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Br J Cancer. 2008 Jan 15;98(1):60-70. Epub 2007 Dec 4.

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review.

Author information

1
School of Health and Social Care, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK. liz.mitchell2@googlemail.com

Abstract

Colorectal cancer is a major global health problem, with survival varying according to stage at diagnosis. Delayed diagnosis can result from patient, practitioner or hospital delay. This paper reports the results of a review of the factors influencing pre-hospital delay - the time between a patient first noticing a cancer symptom and presenting to primary care or between first presentation and referral to secondary care. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Fifty-four studies were included. Patients' non-recognition of symptom seriousness increased delay, as did symptom denial. Patient delay was greater for rectal than colon cancers and the presence of more serious symptoms, such as pain, reduced delay. There appears to be no relationship between delay and patients' age, sex or socioeconomic status. Initial misdiagnosis, inadequate examination and inaccurate investigations increased practitioner delay. Use of referral guidelines may reduce delay, although evidence is currently limited. No intervention studies were identified. If delayed diagnosis is to be reduced, there must be increased recognition of the significance of symptoms among patients, and development and evaluation of interventions that are designed to ensure appropriate diagnosis and examination by practitioners.

PMID:
18059401
PMCID:
PMC2359711
DOI:
10.1038/sj.bjc.6604096
[Indexed for MEDLINE]
Free PMC Article

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