Influence of Diagnostic Delay on Survival Rates for Patients with Colorectal Cancer

Abstract

Colorectal cancer affects men and women alike. Sometimes, due to clinical-pathological factors, the absence of symptoms or the failure to conduct screening tests, its diagnosis may be delayed. However, it has not been conclusively shown that such a delay, especially when attributable to the health system, affects survival. The aim of the present study is to evaluate the overall survival rate of patients with a delayed diagnosis of colorectal cancer. This observational, prospective, multicenter study was conducted at 22 public hospitals located in nine Spanish provinces. For this analysis, 1688 patients with complete information in essential variables were included. The association between diagnostic delay and overall survival at five years, stratified according to tumor location, was estimated by the Kaplan–Meier method. Hazard ratios for this association were estimated using multivariable Cox regression models. The diagnostic delay ≥ 30 days was presented in 944 patients. The presence of a diagnostic delay of more than 30 days was not associated with a worse prognosis, contrary to a delay of less than 30 days (HR: 0.76, 0.64–0.90). In the multivariate analysis, a short delay maintained its predictive value (HR: 0.80, 0.66–0.98) regardless of age, BMI, Charlson index or TNM stage. A diagnostic delay of less than 30 days is an independent factor for short survival in patients with CRC. This association may arise because the clinical management of tumors with severe clinical characteristics and with a poorer prognosis are generally conducted more quickly.

Survival outcomes among colorectal cancer patients at Kenyatta National Hospital: A retrospective cohort study

“…Low and middle‐income countries experience a higher burden and low 5 years survival rates among colorectal cancer patients compared with developed countries 10 . Previous studies demonstrated that late diagnosis had the worst survival in colorectal cancer patients 20,21 . Inadequate health coverage may restrict access to optimal diagnostic and therapeutic care, which can negatively affect the desired treatment outcomes.…”

“… 10 Previous studies demonstrated that late diagnosis had the worst survival in colorectal cancer patients. 20 , 21 Inadequate health coverage may restrict access to optimal diagnostic and therapeutic care, which can negatively affect the desired treatment outcomes.…”

Surgical outcomes and factors associated with postoperative complications of colorectal cancer in a Colombian Caribbean population: Results from a regional referral hospital

“…Evidence suggests that the performance of screening tests and the evolution of new cases vary between regions, making it difficult to extrapolate with confidence all the results found in the literature 28 . It has been observed that in rural and marginalized areas belonging to low‐ and middle‐income countries, where there is a considerable volume of population (mainly due to farming and livestock activities or armed conflict situations), most of whom are elderly, there are inequities in education and screening interventions, which would explain difficulties in access to and compliance with therapeutic regimens and strict follow‐up, which increases mortality 29,30 . Taking into account, the aggressive behavior of colorectal cancer observed in the population studied, it can be inferred, for example, that the population of the rural area with lower education and greater economic hardship, are late in presenting gastrointestinal symptoms suggestive of the presence of cancer, which would explain the frequency of late stages of diagnosis.…”

“… 28 It has been observed that in rural and marginalized areas belonging to low‐ and middle‐income countries, where there is a considerable volume of population (mainly due to farming and livestock activities or armed conflict situations), most of whom are elderly, there are inequities in education and screening interventions, which would explain difficulties in access to and compliance with therapeutic regimens and strict follow‐up, which increases mortality. 29 , 30 Taking into account, the aggressive behavior of colorectal cancer observed in the population studied, it can be inferred, for example, that the population of the rural area with lower education and greater economic hardship, are late in presenting gastrointestinal symptoms suggestive of the presence of cancer, which would explain the frequency of late stages of diagnosis. Therefore, these findings could support that in similar populations, which also have a high prevalence of comorbidities and are also exposed to tropical diseases, personalized strategies should be designed to promote screening and early detection of cancer.…”

Prospects of liquid biopsy in the prognosis and clinical management of gastrointestinal cancers

“…The American Cancer Society reports that the colorectal cancer 5-year survival rate varies greatly depending on the stage at diagnosis. Patients with localized tumors (stages I–II) have a 5-year survival rate of nearly 90%, while those with stage III have a survival rate of nearly 72% compared to a much lower rate for those with stage IV and distant metastases, which is around 14% ( Padilla-Ruiz et al, 2022 ; Siegel et al, 2023b ). This discrepancy underlines the crucial significance of early detection using methods that can overcome difficulties presented by conventional diagnostic approaches and enhance the general prognosis for those affected by these illnesses.…”