Patient Delay in Colorectal Cancer Patients: Associations with Rectal Bleeding and Thoughts about Cancer

Anette F Pedersen,Rikke P Hansen,Peter Vedsted,Wendy Wing Tak Lam

doi:10.1371/journal.pone.0069700

Abstract

Rectal bleeding is considered to be an alarm symptom of colorectal cancer. However, the symptom is seldom reported to the general practitioner and it is often assumed that patients assign the rectal bleeding to benign conditions. The aims of this questionnaire study were to examine whether rectal bleeding was associated with longer patient delays in colorectal cancer patients and whether rectal bleeding was associated with cancer worries. All incident colorectal cancer patients during a 1-year period in the County of Aarhus, Denmark, received a questionnaire. 136 colorectal cancer patients returned the questionnaire (response rate: 42%). Patient delay was assessed as the interval from first symptom to help-seeking and was reported by the patient. Patients with rectal bleeding (N = 81) reported longer patient intervals than patients without rectal bleeding when adjusting for confounders including other symptoms such as pain and changes in bowel habits (HR = 0.43; p = 0.004). Thoughts about cancer were not associated with the patient interval (HR = 1.05; p = 0.887), but more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding (chi2 = 15.29; p<0.001). Conclusively, rectal bleeding was associated with long patient delays in colorectal cancer patients although more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding. This suggests that assignment of symptoms to benign conditions is not the only explanation of long patient delays in this patient group and that barriers for timely help-seeking should be examined.

Highlights

The 1-year relative survival of colorectal cancer is between 70– 90% and has improved during the last decade
It is generally accepted that the higher mortality for patients with very short diagnostic time intervals is a result of bias inflicted by patients with fast-growing tumors who, despite immediate help-seeking, have a poor prognosis as the tumor has often spread at the time of first symptom
The difference between the groups was clear with patients who had experienced rectal bleeding reporting a patient interval of 39 days and 15 days in patients who had not experienced rectal bleeding

Summary

Introduction

The 1-year relative survival of colorectal cancer is between 70– 90% and has improved during the last decade. It continues to be lower in Denmark and UK than in other western countries [1]. One reason for these differences could be that patients in Denmark and UK wait longer for a diagnosis. The results of a recent study revealed a U-shaped curve when examining the association between delay in cancer diagnosis and 5-year mortality in colorectal cancer patients, that is, patients with very short or very long diagnostic time intervals had higher mortality than the rest [5]. It is generally accepted that the higher mortality for patients with very short diagnostic time intervals is a result of bias inflicted by patients with fast-growing tumors who, despite immediate help-seeking, have a poor prognosis as the tumor has often spread at the time of first symptom

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