Colorectal Cancer Provider Delay Risks ‘Not Proven’

The time between a patient’s first presentation with colorectal cancer symptoms and receipt of treatment may not influence survival

medwireNews:  Provider delay may not have a significant impact on disease stage or survival for patients with symptomatic colorectal cancer (CRC), UK researchers suggest.

A review of medical records for 958 CRC patients found no significant correlation between the time from first presentation in primary care to receipt of treatment and patient outcomes after adjusting for confounders such as tumour factors, emergency admission and signs or symptoms of disease.

Peter Murchie, from the University of Aberdeen, and team explain in the British Journal of Cancer that the National Health Service in the UK prioritises waiting times for patient care and publicity around such targets may increase anxiety and concern among patients that even modest delays may affect survival.

“Whether the current emphasis on awareness and early diagnosis in the UK will have any appreciable impact on reducing premature mortality from CRC remains to be proven,” say the researchers, however, “especially when compared with the biology of the underlying cancer, delays might be less important to outcome than is commonly believed.”

Univariate analysis of data for patients diagnosed in Northern Scotland between 1997 and 1998 indicated that advanced stage was significantly associated with younger age, comorbidity and higher grade tumours. Stage was also significantly associated with provider delay, with a delay of between 4 and 34 weeks associated with earlier stage, while delays beyond 34 weeks were associated with more advanced disease at diagnosis.

The risk of mortality was significantly predicted in initial analysis by older age, higher Charlson index for comorbidity score, higher grade tumours, first presentation to a general practitioner during a home visit, emergency admission to hospital and anorexia.

But provider delay was no longer significantly associated with stage at diagnosis or survival in logistic regression models accounting for a raft of potential confounders such as age, gender, smoking, socioeconomic status, Charlson index, tumour grade, place of presentation and patient symptoms of constipation, bleeding, pain, anorexia, weight loss or abdominal mass.

“In both analyses, [confidence intervals] were wide so the possibility of long provider delays having deleterious effects on stage at diagnosis and survival cannot be excluded”, say Peter Murchie and co-authors.

Nevertheless, they conclude that “any true effect from provider delay on CRC outcome seems likely to be small in population terms, certainly when compared with patient delays which are likely to have a much greater role.”

Reference

Murchie P, Raja E, Brewster D, et al. Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival. Br J Cancer 2014; Advance online publication 3 July. doi: 10.1038/bjc.2014.352

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