Delay in the diagnosis and outcome of colorectal cancer:a prospective study

Roncoroni, L; Pietra, N; Violi, Vincenzo; Sarli, Leopoldo; Ouchemi, Choua; Peracchiá, A

doi:10.1053/ejso.1998.0622

Cited by 82 publications

(74 citation statements)

References 20 publications

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“…The staging of the tumours and the proportions with left-or right-sided tumours or with emergency admissions are also similar. The finding of no relationship between the duration of symptoms and staging or mortality -even with our robust methods of identifying the duration -matches previous reports (Stubbs and Long, 1986;Barillari et al, 1989;Kyle et al, 1991;Mulcahy and O'Donoghue, 1997;Majumdar et al, 1999;Roncoroni et al, 1999;Kiran and Glass, 2002;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004;Bharucha et al, 2005;Khattak et al, 2006;Rupassara et al, 2006). It is likely that two effects are cancelling each other out: inherent biological features of the tumour and ease of diagnosis.…”

Section: Comparison Of Findings With Previous Literaturesupporting

confidence: 86%

“…There is a clear relationship between the staging of the cancer and mortality (Mulcahy and O'Donoghue, 1997;Roncoroni et al, 1999;Ponz de Leon et al, 2000;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004). Conversely, most studies have shown no relationship between the duration of symptoms and staging or mortality (Stubbs and Long, 1986;Barillari et al, 1989;Kyle et al, 1991;Mulcahy and O'Donoghue, 1997;Majumdar et al, 1999;Roncoroni et al, 1999;Kiran and Glass, 2002;Gonzalez-Hermoso et al, 2004;Olsson et al, 2004;Bharucha et al, 2005;Khattak et al, 2006;Rupassara et al, 2006). Some have reported an inverse relationship, with a shorter duration of symptoms being associated with both worse staging and worse prognosis (Mulcahy and O'Donoghue, 1997;Olsson et al, 2004;Rupassara et al, 2006).…”

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confidence: 99%

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The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

Stapley¹,

et al. 2006

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The association between the staging of colorectal cancer and mortality is well known. Much less researched is the relationship between the duration of symptoms and outcome, and whether particular initial symptoms carry a different prognosis. We performed a cohort study of 349 patients with primary colorectal cancer in whom all their prediagnostic symptoms and investigation results were known. Survival data for 3 -8 years after diagnosis were taken from the cancer registry. Six features were studied: rectal bleeding, abdominal pain, diarrhoea, constipation, weight loss, and anaemia. Two of these were significantly associated with different staging and mortality. Rectal bleeding as an initial symptom was associated with less advanced staging (odds ratio from one Duke's stage to the next 0.50, 95% confidence interval 0.31, 0.79; P ¼ 0.003) and with reduced mortality (Cox's proportional hazard ratio (HR) 0.56 (0.41, 0.79); P ¼ 0.001. Mild anaemia, with a haemoglobin of 10.0 -12.9 g dl À1 , was associated with more advanced staging (odds ratio 2.2 (1.2, 4.3); P ¼ 0.021) and worse mortality (HR 1.5 (0.98, 2.3): P ¼ 0.064). When corrected for emergency admission, sex, and the site of the tumour, the HR for mild anaemia was 1.7 (1.1, 2.6); P ¼ 0.015. No relationship was found between the duration of symptoms and staging or mortality.

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Section: Comparison Of Findings With Previous Literaturesupporting

confidence: 86%

mentioning

confidence: 99%

The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

Stapley¹,

et al. 2006

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“…However, this may reflect the cancer biology -a more aggressive clinical picture would prompt higher suspicion for malignancy and a shorter starting time for the treatment of more advanced disease which has a worse outcome. Other studies evaluating diagnostic and treatment delays in other cancers and survival were inconclusive, but they suffered from small sample sizes, and therefore could not detect small but clinically meaningful survival differences (Norum, 1995;Roncoroni et al, 1999;Bozcuk and Martin, 2001;Jensen et al, 2002). Assessing the impact of delay in diagnosis and treatment on survival will therefore require continuing research effort.…”

Section: Discussionmentioning

confidence: 99%

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

et al. 2003

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Lymphadenopathy is common, affecting patients of all ages. The current referral pattern for investigating patients with lymphadenopathy varies widely with no universally practised pathway. Our institution set up a lymph node diagnostic clinic (LNDC) accepting direct referrals from primary care physicians. Details of clinical presentation and investigations were recorded prospectively. Between December 1996 and July 2001, 550 patients were referred (M: 203; F:347). The median age was 40 years (range 14 -90). The median time between initial referral and the first clinic visit was 6 days. Of 95 patients diagnosed to have malignant diseases, the median time from the first clinic visit to reaching malignant diagnosis was 15 days. Multivariate logistic regression analysis identified five significant predictors for malignant nodes: male gender (risk ratio (RR) ¼ 2.72; 95% confidence interval (CI): 1.63 -4.56), increasing age (RR ¼ 1.05; 95% CI: 1.04 -1.07), white ethnicity (RR ¼ 3.01; 95% CI: 1.19 -7.6) and sites of lymph nodes: supraclavicular region (RR ¼ 3.72; 95% CI: 1.52 -9.12) and X2 regions of lymph nodes (RR ¼ 6.41; 95% CI: 2.82 -14.58). Ultrasound and fine-needle aspiration cytology of palpable lymph nodes were performed in 154 and 289 patients, respectively. An accuracy of 97 and 84% was found, respectively. In conclusion, a multidisciplinary lymph node diagnostic clinic enables a rapid, concerted approach to a common medical problem and patients with malignant diseases were diagnosed in a timely fashion.

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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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Delay in the diagnosis and outcome of colorectal cancer:a prospective study

Cited by 82 publications

References 20 publications

The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

The mortality of colorectal cancer in relation to the initial symptom at presentation to primary care and to the duration of symptoms: a cohort study using medical records

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients

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

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