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

Abstract

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.

Epidemioclinical Feature of Early-Onset Colorectal Cancer at-Risk for Lynch Syndrome in Central Iran

“…HNPCC-CRC probands in our study lived averagely 8.0 years after the first diagnosis. Meanwhile, only 35.5% of them had been clinically identified in TNM stage I or II .Since advanced pathologic stage at diagnosis time is due to diagnostic delays (Mitchell et al, 2008), we expect to identify the patients in more advanced pathologic stage in Iran than most developed countries according to lack of a systematic program for cancer screening in Iranian Health System leading to worse prognosis (Cappell, 2008). Therefore, establishing a systematic screening program to early detection of CRC, particularly…”

Missed opportunities in early diagnosis of symptomatic colorectal cancer

“…Contrary to previous studies (5,12), and by applying the definitions proposed in the literature (15,16) it was found that the case histories failed in only 6.6% of the cases, 8.8% of patients did not receive a correct clinical examination, and all the abnormal results were followed up.…”

“…In the literature, abundant references to factors increasing the diagnostic delay of CRC were found: system-based errors (such as inadequate use of clinical guidelines), absence of follow-up in case of abnormal test results or other factors regarding the patient (5,(11)(12)(13). Open error reporting could be very useful to analyse eventual delays and to, then, create and update a research framework (14).…”

Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?

“…People with high levels of awareness and positive beliefs about cancer outcomes may be more likely to demand referral or may be more likely to take up the offer of more aggressive treatment (Mitchell et al, 2007).…”