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

BMC Cancer

Magdalena Esteva¹¹  Alfonso Leiva¹¹  María Ramos⁶  Salvador Pita-Fernández⁴  Luis González-Luján⁹  Montse Casamitjana³  María A Sánchez¹³  Sonia Pértega-Díaz⁴  Amador Ruiz¹¹  Paloma Gonzalez-Santamaría⁴  María Martín-Rabadán¹⁰  Ana M Costa-Alcaraz⁸  Alejandro Espí⁵  Francesc Macià⁷  Josep M Segura¹⁵  Sergio Lafita¹⁶  Francisco Arnal-Monreal¹  Isabel Amengual¹²  Marta M Boscá-Watts⁵  Angels Hospital⁷  Hermini Manzano²  Rosa Magallón¹⁴ 

[1] Department of Anatomical Pathology, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006, A Coruña, Spain

[2] Department of Oncology, Hospital Universitario Son Espases, Carretera Valldemosa, Palma, Spain

[3] Health Consorcium of Barcelona, Parc Sanitari Pere Virgili - Edifici Mestral, Esteve Terrades, 30, 08023, Barcelona, Spain

[4] Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006, A Coruña, Spain

[5] Department of Gastroenterology, University Clinic Hospital of Valencia, Avenida Blasco Ibañez 17, 46010, Valencia, Spain

[6] Department of Public Health, Balearic Department of Health, Majorca Cancer Registry, C/ Jesus n 33, 07001, Palma de Mallorca, Spain

[7] Evaluation and Clinical Epidemiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain

[8] Nazareth Primary Care Centre, Parque Nazareth 16, 46024, Valencia, Spain

[9] Serreria II Primary Care Centre, Valencia Institute of Health, C/ Pedro de Valencia 28, 46022, Valencia, Spain

[10] Can Misses Primary Care Centre, Primary Health Care Eivissa Department, Avinguda de la Pau s/n, 07800, Eivissa, Spain

[11] Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003, Palma de Mallorca, Spain

[12] Department of Anatomical Pathology, Hospital Universitario Son Espases, Carretera Valldemosa, Palma, Spain

[13] Canal Imperial Primary Care Centre, Paseo Colon 4, 50006, Zaragoza, Spain

[14] Primary Care Research Unit, Arrabal Health Centre, Gracia Gazulla, 50015, Zaragoza, Spain

[15] Lluis Saye Primary Care Centre, C/ Torres i Amat 8, 08001, Barcelona, Spain

[16] Pirinees High Resolution Hospital, Calzada de Rapit s/n, 22700, Jaca, Spain

关键词: Delay;    Primary health care;    Early diagnosis;    Colorectal cancer;   

Others  :  1079903
DOI  :  10.1186/1471-2407-13-87

 received in 2012-04-28, accepted in 2013-02-18,  发布年份 2013

【 摘 要 】

Background

Colorectal 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.

Methods

This 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.

Results

Symptom 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.

Conclusions

Results 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.

【 授权许可】

   
2013 Esteva et al; licensee BioMed Central Ltd.

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