Robertson R, Campbell N C, Smith S, Donnan P T, Sullivan F, Duffy R, Ritchie L D, Millar D, Cassidy J, Munro A
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, AB25 2AY Aberdeen, UK.
Br J Cancer. 2004 Apr 19;90(8):1479-85. doi: 10.1038/sj.bjc.6601753.
Stage at diagnosis and survival from cancer vary according to where people live, suggesting some may have delays in diagnosis. The aim of this study was to determine if time from presentation to treatment was longer for colorectal and breast cancer patients living further from cancer centres, and identify other important factors in delay. Data were collected on 1097 patients with breast and 1223 with colorectal cancer in north and northeast Scotland. Women with breast cancer who lived further from cancer centres were treated more quickly than those living closer to cancer centres (P=0.011). Multilevel modelling found that this was largely due to them receiving earlier treatment at hospitals other than cancer centres. Breast lump, change in skin contour, lymphadenopathy, more symptoms and signs, and increasing age predicted faster treatment. Screen detected cancers and private referrals were treated more quickly. For colorectal cancer, time to treatment was similar for people in rural and urban areas. Quicker treatment was associated with palpable rectal or abdominal masses, tenesmus, abdominal pain, frequent GP consultations, age between 50 and 74 years, tumours of the transverse colon, and iron medication at presentation. Delay was associated with past anxiety or depression. There was variation between general practices and treatment appeared quicker at practices with more female general practitioners.
癌症诊断时的分期及生存率因人们居住地点而异，这表明部分患者可能存在诊断延迟的情况。本研究的目的是确定居住在距离癌症中心较远的结直肠癌和乳腺癌患者从就诊到接受治疗的时间是否更长，并找出导致延迟的其他重要因素。收集了苏格兰北部和东北部1097例乳腺癌患者及1223例结直肠癌患者的数据。居住在距离癌症中心较远的乳腺癌女性患者比居住在较近癌症中心的患者接受治疗的速度更快（P = 0.011）。多水平模型分析发现，这主要是因为她们在癌症中心以外的医院更早接受了治疗。乳房肿块、皮肤轮廓改变、淋巴结病、更多的症状和体征以及年龄增长预示着治疗速度更快。筛查发现的癌症和私人转诊患者接受治疗的速度更快。对于结直肠癌，农村和城市地区患者的治疗时间相似。治疗较快与可触及的直肠或腹部肿块、里急后重、腹痛、频繁看全科医生、年龄在50至74岁之间、横结肠癌以及就诊时服用铁剂有关。延迟与过去的焦虑或抑郁有关。不同全科诊所之间存在差异，在女性全科医生较多的诊所，治疗似乎更快。
