Patient's and doctor's delay in carcinoma of the colon and rectum

Abstract

Despite sophisticated diagnostic equipment and modern surgical therapy, the prognosis for patients with colorectal carcinoma has not improved during the last few decades. One of the factors, possibly contributing to the prognosis, is the time between the patient's visit to the doctor and the final therapy. In order to estimate patients' and doctors' delay and to investigate the factors which may influence the time of delay, a prospective study was designed including 50 patients with carcinoma of the rectum or the sigmoid colon and 50 patients with colonic carcinoma above this level. All patients were interviewed by a doctor using a standard questionnaire, and initial symptoms, duration of symptoms, and type of clinical examination leading to diagnosis were recorded. The results show that 16% of the patients in the recto/sigmoid group suffered from patient's delay as opposed to 20% in the group of patients with carcinoma above 25 cm from the anal verge. Doctor's delay was found in 27% of all cases, being evenly distributed in the two groups. The reason for doctor's delay was usually the doctor's neglecting to perform rectosigmoidoscopy or rectal palpation, and in some cases a false-negative X-ray. No significant correlation was found between tumor stage and doctor's or patient's delay.

Why so late?!—delay in treatment of colorectal cancer is socially determined

“…Social networks and support are known to be associated with less delay [3,[10][11][12][13][14] because these patients can talk about their symptoms and then receive advice from their family or friends. Furthermore, socially isolated patients are particularly likely to neglect their health and tend to overlook the symptoms.…”

“…In some of the previous studies, therefore, patient delay, practitioner delay, and hospital delay were analysed separately [9][10][11][12][13][14][15][16][17][18][19][20].…”

Missed Opportunities to Initiate Endoscopic Evaluation for Colorectal Cancer Diagnosis

“…Multiple factors have been implicated in such delays, including misdiagnosis (20), lack of appropriate physical examination (21,24), observation of symptoms suggestive of CRC without subsequent investigation (20,25), lack of awareness of symptoms suggestive of CRC (7,24) and false-negative barium enema (21,26). Our study provides a more comprehensive view of these factors and demonstrates that patients who experience diagnostic delays do so in the presence of multiple definitive clues and likely encounter multiple missed opportunities.…”

Lagtimes in diagnosis and treatment of colorectal cancer: determinants and association with cancer stage and survival

“…The severe-delay group did not differ from the rest of the patients in Duke’s classification. Graffner and Olsson5 used a 3-month time interval to define patient and doctor delay in 50 patients with rectosigmoid cancer and 50 patients with other colon cancer. Doctor delay was present in 27% of both groups, usually due to neglecting to perform proctoscopy or rectal exam, and in some cases a false negative x-ray; no association between Duke stage and frequency or time of delay was seen.…”