Time from first presentation in primary care to treatment of symptomatic colorectal cancer

effect on disease stage and survival

Peter Murchie, E A Raja, D H Brewster, N C Campbell, L D Ritchie, R Robertson, L Samuel, N Gray, A J Lee

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: British 5-year survival from colorectal cancer (CRC) is below the European average, but the reasons are unclear. This study explored if longer provider delays (time from presentation to treatment) were associated with more advanced stage disease at diagnosis and poorer survival.

METHODS: Data on 958 people with CRC were linked with the Scottish Cancer Registry, the Scottish Death Registry and the acute hospital discharge (SMR01) dataset. Time from first presentation in primary care to first treatment, disease stage at diagnosis and survival time from date of first presentation in primary care were determined. Logistic regression and Cox survival analyses, both with a restricted cubic spline, were used to model stage and survival, respectively, following sequential adjustment of patient and tumour factors.

RESULTS: On univariate analysis, those with <4 weeks from first presentation in primary care to treatment had more advanced disease at diagnosis and the poorest prognosis. Treatment delays between 4 and 34 weeks were associated with earlier stage (with the lowest odds ratio occurring at 20 weeks) and better survival (with the lowest hazard ratio occurring at 16 weeks). Provider delays beyond 34 weeks were associated with more advanced disease at diagnosis, but not increased mortality. Following adjustment for patient, tumour factors, emergency admissions and symptoms and signs, no significant relationship between provider delay and stage at diagnosis or survival from CRC was found.

CONCLUSIONS: Although allowing for a nonlinear relationship and important confounders, moderately long provider delays did not impact adversely on cancer outcomes. Delays are undesirable because they cause anxiety; this may be fuelled by government targets and health campaigns stressing the importance of very prompt cancer diagnosis. Our findings should reassure patients. They suggest that a health service's primary emphasis should be on quality and outcomes rather than on time to treatment.

Original languageEnglish
Pages (from-to)461-469
Number of pages9
JournalBritish Journal of Cancer
Volume111
Issue number3
Early online date3 Jul 2014
DOIs
Publication statusPublished - 29 Jul 2014

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Colorectal Neoplasms
Primary Health Care
Survival
Neoplasms
Registries
Therapeutics
Social Adjustment
Survival Analysis
Health Promotion
Signs and Symptoms
Health Services
Emergencies
Anxiety
Logistic Models
Odds Ratio
Mortality

Keywords

  • Aged
  • Colorectal Neoplasms
  • Delayed Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Proportional Hazards Models
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome

Cite this

Time from first presentation in primary care to treatment of symptomatic colorectal cancer : effect on disease stage and survival. / Murchie, Peter; Raja, E A; Brewster, D H; Campbell, N C; Ritchie, L D; Robertson, R ; Samuel, L; Gray, N; Lee, A J.

In: British Journal of Cancer, Vol. 111, No. 3, 29.07.2014, p. 461-469.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: British 5-year survival from colorectal cancer (CRC) is below the European average, but the reasons are unclear. This study explored if longer provider delays (time from presentation to treatment) were associated with more advanced stage disease at diagnosis and poorer survival.METHODS: Data on 958 people with CRC were linked with the Scottish Cancer Registry, the Scottish Death Registry and the acute hospital discharge (SMR01) dataset. Time from first presentation in primary care to first treatment, disease stage at diagnosis and survival time from date of first presentation in primary care were determined. Logistic regression and Cox survival analyses, both with a restricted cubic spline, were used to model stage and survival, respectively, following sequential adjustment of patient and tumour factors.RESULTS: On univariate analysis, those with <4 weeks from first presentation in primary care to treatment had more advanced disease at diagnosis and the poorest prognosis. Treatment delays between 4 and 34 weeks were associated with earlier stage (with the lowest odds ratio occurring at 20 weeks) and better survival (with the lowest hazard ratio occurring at 16 weeks). Provider delays beyond 34 weeks were associated with more advanced disease at diagnosis, but not increased mortality. Following adjustment for patient, tumour factors, emergency admissions and symptoms and signs, no significant relationship between provider delay and stage at diagnosis or survival from CRC was found.CONCLUSIONS: Although allowing for a nonlinear relationship and important confounders, moderately long provider delays did not impact adversely on cancer outcomes. Delays are undesirable because they cause anxiety; this may be fuelled by government targets and health campaigns stressing the importance of very prompt cancer diagnosis. Our findings should reassure patients. They suggest that a health service's primary emphasis should be on quality and outcomes rather than on time to treatment.",
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note = "The study was funded by NHS Grampian Research Endowment Award 11/26, and a grant from The Colorectal Study Fund (a NHS Grampian Endowment fund). The study was approved on 24 May 2011 by the Privacy Advisory Committee of ISD Scotland. Following discussion with the North of Scotland Research Ethics Committee it was decided on 7 February 2011 that formal ethical approval was not required. Research and Development approval was granted from NHS Grampian on 14 June 2011. The University of Aberdeen acted as sponsor for the study.",
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T1 - Time from first presentation in primary care to treatment of symptomatic colorectal cancer

T2 - effect on disease stage and survival

AU - Murchie, Peter

AU - Raja, E A

AU - Brewster, D H

AU - Campbell, N C

AU - Ritchie, L D

AU - Robertson, R

AU - Samuel, L

AU - Gray, N

AU - Lee, A J

N1 - The study was funded by NHS Grampian Research Endowment Award 11/26, and a grant from The Colorectal Study Fund (a NHS Grampian Endowment fund). The study was approved on 24 May 2011 by the Privacy Advisory Committee of ISD Scotland. Following discussion with the North of Scotland Research Ethics Committee it was decided on 7 February 2011 that formal ethical approval was not required. Research and Development approval was granted from NHS Grampian on 14 June 2011. The University of Aberdeen acted as sponsor for the study.

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N2 - BACKGROUND: British 5-year survival from colorectal cancer (CRC) is below the European average, but the reasons are unclear. This study explored if longer provider delays (time from presentation to treatment) were associated with more advanced stage disease at diagnosis and poorer survival.METHODS: Data on 958 people with CRC were linked with the Scottish Cancer Registry, the Scottish Death Registry and the acute hospital discharge (SMR01) dataset. Time from first presentation in primary care to first treatment, disease stage at diagnosis and survival time from date of first presentation in primary care were determined. Logistic regression and Cox survival analyses, both with a restricted cubic spline, were used to model stage and survival, respectively, following sequential adjustment of patient and tumour factors.RESULTS: On univariate analysis, those with <4 weeks from first presentation in primary care to treatment had more advanced disease at diagnosis and the poorest prognosis. Treatment delays between 4 and 34 weeks were associated with earlier stage (with the lowest odds ratio occurring at 20 weeks) and better survival (with the lowest hazard ratio occurring at 16 weeks). Provider delays beyond 34 weeks were associated with more advanced disease at diagnosis, but not increased mortality. Following adjustment for patient, tumour factors, emergency admissions and symptoms and signs, no significant relationship between provider delay and stage at diagnosis or survival from CRC was found.CONCLUSIONS: Although allowing for a nonlinear relationship and important confounders, moderately long provider delays did not impact adversely on cancer outcomes. Delays are undesirable because they cause anxiety; this may be fuelled by government targets and health campaigns stressing the importance of very prompt cancer diagnosis. Our findings should reassure patients. They suggest that a health service's primary emphasis should be on quality and outcomes rather than on time to treatment.

AB - BACKGROUND: British 5-year survival from colorectal cancer (CRC) is below the European average, but the reasons are unclear. This study explored if longer provider delays (time from presentation to treatment) were associated with more advanced stage disease at diagnosis and poorer survival.METHODS: Data on 958 people with CRC were linked with the Scottish Cancer Registry, the Scottish Death Registry and the acute hospital discharge (SMR01) dataset. Time from first presentation in primary care to first treatment, disease stage at diagnosis and survival time from date of first presentation in primary care were determined. Logistic regression and Cox survival analyses, both with a restricted cubic spline, were used to model stage and survival, respectively, following sequential adjustment of patient and tumour factors.RESULTS: On univariate analysis, those with <4 weeks from first presentation in primary care to treatment had more advanced disease at diagnosis and the poorest prognosis. Treatment delays between 4 and 34 weeks were associated with earlier stage (with the lowest odds ratio occurring at 20 weeks) and better survival (with the lowest hazard ratio occurring at 16 weeks). Provider delays beyond 34 weeks were associated with more advanced disease at diagnosis, but not increased mortality. Following adjustment for patient, tumour factors, emergency admissions and symptoms and signs, no significant relationship between provider delay and stage at diagnosis or survival from CRC was found.CONCLUSIONS: Although allowing for a nonlinear relationship and important confounders, moderately long provider delays did not impact adversely on cancer outcomes. Delays are undesirable because they cause anxiety; this may be fuelled by government targets and health campaigns stressing the importance of very prompt cancer diagnosis. Our findings should reassure patients. They suggest that a health service's primary emphasis should be on quality and outcomes rather than on time to treatment.

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KW - Humans

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KW - Middle Aged

KW - Neoplasm Staging

KW - Proportional Hazards Models

KW - Retrospective Studies

KW - Time Factors

KW - Treatment Outcome

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DO - 10.1038/bjc.2014.352

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JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

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