Features of the diagnostic pathway associated with early death from colon cancer: A nested case-control study in a UK region

Background: Population level studies of colon cancer survival have identified the first three months following diagnosis as critical in explaining international survival variation. This study investigates factors associated with mortality in this early phase following diagnosis with the aim informing interventions to address early cancer death.Methods: This retrospective nested case-control study collected GP and hospital data on 500 colon cancer patients who survived less than 3 months from diagnosis (cases) and 500 patients with survival greater than 6 months and less than 3 years (controls). Patients were matched by age, sex and year of diagnosis. Patient, disease and service characteristics were investigated including the time and pathway to diagnosis,number of service visits, treatment, co-morbidity and health seeking behaviours (e.g. flu vaccine uptake).Results: The mean age at diagnosis of patients in the study was 74.4 yrs (70.8 yrs for all colon cancer patients) and 52%were male (51.8% for all colon cancer patients). Being single,widowed, having unknown marital status and increasing deprivation were associated with early death. Attendance for flu vaccine was associated with lower odds of early death(OR=0.62, CI:0.42–0.92). While number of consultations between one and three years pre-diagnosis was not associated with early death, the pathway to diagnosis differed between the two groups with the number of GP consultations in the 3 months before diagnosis associated with early death(OR=1.16, CI:1.09–1.22) as were increasing out of hours appointments (OR=1.24, CI:1.11–1.41) and emergency presentations (OR=1.17, CI:1.06–1.29)