Peter Vedsted

TY - JOUR

T1 - Diagnostic interval and mortality in colorectal cancer

T2 - U-shaped association demonstrated for three different datasets

AU - Tørring, Marie Louise

AU - Frydenberg, Morten

AU - Hamilton, William

AU - Hansen, Rikke Pilegaard

AU - Lautrup, Marianne Djernes

AU - Vedsted, Peter

PY - 2012/3/27

Y1 - 2012/3/27

N2 - ObjectiveTo test the theory of a U-shaped association between time from the first presentation of symptoms in primary care to the diagnosis (the diagnostic interval) and mortality after diagnosis of colorectal cancer (CRC).Study Design and SettingThree population-based studies in Denmark and the United Kingdom using data from general practitioner’s questionnaires, interviewer-administered patient questionnaires, and primary care records, respectively.ResultsDespite variations in the potential selection and information bias when using different methods of identifying the date of first presentation, the association between the length of the diagnostic interval and 5-year mortality rate after the diagnosis of CRC was the same for all three types of data: displaying a U-shaped association with decreasing and subsequently increasing mortality with longer diagnostic intervals.ConclusionUnknown confounding and in particular confounding by indication is likely to explain the counterintuitive findings of higher mortality among patients with very short diagnostic intervals, but cannot explain the increasing mortality with longer diagnostic intervals. The results support the theory that longer diagnostic intervals cause higher mortality in patients with CRC.

AB - ObjectiveTo test the theory of a U-shaped association between time from the first presentation of symptoms in primary care to the diagnosis (the diagnostic interval) and mortality after diagnosis of colorectal cancer (CRC).Study Design and SettingThree population-based studies in Denmark and the United Kingdom using data from general practitioner’s questionnaires, interviewer-administered patient questionnaires, and primary care records, respectively.ResultsDespite variations in the potential selection and information bias when using different methods of identifying the date of first presentation, the association between the length of the diagnostic interval and 5-year mortality rate after the diagnosis of CRC was the same for all three types of data: displaying a U-shaped association with decreasing and subsequently increasing mortality with longer diagnostic intervals.ConclusionUnknown confounding and in particular confounding by indication is likely to explain the counterintuitive findings of higher mortality among patients with very short diagnostic intervals, but cannot explain the increasing mortality with longer diagnostic intervals. The results support the theory that longer diagnostic intervals cause higher mortality in patients with CRC.

KW - Forsinket diagnose

KW - Ventelister

KW - Dødelighed

KW - Primær sektor

KW - Kolorektalkræft

KW - Bias

KW - Delayed diagnosis

KW - Waiting lists

KW - Mortality

KW - Colorectal cancer

KW - Primary Health Care

KW - Bias

U2 - 10.1016/j.jclinepi.2011.12.006

DO - 10.1016/j.jclinepi.2011.12.006

M3 - Journal article

C2 - 22459430

VL - 65

SP - 669

EP - 678

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

IS - 6

ER -