female general practitioners.

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

“…For NHL, age was an important factor. For breast cancer, marital status and ethnic group were important factors, again strengthening the current evidence base (Tartter et al, 1999;Nosarti et al, 2000;Thongsuksai et al, 2000;Arndt et al, 2002;Meechan et al, 2002;Gwyn et al, 2004;Robertson et al, 2004). The trends in the associations using both statistical approaches were all in the same direction for each of the six cancers.…”

“…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.…”

“…No associations have been reported with patient delays (Nosarti et al, 2000;Meechan et al, 2002) or physician delays (Tartter et al, 1999). Longer delays have been associated with older age (Arndt et al, 2002), but faster times to treatment have also been associated with increasing age (Robertson et al, 2004). Other positive findings from the literature include: African-American women having longer delays than white women (Gwyn et al, 2004), and unmarried women having longer patient delays than married women (Thongsuksai et al, 2000).…”

“…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).…”

Social and geographical factors influencing the delay in treatment for colorectal cancer

“…In a recent issue, Robertson et al (2004) reported on the time from presentation to treatment of colorectal and breast cancers in Scottish urban and rural areas.…”