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Erschienen in: Langenbeck's Archives of Surgery 8/2010

01.11.2010 | Original Article

Why so late?!—delay in treatment of colorectal cancer is socially determined

verfasst von: Mike Ralf Langenbach, Stefan Sauerland, Karl-Wilhelm Kröbel, Hubert Zirngibl

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2010

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Abstract

Purpose

The interval between symptom onset and therapy in patients with colorectal cancer was studied.

Methods

One hundred twenty three patients with colorectal cancer were included. Demography data, symptoms, consultations, and tumour stage were obtained by standardized questionnaires. Risk factors for delayed treatment were analysed.

Results

Eighty six patients suffered from colonic cancer. The total time between the first symptoms and therapy ranged from 13 to 442 days (mean, 148). Delay of surgical therapy was responsible for significantly higher tumour grades. Delayed start of therapy was found to be correlated to the type of cancer, socioeconomic status, marital status, and quality of first consultation (univariate analysis). On multivariate analyses, type of cancer, marital and socioeconomic status remained significantly associated with delayed treatment (all p values ≤ 0.001, r2 = 0.50).

Conclusions

The delay in treatment of colorectal cancer depends on socioeconomic status and family background. Achieving equity in colorectal cancer detection may require consideration of high-risk subgroups.
Literatur
1.
Zurück zum Zitat Rim SH, Seeff L, Ahmed F, King JB, Coughlin SS (2009) Colorectal cancer incidence in the United States, 1999–2004: an updated analysis of data from the national program of cancer registries and the surveillance, epidemiology, and end results program. Cancer 115:1967–76CrossRefPubMed Rim SH, Seeff L, Ahmed F, King JB, Coughlin SS (2009) Colorectal cancer incidence in the United States, 1999–2004: an updated analysis of data from the national program of cancer registries and the surveillance, epidemiology, and end results program. Cancer 115:1967–76CrossRefPubMed
2.
Zurück zum Zitat Brenner H, Hoffmeister M, Brenner G, Altenhofen L, Haug U (2009) Expected reduction of colorectal cancer incidence within 8 years after introduction of the German screening colonoscopy programme: estimates based on 1, 875, 708 screening colonoscopies. Eur J Cancer 45:2027–33CrossRefPubMed Brenner H, Hoffmeister M, Brenner G, Altenhofen L, Haug U (2009) Expected reduction of colorectal cancer incidence within 8 years after introduction of the German screening colonoscopy programme: estimates based on 1, 875, 708 screening colonoscopies. Eur J Cancer 45:2027–33CrossRefPubMed
3.
Zurück zum Zitat McArdle CS, Hole DJ (2002) Outcome following surgery for colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation. Br J Cancer 86:331–5CrossRefPubMed McArdle CS, Hole DJ (2002) Outcome following surgery for colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation. Br J Cancer 86:331–5CrossRefPubMed
4.
Zurück zum Zitat Schiffmann L, Ozcan S, Schwarz F, Lange J, Prall F, Klar E (2008) Colorectal cancer in the elderly: surgical treatment and long-term survival. Int J Colorectal Dis 23:601–10CrossRefPubMed Schiffmann L, Ozcan S, Schwarz F, Lange J, Prall F, Klar E (2008) Colorectal cancer in the elderly: surgical treatment and long-term survival. Int J Colorectal Dis 23:601–10CrossRefPubMed
5.
Zurück zum Zitat Merkel S, Klossek D, Gohl J, Papadopoulos T, Hohenberger W, Hermanek P (2009) Quality management in rectal carcinoma: what is feasible? Int J Colorectal Dis 24:931–42CrossRefPubMed Merkel S, Klossek D, Gohl J, Papadopoulos T, Hohenberger W, Hermanek P (2009) Quality management in rectal carcinoma: what is feasible? Int J Colorectal Dis 24:931–42CrossRefPubMed
6.
Zurück zum Zitat Steinert R, Marusch F, Koch A, Ptok H, Reymond MA, Gastinger I (2005) Möglichkeitern der Qualitätsverbesserung bei der Therapie des Rektumkarzinoms. Zentralbl Chir 130:387–92CrossRefPubMed Steinert R, Marusch F, Koch A, Ptok H, Reymond MA, Gastinger I (2005) Möglichkeitern der Qualitätsverbesserung bei der Therapie des Rektumkarzinoms. Zentralbl Chir 130:387–92CrossRefPubMed
7.
Zurück zum Zitat Taskila T, Wilson S, Damery S, Roalfe A, Redman V, Ismail T, Hobbs R (2009) Factors affecting attitudes toward colorectal cancer screening in the primary care population. Br J Cancer 101:250–5CrossRefPubMed Taskila T, Wilson S, Damery S, Roalfe A, Redman V, Ismail T, Hobbs R (2009) Factors affecting attitudes toward colorectal cancer screening in the primary care population. Br J Cancer 101:250–5CrossRefPubMed
8.
Zurück zum Zitat Schoppmeyer K, Spieker H, Mössner J (2009) Failure of screening or failure to screen? The screening behavior of patients with colorectal cancer in the Leipzig area. Dtsch Ärztebl Int 106:195–201PubMed Schoppmeyer K, Spieker H, Mössner J (2009) Failure of screening or failure to screen? The screening behavior of patients with colorectal cancer in the Leipzig area. Dtsch Ärztebl Int 106:195–201PubMed
9.
Zurück zum Zitat Mitchell E, Macdonald S, Campbell NC, Weller D, Macleod U (2008) Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. Br J Cancer 98:60–70CrossRefPubMed Mitchell E, Macdonald S, Campbell NC, Weller D, Macleod U (2008) Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. Br J Cancer 98:60–70CrossRefPubMed
10.
Zurück zum Zitat Robinson E, Mohilever J, Zidan J, Sapir D (1986) Colorectal cancer: incidence, delay in diagnosis and stage of disease. Eur J Cancer Clin Oncol 22:157–61CrossRefPubMed Robinson E, Mohilever J, Zidan J, Sapir D (1986) Colorectal cancer: incidence, delay in diagnosis and stage of disease. Eur J Cancer Clin Oncol 22:157–61CrossRefPubMed
11.
Zurück zum Zitat Frederiksen BL, Osler M, Harling H, Jorgensen T (2008) Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study. Br J Cancer 98:668–73CrossRefPubMed Frederiksen BL, Osler M, Harling H, Jorgensen T (2008) Social inequalities in stage at diagnosis of rectal but not in colonic cancer: a nationwide study. Br J Cancer 98:668–73CrossRefPubMed
12.
Zurück zum Zitat Turunen MJ, Peltokallio P (1982) Delay in the diagnosis of colorectal cancer. Ann Chir Gynaecol 71:277–82PubMed Turunen MJ, Peltokallio P (1982) Delay in the diagnosis of colorectal cancer. Ann Chir Gynaecol 71:277–82PubMed
13.
Zurück zum Zitat Graffner H, Olsson SA (1986) Patient's and doctor's delay in carcinoma of the colon and rectum. J Surg Oncol 31:188–90CrossRefPubMed Graffner H, Olsson SA (1986) Patient's and doctor's delay in carcinoma of the colon and rectum. J Surg Oncol 31:188–90CrossRefPubMed
14.
Zurück zum Zitat Holliday HW, Hardcastle JD (1979) Delay in diagnosis and treatment of symptomatic colorectal cancer. Lancet 1:309–11CrossRefPubMed Holliday HW, Hardcastle JD (1979) Delay in diagnosis and treatment of symptomatic colorectal cancer. Lancet 1:309–11CrossRefPubMed
15.
Zurück zum Zitat Korsgaard M, Pedersen L, Sorensen HT, Laurberg S (2006) Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark. Colorectal Dis 8:688–95CrossRefPubMed Korsgaard M, Pedersen L, Sorensen HT, Laurberg S (2006) Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark. Colorectal Dis 8:688–95CrossRefPubMed
16.
Zurück zum Zitat MacArthur C, Smith A (1984) Factors associated with speed of diagnosis, referral, and treatment in colorectal cancer. J Epidemiol Community Health 38:122–6CrossRefPubMed MacArthur C, Smith A (1984) Factors associated with speed of diagnosis, referral, and treatment in colorectal cancer. J Epidemiol Community Health 38:122–6CrossRefPubMed
17.
Zurück zum Zitat Arbman G, Nilsson E, Storgren-Fordell V, Sjodahl R (1996) A short diagnostic delay is more important for rectal cancer than for colonic cancer. Eur J Surg 162:899–904PubMed Arbman G, Nilsson E, Storgren-Fordell V, Sjodahl R (1996) A short diagnostic delay is more important for rectal cancer than for colonic cancer. Eur J Surg 162:899–904PubMed
18.
Zurück zum Zitat Carter S, Winslet M (1998) Delay in the presentation of colorectal carcinoma: a review of causation. Int J Colorectal Dis 13:27–31CrossRefPubMed Carter S, Winslet M (1998) Delay in the presentation of colorectal carcinoma: a review of causation. Int J Colorectal Dis 13:27–31CrossRefPubMed
19.
Zurück zum Zitat Langenbach MR, Schmidt J, Neumann J, Zirngibl H (2003) Delay in treatment of colorectal cancer: multifactorial problem. World J Surg 27:304–8CrossRefPubMed Langenbach MR, Schmidt J, Neumann J, Zirngibl H (2003) Delay in treatment of colorectal cancer: multifactorial problem. World J Surg 27:304–8CrossRefPubMed
20.
Zurück zum Zitat Ristvedt SL, Birnbaum EH, Dietz DW, Fleshman JW, Kodner IJ, Read TE (2005) Delayed treatment for rectal cancer. Dis Colon Rectum 48:1736–41CrossRefPubMed Ristvedt SL, Birnbaum EH, Dietz DW, Fleshman JW, Kodner IJ, Read TE (2005) Delayed treatment for rectal cancer. Dis Colon Rectum 48:1736–41CrossRefPubMed
21.
Zurück zum Zitat Davies E, van der Molen B, Cranston A (2007) Using clinical audit, qualitative data from patients and feedback from general practitioners to decrease delay in the referral of suspected colorectal cancer. J Eval Clin Pract 13:310–7CrossRefPubMed Davies E, van der Molen B, Cranston A (2007) Using clinical audit, qualitative data from patients and feedback from general practitioners to decrease delay in the referral of suspected colorectal cancer. J Eval Clin Pract 13:310–7CrossRefPubMed
22.
Zurück zum Zitat Ramos M, Esteva M, Cabeza E, Llobera J, Ruiz A (2008) Lack of association between diagnostic and therapeutic delay and stage of colorectal cancer. Eur J Cancer 44:510–21CrossRefPubMed Ramos M, Esteva M, Cabeza E, Llobera J, Ruiz A (2008) Lack of association between diagnostic and therapeutic delay and stage of colorectal cancer. Eur J Cancer 44:510–21CrossRefPubMed
23.
Zurück zum Zitat Ramos M, Esteva M, Cabeza E, Campillo C, Llobera J, Aguilo A (2007) Relationship of diagnostic and therapeutic delay with survival in colorectal cancer: a review. Eur J Cancer 43:2467–78CrossRefPubMed Ramos M, Esteva M, Cabeza E, Campillo C, Llobera J, Aguilo A (2007) Relationship of diagnostic and therapeutic delay with survival in colorectal cancer: a review. Eur J Cancer 43:2467–78CrossRefPubMed
24.
Zurück zum Zitat Korsgaard M, Pedersen L, Sorensen HT, Laurberg S (2006) Delay of treatment is associated with advanced stage of rectal cancer but not of colon cancer. Cancer Detect Prev 30:341–6CrossRefPubMed Korsgaard M, Pedersen L, Sorensen HT, Laurberg S (2006) Delay of treatment is associated with advanced stage of rectal cancer but not of colon cancer. Cancer Detect Prev 30:341–6CrossRefPubMed
25.
Zurück zum Zitat Rupassara KS, Ponnusamy S, Withanage N, Milewski PJ (2006) A paradox explained? Patients with delayed diagnosis of symptomatic colorectal cancer have good prognosis. Colorectal Dis 8:423–9CrossRefPubMed Rupassara KS, Ponnusamy S, Withanage N, Milewski PJ (2006) A paradox explained? Patients with delayed diagnosis of symptomatic colorectal cancer have good prognosis. Colorectal Dis 8:423–9CrossRefPubMed
26.
Zurück zum Zitat Gomez-Dominguez E, Trapero-Marugan M, del Pozo AJ, Cantero J, Gisbert JP, Mate J (2006) The colorectal carcinoma prognosis factors. Significance of diagnosis delay. Rev Esp Enferm Dig 98:322–9PubMed Gomez-Dominguez E, Trapero-Marugan M, del Pozo AJ, Cantero J, Gisbert JP, Mate J (2006) The colorectal carcinoma prognosis factors. Significance of diagnosis delay. Rev Esp Enferm Dig 98:322–9PubMed
27.
Zurück zum Zitat Khattak I, Eardley NJ, Rooney PS (2006) Colorectal cancer—a prospective evaluation of symptom duration and GP referral patterns in an inner city teaching hospital. Colorectal Dis 8:518–21CrossRefPubMed Khattak I, Eardley NJ, Rooney PS (2006) Colorectal cancer—a prospective evaluation of symptom duration and GP referral patterns in an inner city teaching hospital. Colorectal Dis 8:518–21CrossRefPubMed
28.
Zurück zum Zitat Roncoroni L, Pietra N, Violi V, Sarli L, Choua O, Peracchia A (1999) Delay in the diagnosis and outcome of colorectal cancer: a prospective study. Eur J Surg Oncol 25:173–8CrossRefPubMed Roncoroni L, Pietra N, Violi V, Sarli L, Choua O, Peracchia A (1999) Delay in the diagnosis and outcome of colorectal cancer: a prospective study. Eur J Surg Oncol 25:173–8CrossRefPubMed
29.
Zurück zum Zitat Harris GJC, Simson JNL (1998) Causes of late diagnosis in cases of colorectal cancer seen in a district general hospital over a 2-year period. Ann R Coll Surg Engl 80:246–8PubMed Harris GJC, Simson JNL (1998) Causes of late diagnosis in cases of colorectal cancer seen in a district general hospital over a 2-year period. Ann R Coll Surg Engl 80:246–8PubMed
30.
Zurück zum Zitat Taylor C, Schultz SE, Paszat LF, Bondy S, Rabeneck L (2007) Prevalence of screening in patients newly diagnosed with colorectal cancer in Ontario. Can J Gastroenterol 21:805–8PubMed Taylor C, Schultz SE, Paszat LF, Bondy S, Rabeneck L (2007) Prevalence of screening in patients newly diagnosed with colorectal cancer in Ontario. Can J Gastroenterol 21:805–8PubMed
31.
Zurück zum Zitat Frederiksen BL, Osler M, Harling H, Ladelund S, Jorgensen T (2009) Do patient characteristics, disease, or treatment explain social inequality in survival from colorectal cancer? Soc Sci Med 6(7):1107–1115CrossRef Frederiksen BL, Osler M, Harling H, Ladelund S, Jorgensen T (2009) Do patient characteristics, disease, or treatment explain social inequality in survival from colorectal cancer? Soc Sci Med 6(7):1107–1115CrossRef
Metadaten
Titel
Why so late?!—delay in treatment of colorectal cancer is socially determined
verfasst von
Mike Ralf Langenbach
Stefan Sauerland
Karl-Wilhelm Kröbel
Hubert Zirngibl
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 8/2010
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-010-0664-8

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