Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer

Abstract

BackgroundColorectal cancer (CRC) survival depends mostly on stage at the time of diagnosis. However, symptom duration at diagnosis or treatment have also been considered as predictors of stage and survival. This study was designed to: 1) establish the distinct time-symptom duration intervals; 2) identify factors associated with symptom duration until diagnosis and treatment.MethodsThis is a cross-sectional study of all incident cases of symptomatic CRC during 2006–2009 (795 incident cases) in 5 Spanish regions. Data were obtained from patients’ interviews and reviews of primary care and hospital clinical records. Measurements: CRC symptoms, symptom perception, trust in the general practitioner (GP), primary care and hospital examinations/visits before diagnosis, type of referral and tumor characteristics at diagnosis. Symptom Diagnosis Interval (SDI) was calculated as time from first CRC symptoms to date of diagnosis. Symptom Treatment Interval (STI) was defined as time from first CRC symptoms until start of treatment. Nonparametric tests were used to compare SDI and STI according to different variables.ResultsSymptom to diagnosis interval for CRC was 128 days and symptom treatment interval was 155. No statistically significant differences were observed between colon and rectum cancers. Women experienced longer intervals than men. Symptom presentation such as vomiting or abdominal pain and the presence of obstruction led to shorter diagnostic or treatment intervals. Time elapsed was also shorter in those patients that perceived their first symptom/s as serious, disclosed it to their acquaintances, contacted emergencies services or had trust in their GPs. Primary care and hospital doctor examinations and investigations appeared to be related to time elapsed to diagnosis or treatment.ConclusionsResults show that gender, symptom perception and help-seeking behaviour are the main patient factors related to interval duration. Health service performance also has a very important role in symptom to diagnosis and treatment interval. If time to diagnosis is to be reduced, interventions and guidelines must be developed to ensure appropriate examination and diagnosis during both primary and hospital care.

Prognosis, Cost, and Occurrence of Colorectal, Lung, Breast, and Prostate Cancer in Hungary

“…Macià et al [23] have reported data from Spain with better median values for lung cancer but worse indicators for the treatment of breast and prostate cancers compared with Hungary. Median data reported by Esteva et al [24] in colorectal cancer have been similar to our results. Further figures are also available for colorectal cancer [25] and lung cancer [26][27][28] in the literature; however, these studies report median data on treatment delay from first suspicion/visit/ symptom onset instead of first diagnosis; therefore, they result in higher delays.…”

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study

“…Patient factors, including cancer awareness, beliefs and attitudes before presentation to healthcare system, are also factors contributing to delayed diagnosis [37]. On the contrary, others have found that poor physical examination and misdiagnosis by both primary and hospital physicians might contribute to repeated visits and lengthen time to diagnosis [38]. Increased healthcare utilization may also be due to 1) GP’s perception of needing more follow-up visits prior to referring for endoscopy, 2) management during the wait for “non-urgent” specialist consultation and 3) lack of service integration that would allow provision of multiple services at the same patient visit by the same healthcare provider or clinical team [12, 39].…”

Advanced-Stage Colorectal Cancer in Persons Younger Than 50 Years Not Associated With Longer Duration of Symptoms or Time to Diagnosis

“…5, 10 Sporadic mutations in young persons may cause more biologically aggressive tumor phenotypes, with hereditary CRC syndromes only accounting for approximately 15% of young-onset CRCs. 11–17 Some studies have explored features of CRC presentation in younger patients, 18–21 including the potential influence of health insurance 10 and racial background. 22 …”