Delay in Diagnosis and Treatment of Symptomatic Colorectal Cancer

Holliday, Holly; Hardcastle, J. D.

doi:10.1016/s0140-6736(79)90718-9

Cited by 161 publications

(109 citation statements)

References 3 publications

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“…The results of previous studies of the associated between delay and the outcome of colon cancer are equivocal (Auvinen, 1992;Holliday and Hardcastle, 1979;Turunen and Peltokallio, 1982;MacArthur and Smith, 1984;Robinson et al, 1986;Barillari et al, 1989). In our study, married patients had significantly better survival than single patients, even when extent of disease at diagnosis was controlled for in the analysis.…”

Section: Discussionmentioning

confidence: 97%

Influence of marital status on survival from colon and rectal cancer in Denmark

Johansen¹,

Schou²,

Soll-Johanning³

et al. 1996

Br J Cancer

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Summary Survival from colorectal cancer has been analysed in relation to marital status in a nationwide Danish study of 9596 patients with complete follow-up of 22-26 years. After exclusion of 2294 patients with missing information adjusted five-year survival among married patients was significantly longer (RR=0.85; 95% CI 0.78-0.93).Keywords: Colorectal cancer; marital status; survival; epidemiology Indications of an association between marital status and health were first reported long ago (Ramazzini, 1965;Stavola 1987;Farr, 1859). An extensive literature showed subsequently that married persons have lower mortality rates from a variety of diseases (Blazer, 1982;House et al., 1982;Schoenbach et al., 1986). In addition, marital status has been claimed to be an independent prognostic factor in survival from cancer (Neale et al., 1986;Goodwin et al., 1987). Owing to its high incidence and relatively poor prognosis, colorectal cancer is a major public health problem in most affluent industrial countries, including Denmark (Johansen et al., 1993). We studied the influence of marital status on survival from colorectal cancer in a nationwide cohort with complete long-term follow-up. Materials and methodsThe present study concerns Danish patients recorded in the Danish Cancer Registry with adenocarcinoma of the colon or rectum diagnosed between 1 April 1968 and 31 March 1972. These patients numbered 9596. Of these, 2182 patients were excluded for at least one of the following reasons: a previous cancer (691 patients, 7.2%); information was missing: on extent of the disease (1112 patients, 6.8%); on the anatomical subsite of the tumour, mainly notified as colon unspecified (657 patients, 6.8%); or the diagnosis was given only on a death record (25 patients, 0.3%). Information on marital status at the time of diagnosis was sought in the Central Population Register (CPR), municipality population registers, probate court records, parish registers and regional administration archives, as reported earlier (Mellemgaard et al., 1989). We also excluded 112 patients (1.2%) whose marital status could not be identified in one of the above-mentioned ways, leaving 7302 persons for the survival study. Updating of the Danish Cancer Register resulted in minor differences in the number of patients including in this and a previous study due to late registration in the register (Mellemgaard et al., 1989). Cases were followed-up by linkage to the CPR before 18 August 1994 for dates of death and emigration and for verification of each personal identification number, which is a unique ten digit identification of every Danish resident.Analyses of survival after colorectal cancer The multivariate analyses included sex, age at diagnosis in the age groups 0-49, 50-59, 60-69, 70-79, 80 -89, and >90 and year of diagnosis (1968, 1969, 1970, 1971, 1972). The anatomical site of the tumour was divided into the categories of right colon, left colon and rectum as previously described (Johansen et al., 1993). The extent of disease at diagnosis was...

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Section: Discussionmentioning

confidence: 97%

Influence of marital status on survival from colon and rectal cancer in Denmark

Johansen¹,

Schou²,

Soll-Johanning³

et al. 1996

Br J Cancer

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“…and Weisman, 1975;Holliday and Hardcastle, 1979;Rubin et al, 1980;Anon, 1982;Marshall and Funch, 1986;Mor et al, 1990;Prohaska et al, 1990;Byles et al, 1992;Curless et al, 1994;Porta et al, 1996;Roncoroni et al, 1999;Sladden et al, 1999;Young et al, 2000;de Nooijer et al, 2001;Cockburn et al, 2003), or lack of knowledge, either about the disease itself or about the availability of screening was a major contributor to increased delay (Anon, 1982(Anon, , 1986Camilleri-Brennan and Steele, 1999;Pullyblank et al, 2002;McCaffery et al, 2003). Patients who presented late tended to either deny their symptoms entirely, or redefine these in relation to benign disease (Worden and Weisman, 1975;Bain et al, 2002;Langenbach et al, 2003).…”

Section: Patient Behaviourmentioning

confidence: 99%

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

et al. 2007

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Colorectal cancer is a major global health problem, with survival varying according to stage at diagnosis. Delayed diagnosis can result from patient, practitioner or hospital delay. This paper reports the results of a review of the factors influencing pre-hospital delay -the time between a patient first noticing a cancer symptom and presenting to primary care or between first presentation and referral to secondary care. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Fifty-four studies were included. Patients' non-recognition of symptom seriousness increased delay, as did symptom denial. Patient delay was greater for rectal than colon cancers and the presence of more serious symptoms, such as pain, reduced delay. There appears to be no relationship between delay and patients' age, sex or socioeconomic status. Initial misdiagnosis, inadequate examination and inaccurate investigations increased practitioner delay. Use of referral guidelines may reduce delay, although evidence is currently limited. No intervention studies were identified. If delayed diagnosis is to be reduced, there must be increased recognition of the significance of symptoms among patients, and development and evaluation of interventions that are designed to ensure appropriate diagnosis and examination by practitioners.

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“…-13 days (Sainsbury et al, 1999) 11 days (Jones et al, 1992) 9 days (urgent referrals) (Spurgeon et al, 2000) 14 days (nonurgent referrals) (Spurgeon et al, 2000) 13 days (Nosarti et al, 2000) -1/3 experience total pre-hospital delays of 412 weeks Provider delay of 1 Week (Thulesius et al, 2004) Colorectal -60 days (Aithal and Tanner, 1996) 27.5 days (Thongsuksai et al, 2000) 46 weeks (54%) (Robinson et al, 1986) 16.2 days (mean, rectum) (Holliday and Hardcastle, 1979) 12.7 days (mean, colon) (Holliday and Hardcastle, 1979) 20 -66%) 43 months (Graffner and Olsson, 1986) 47%46 weeks (Robinson et al, 1986) 15.3 days (mean, rectum) (Holliday and Hardcastle, 1979) 11.2 days (mean, colon) (Holliday and Hardcastle, 1979) 20 -34% 43 months (Holliday and Hardcastle, 1979) 16 days (Aithal and Tanner, 1996) 11 days (Jones et al, 1992) 13 days (urgent referrals) (Spurgeon et al, 2000) 27 days (nonurgent referrals) (Spurgeon et al, 2000) 15 days (Aithal and Tanner, 1996) 17 days (mean 52) (Potter and Wilson, 1999) Mean delay to treatment delay: 244 days (Rectal), 149 days (colon) (Langenbach et al, 2003) Lung 4.6 months (mean 5.8) (Myrdal et al, 2004) 189 days (Koyi et al, 2002) 109 days (Billing and Wells, 1996) 21 days (mean 43) (Koyi et al, 2002) 31 days (Jones et al, 1992) 33 days (mean 56) (Koyi et al, 2002) 7 days (Jones et al, 1992) 7 days (urgent referrals) …”

Section: Section 1 -National Survey Of Nhs Patients: Cancermentioning

confidence: 99%

Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer

2005

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The aim of this paper is to describe and compare components of diagnostic delay (patient, primary care, referral, secondary care) for six cancers (breast, colorectal, lung, ovarian, prostate and non-Hodgkin's lymphoma), and to compare delays in patients who saw their GP prior to diagnosis with those who did not. Secondary data analysis of The National Survey of NHS Patients: Cancer was undertaken (65 192 patients). Breast cancer patients experienced the shortest total delays (mean 55.2 days), followed by lung (88.5), ovarian (90.3), non-Hodgkin's lymphoma (102.8), colorectal (125.7) and prostate (148.5). Trends were similar for all components of delay. Compared with patient and primary care delays, referral delays and secondary care delays were much shorter. Patients who saw their GP prior to diagnosis experienced considerably longer total diagnostic delays than those who did not. There were significant differences in all components of delay between the six cancers. Reducing diagnostic delays with the intention of increasing the proportion of early stage cancers may improve cancer survival in the UK, which is poorer than most other European countries. Interventions aimed at reducing patient and primary care delays need to be developed and their effect on diagnostic stage and psychological distress evaluated.

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Delay in Diagnosis and Treatment of Symptomatic Colorectal Cancer

Cited by 161 publications

References 3 publications

Influence of marital status on survival from colon and rectal cancer in Denmark

Influence of marital status on survival from colon and rectal cancer in Denmark

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer

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