Cancer Res Treat.  2018 Oct;50(4):1270-1280. 10.4143/crt.2017.371.

Factors Associated with Prolonged Patient-Attributable Delay in the Diagnosis of Colorectal Cancer

• Zarcos-Pedrinaci I
• Téllez T
• Rivas-Ruiz F
• Padilla-Ruiz MdC
• Alcaide J
• Rueda A
• Baré ML
• Suárez-Varela MMM
• Briones E
• Sarasqueta C
• Fernández-Larrea N
• Escobar A
• Quintana J
• Redondo M
• For the REDISSEC-CARESS/CCR group

• KMID: 2424799
• DOI: http://doi.org/10.4143/crt.2017.371

Abstract

PURPOSE
The delayed diagnosis of colorectal cancer (CRC) may be attributable to sociodemographic characteristics, to aspects of tumour histopathology or to the functioning of the health system. We seek to determine which of these factors most influences prolonged patient-attributable delay (PPAD) in the diagnosis and treatment of CRC.
MATERIALS AND METHODS
A prospective, multicentre observational study was conducted in 22 Spanish hospitals. In total, 1,785 patients were recruited to the study between 2010 and 2012 and underwent elective or urgent surgery. PPAD is considered to occur when the time elapsed between a patient presenting the symptom and him/her seeking attention from the primary care physician or hospital emergency department exceeds 180 days. A bivariate analysis was performed to assess differences in variables segmented by tumour location and patient delay. Multivariate logistic regression analysis was performed on the outcome variable, PPAD.
RESULTS
The rate of PPAD among this population was 12.1%. PPAD was significantly associated with altered bowel rhythm (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.02 to 1.83) and with adenocarcinoma histology, in comparison with mucinous adenocarcinoma (OR, 2.03; 95% CI, 1.11 to 3.71). Other sociocultural factors and clinicopathological features were not independent predictors of PPAD.
CONCLUSION
Many patients do not consider altered bowel rhythm an alarming symptom, warranting a visit to the doctor. PPAD could be reduced by improving health education, raising awareness of CRC-related symptoms.

Keyword

Delay; Patients; Diagnosis; Colorectal neoplasms

MeSH Terms

Adenocarcinoma
Adenocarcinoma, Mucinous
Colorectal Neoplasms*
Delayed Diagnosis
Diagnosis*
Emergency Service, Hospital
Health Education
Humans
Logistic Models
Observational Study
Physicians, Primary Care
Prospective Studies

Figure

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  Fig. 1. Description of subject selection for the study. PPAD, prolonged patient-attributable delay.

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  Fig. 2. Distribution of patient delays. The line within each box represents the median, and the height of each box, the interquartile range (Q3-Q1).

Reference

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