Determinants of patientʼs and doctorʼs delay in diagnosis and treatment of colorectal cancer

BACKGROUNDEarly detection and treatment is important for the management of colorectal cancer (CRC). AIMTo assess patient and doctor delay and their determinants. METHODSA retrospective observational study in a primary care setting concerning 197 patients with CRC. The time between initial symptoms and the onset of treatment was categorized into four periods. With multivariable logistic regression analysis, determinants of delay were investigated. RESULTSThe median time from onset of symptoms until the start of treatment was 138 days. Median time for the four periods tofirst general practitioner consult, first specialist consult, histological diagnosis, and start treatment were 30, 14, 27, and 18 days, respectively. Rectal blood loss and weight loss were significantly related to patient delay, whereas psychiatric comorbidity was related to delay in referral by the general practitioner. For delay in histological diagnosis and start of definitive treatment no determinants were found. Delay was not associated with more advanced disease stages. CONCLUSIONThere is considerable delay in the management of CRC, especially in time to consultation and time to onset of clinical treatment. Education among the general public about the importance of alarm symptoms and increasing efficiency of the diagnostic process in hospital setting are a key in improving CRC disease management.