Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/20387
Title
Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries
Author(s)
Date issued
2017-09-05
Citation
Torring ML, Murchie P, Hamilton W, Vedsted P, Esteva M, Lautrup M, et al. Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries. Br J Cancer. 2017 Sep 05;117(6):888-97. Epub 2017 Aug 8.
Language
Inglés
Document type
research article
Abstract
Background: The benefits from expedited diagnosis of symptomatic cancer are uncertain. We aimed to analyse the relationship between stage of colorectal cancer (CRC) and the primary and specialist care components of the diagnostic interval. Methods: We identified seven independent data sets from population-based studies in Scotland, England, Canada, Denmark and Spain during 1997-2010 with a total of 11 720 newly diagnosed CRC patients, who had initially presented with symptoms to a primary care physician. Data were extracted from patient records, registries, audits and questionnaires, respectively. Data sets were required to hold information on dates in the diagnostic interval (defined as the time from the first presentation of symptoms in primary care until the date of diagnosis), symptoms at first presentation in primary care, route of referral, gender, age and histologically confirmed stage. We carried out reanalysis of all individual data sets and, using the same method, analysed a pooled individual patient data set. Results: The association between intervals and stage was similar in the individual and combined data set. There was a statistically significant convex (boolean AND-shaped) association between primary care interval and diagnosis of advanced (i.e., distant or regional) rather than localised CRC (P = 0.004), with odds beginning to increase from the first day on and peaking at 90 days. For specialist care, we saw an opposite and statistically significant concave (boolean OR-shaped) association, with a trough at 60 days, between the interval and diagnosis of advanced CRC (P<0.001). Conclusions: This study provides evidence that longer diagnostic intervals are associated with more advanced CRC. Furthermore, the study cannot define a specific 'safe' waiting time as the length of the primary care interval appears to have negative impact from day one.
Subject
MESH
England | Aged, 80 and over | Aged | Denmark | Spain | Adult | Datasets as Topic | Symptom Assessment | Humans | Middle Aged | Canada | Early Detection of Cancer | Male | Referral and Consultation | Time Factors | Scotland | Female | Delayed Diagnosis | Colorectal Neoplasms | Cohort Studies | Primary Health Care
DECS
Estudios de Cohortes | Neoplasias Colorrectales | Factores de Tiempo | Femenino | Canadá | Conjuntos de Datos como Asunto | Evaluación de Síntomas | Masculino | Escocia | Humanos | Persona de Mediana Edad | Derivación y Consulta | Anciano | Diagnóstico Tardío | Anciano de 80 o más Años | Detección Precoz del Cáncer | Atención Primaria de Salud | Adulto | Dinamarca | Inglaterra | España
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