Timely access to care in the treatment of rectal cancer and the effect on quality of life

Abstract

Aim The aim of this study was to investigate if a delay in a patient's first contact with a healthcare professional, and any subsequent delay in diagnosis, affected selfassessed quality of life prior to start of treatment for rectal cancer.Method Questionnaires were administered when patients had been informed of the diagnosis and planned treatment. The primary end-point was self-assessed quality of life according to a seven-point Likert scale. The response variables were dichotomized and analysed by unadjusted and adjusted binary logistic regression.Results A reported duration of symptoms longer than 4 months was found to be associated with a lower quality of life than a reported duration of symptoms of less than 3 months. Furthermore, a reported period of longer than 2 months from first contact with a healthcare professional to a diagnosis was found to correlate with lower quality of life compared with a period shorter than 2 months. However, when adjusting for possible confounding variables the duration of symptoms and time to diagnosis were not found to affect self-assessed quality of life. Several variables were found to have significant influence in the statistical model, including sense of coherence, the presence of negative intrusive thoughts, comorbidity, depressed mood, male sex and comorbidity.Conclusion One conclusion of our study is that further efforts to shorten delay in rectal cancer care with the aim of improving quality of life may be futile. To improve the patient's quality of life at diagnosis other interventions should be considered, such as screening for depression and/or negative intrusive thoughts.Keywords Rectal cancer, quality of life, diagnostic delay, symptoms, health services accessibility What does this paper add to the literature? Improved survival rates in rectal cancer treatment have led to an increasing interest in quality of life. This study attempts to establish whether quality of life is affected by how long it takes from symptom onset to first contact with a healthcare professional and then before the diagnosis is confirmed.

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study

“…Of the remaining 12 papers, three were applicable to the evaluation in question and reported data on QoL that could be used to extrapolate utility values. [15][16][17] However, none of these papers reported utilities based on responses to the EQ-5D questionnaire, which is the preferred patient-reported outcome measure used to calculate utilities required for health economic evaluation. 11 Because of this lack of EQ-5D results in the published literature, utilities were extrapolated from the general population 18 with pre-diagnosis anxiety-related decrements applied based on relative literature values.…”

“…11 Because of this lack of EQ-5D results in the published literature, utilities were extrapolated from the general population 18 with pre-diagnosis anxiety-related decrements applied based on relative literature values. [15][16][17] Further information and a detailed list of input parameters and data sources are available from the authors on request. incremental cost-effectiveness ratio (ICER) resulting from the CUA was compared with the willingness-to-pay threshold of £20 000 per QALY gained as standardised by NICE.…”

“…Utilities had to be extrapolated from the general population 18 with decrements applied based on relative literature values. [15][16][17] Although this was deemed the best available approach, this amount of data manipulation may have introduced bias. However, removing the effect of anxiety on patient QoL in sensitivity analysis showed that the effect of this uncertainty was small and did not change the direction of results.…”

The route to diagnosis of sarcoma patients: Results from an interview study in the Netherlands and the United Kingdom

“…Early and adequate diagnosis of sarcoma is challenging due to the heterogeneity in presentation and histology, but is important for local control, and potentially (health-related) quality of life ((HR)QoL) and survival, as seen in other cancer diagnoses [3][4][5][6][7][8]. Different histological sarcoma subtypes vary in biological behaviour; some aggressive sarcomas cause severe symptoms at an early stage, leading to an early presentation and potentially faster diagnosis, but with a worse outcome than sarcomas that grow slow, causing symptoms with a long total interval.…”

Quality of life and experiences of sarcoma trajectories (the QUEST study): protocol for an international observational cohort study on diagnostic pathways of sarcoma patients

“… 15–17 In other cancers and chronic diseases, lengthening of total interval was associated with decreased HRQoL. 18 19 HRQoL is an interesting outcome parameter for evaluating consequences of long total interval length and provides an insight into the patient’s experience of the consequences of diagnostic delay. In addition to using patient-reported outcomes as a measure for quality of care, HRQoL can be used to conduct cost-utility analysis to estimate the ratio between the cost of a prolonged total interval and the benefit of earlier diagnosis in terms of life-years (quality-adjusted life years (QALY)).…”