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

Dejardin, Olivier; Herbert, Catherine A.; Velten, Michel; Buémi, Antoine; Ménegoz, F; Maarouf, Nabil; Launoy, Guy

doi:10.1038/sj.bjc.6602170

Cited by 7 publications

(7 citation statements)

References 2 publications

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“…Other barriers to obtaining a timely diagnosis included faulty initial diagnoses, structural barriers such as physicians delaying a referral for further testing or to a specialist, and patients who failed to follow through with physician recommendation. These findings coincide with those of other studies [12–16]. …”

Section: Discussionsupporting

confidence: 93%

“…While most studies have examined breast cancer or a mix of cancers, several have been specific to CRC. CRC DD in a French sample was not associated with geographic or demographic factors such as gender, marital status, or type of physician first consulted [12]. In Denmark, lack of knowledge about the significance of bowel symptoms was a main component of CRC patient delay [13].…”

Section: Introductionmentioning

confidence: 99%

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Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer

Siminoff

Rogers

Thomson

et al. 2011

Patient Education and Counseling

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Objective To examine the influence of patient and physician communication factors on diagnostic delay (DD). Methods 242 patients diagnosed with colorectal cancer (CRC) in the past 6 months who experienced symptoms prior to diagnosis were administered a 2-hour semi-structured qualitative interview to assess communication with health care provider and ease of access to care, among other factors. Patient-provided information was verified via review of medical records. Results The factors associated with DD > 2 months included lower income (OR=0.56, p=0.03), having regular physician prior to receiving a cancer diagnosis (OR=2.52, p=0.03), having a physician who used temporizing communication strategies during the consultation (OR=2.41, p=0.02), receiving an initial alternate diagnosis (OR=3.36, p=0.02), experiencing referral delay (OR=3.61, p=<0.001), and experiencing follow-up delay of any kind (OR=3.32, p=0.01). Conclusion Excellent communication skills that appropriately probe for relevant social and economic patient information, assist patients in distinguishing and elaborating on symptoms, and provide clear rationale and instructions for future steps, will speed along the diagnosis process and could be the difference between early and late stage CRC. Practice Implications Increased understanding of physician communication and practice styles that contribute to DD could have a positive impact on decreasing the morbidity and mortality from this disease.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer

Siminoff

Rogers

Thomson

et al. 2011

Patient Education and Counseling

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show abstract

“…Women and patients with lower household income tend to have treatment delays, which was consistent with the observations in patients with colorectal cancer that women 28 and patients on welfare 29 had a longer treatment delay. Finally, although some studies indicate smoking status is a significant predictor of diagnostic delay for head and neck cancer, 30,31 our data point to no effect of cigarette smoking on the treatment delay.…”

Section: Discussionsupporting

confidence: 86%

Does use of alternative medicine delay treatment of head and neck cancer? A surveillance, epidemiology, and end results (SEER) cancer registry study

Kato

Neale

2007

Head & Neck

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“…To provide an indication of trends in practices across time in France, we collated information from four comparable studies performed between 1900 and 2004 [4,14,36,39]. We note that the general trend for chemotherapy use in stage II patients did not change between 1990-1999 (21.8%) [4] to 2000 (20.4%) [14] and 2003/2004 (20.6%) in the present study.…”

Section: Discussionmentioning

confidence: 80%

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

et al. 2012

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BackgroundColorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care.MethodsCRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively.ResultsWe included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals.ConclusionsAlthough some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation.

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

Cited by 7 publications

References 2 publications

Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer

Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer

Does use of alternative medicine delay treatment of head and neck cancer? A surveillance, epidemiology, and end results (SEER) cancer registry study

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

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