Abstract
BackgroundDisparate and contradictory results make studies necessary to investigate in more depth the relationship between diagnostic delay and survival in colorectal cancer (CRC) patients. The aim of this study is to analyse the relationship between the interval from first symptom to diagnosis (SDI) and survival in CRC.MethodsRetrospective study of n = 942 CRC patients. SDI was calculated as the time from the diagnosis of cancer and the first symptoms of CRC.Cox regression was used to estimate five-year mortality hazard ratios as a function of SDI, adjusting for age and gender. SDI was modelled according to SDI quartiles and as a continuous variable using penalized splines.ResultsMedian SDI was 3.4 months. SDI was not associated with stage at diagnosis (Stage I = 3.6 months, Stage II-III = 3.4, Stage IV = 3.2; p = 0.728). Shorter SDIs corresponded to patients with abdominal pain (2.8 months), and longer SDIs to patients with muchorrhage (5.2 months) and rectal tenesmus (4.4 months).Adjusting for age and gender, in rectum cancers, patients within the first SDI quartile had lower survival (p = 0.003), while in colon cancer no significant differences were found (p = 0.282). These results do not change after adjusting for TNM stage.The splines regression analysis revealed that, for rectum cancer, 5-year mortality progressively increases for SDIs lower than the median (3.7 months) and decreases as the delay increases until approximately 8 months. In colon cancer, no significant relationship was found between SDI and survival.ConclusionsShort diagnostic intervals are significantly associated with higher mortality in rectal but not in colon cancers, even though a borderline significant effect is also observed in colon cancer. Longer diagnostic intervals seemed not to be associated with poorer survival. Other factors than diagnostic delay should be taken into account to explain this “waiting-time paradox”.
Highlights
Disparate and contradictory results make studies necessary to investigate in more depth the relationship between diagnostic delay and survival in colorectal cancer (CRC) patients
Results showed that short diagnostic intervals are significantly associated with higher mortality in rectal cancer, but not in colon cancer, even though a borderline significant effect is observed in colon cancer
Symptoms-to-diagnosis interval Diagnostic delay in this study was significantly lower in comparison with other reported series in Spain [26, 27], being closer to the results found in a recent multicenter study made in 5 Spanish regions which reported a median delay of 4.2 months [28]
Summary
Disparate and contradictory results make studies necessary to investigate in more depth the relationship between diagnostic delay and survival in colorectal cancer (CRC) patients. Colorectal cancer (CRC) is one of the leading causes of deaths due to cancer worldwide. It is the third most common cancer in men (10.0 % of the total) and the second in women (9.2 % of the total), affecting mainly to developed regions [1]. In Europe, CRC is the most common cancer and the second most common cancer causing death, with an estimated number of 436,000 new cases and 212,000 deaths in 2008 [2]. The same trend was observed in other European countries, with an increase in incidence and a decrease in mortality, probably associated with an improvement in CRC survival [4, 5]
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