Time to diagnosis and stage of symptomatic colorectal cancer determined by three different sources of information: A population based retrospective study |
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| Institution: | 1. Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, 07005 Palma, España, Instituto de Investigación Sanitaria de Palma, 07010 Palma, Spain;2. Evaluation and Clinical Epidemiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain;3. 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;4. Serreria II Primary Care Centre, Valencia Institute of Health, C/Pedro de Valencia 28, 46022, Valencia, Spain;5. Canal Imperial Primary Care Centre, Paseo Colon 4, Zaragoza, 50006, Spain;6. Department of Public Health, Balearic Department of Health, C/Jesus n 33, 07001, Instituto de Investigación Sanitaria de Palma, 07010 Palma, Spain, Spain;1. Department of Epidemiology, Fielding School of Public Health, University of California, CA, USA;2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;3. Division of Pediatric Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA;1. Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;2. School of Pharmacy, Queen’s University Belfast, Northern Ireland, United Kingdom;3. Centre of Excellence for Public Health (NI), Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom;1. College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331;2. Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX 78714;1. Cancer Prevention Institute of California, Fremont, CA, United States;2. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, United States;3. Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, United States;1. Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, Suite 202, San Bernardino, CA 92408, USA;2. School of Public Health, Center for Community Resilience, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA 92350, USA;3. School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA 92350, USA |
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| Abstract: | BackgroundSurvival rates from colorectal cancer (CRC) are highly variable in Europe. This variability could potentially be explained by differences in healthcare system delays in diagnosis. However, even when such delays are reduced, the relationship of the diagnostic interval (time from presentation with symptoms to diagnosis) with outcome is uncertain.MethodsA total of 795 patients with CRC from 5 regions of Spain were retrospectively examined in this population-based multicenter study. Consecutive incident cases of CRC were identified from pathology services. The total diagnostic interval (TDI) was defined as the time from the first presentation with symptoms to diagnosis based on 3 different sources of information: (i) patient-recorded data (PR-TDI) by interview, (ii) hospital-recorded data (HR-TDI), and (iii) general practitioner-recorded data (GPR-TDI). Concordance correlation coefficients (CCCs) were used to estimate the agreement of 3 different TDIs. The TDIs of patients with different stages of CRC were also compared using the Kruskal-Wallis test.ResultsThe median TDI was 131 days based on patient interview data, 91 days based on HR data, and 111 days based on GPR data. Overall, the agreement of these TDIs was poor (CCCPRvsHR = 0.399, CCCPRvsGPR = 0.518, CCCHRvsGPR = 0.383). Univariate analysis indicated that the TDI was greater in those with less advanced CRC for all 3 methods of calculation, but this association was only statistically significant for the HR-TDI (p = 0.021).ConclusionThere is no evidence that patients with more advanced CRC have longer TDIs. In fact, we found an inverse relationship between the TDI and CRC stage, an example of the “waiting time paradox”. This association may likely be due to the presence of unmeasured confounders as the stage when symptoms appear or the tumour aggressiveness. |
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| Keywords: | Colorectal neoplasms/mortality Colorectal neoplasms/pathology Colorectal neoplasms/therapy Delayed diagnosis Middle aged Neoplasm staging Retrospective studies |
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