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

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  • Marie Louise Tørring
  • P Murchie, Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
  • ,
  • Willie Hamilton, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter EX1 2 LU, UK.
  • ,
  • Peter Vedsted
  • M Esteva, Primary Care Research Unit, Primary Care Majorca Department, Balearic Islands Health Research Institute (IdISBa), Reina Esclaramunda 9, Palma Mallorca 07003, Spain.
  • ,
  • Marianne Djernes Lautrup, Department of Organ and Plastic Surgery, Breast Centre, Vejle Hospital, Kabbeltoft 25, Vejle DK-7100, Denmark.
  • ,
  • M Winget, Stanford University
  • ,
  • Greg Rubin, School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Queen's Campus, University Boulevard, Stockton on Tees, England TS17 6BH, UK.

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 (∩-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 (∪-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.British Journal of Cancer advance online publication 8 August 2017; doi:10.1038/bjc.2017.236 www.bjcancer.com.

Original languageEnglish
JournalB J C
Pages (from-to)888-897
Number of pages10
Publication statusPublished - Sep 2017

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  • Journal Article

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