Suryani Norma Dewi, Wiranata Juan Adrian, Puspitaningtyas Herindita, Hutajulu Susanna Hilda, Prabandari Yayi Suryo, Handaya Adeodatus Yuda, Hardianti Mardiah Suci, Taroeno-Hariadi Kartika Widayati, Kurnianda Johan, Purwanto Ibnu
Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
Academic Hospital, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
Ecancermedicalscience. 2024 Sep 11;18:1761. doi: 10.3332/ecancer.2024.1761. eCollection 2024.
Early colorectal cancer (CRC) symptom recognition and prompt diagnosis are crucial for the identification of cases in the earliest stage and for improving survival. This study investigates the incidence of presentation and diagnosis delays, their contributing determinants and their impact on the cancer stage at diagnosis.
This cross-sectional study recruited 227 CRC patients between November 2022 and October 2023. We developed a semi-structured questionnaire to collect information on the factors related to delays in the presentation and diagnosis. Presentation delay was defined as the time between the initial symptoms and the first consultation exceeding 1 month, while diagnosis delay was defined as the time between presentation and the pathological diagnosis confirmation exceeding 4 months. We examined the impact of these delays on the status of the metastatic disease and identified the determinants of the presentation and diagnosis delays.
The median values for presentation and diagnosis delay are 1 and 4 months, respectively. Patients aged ≥60 years were less likely to experience diagnosis delays odds ratio (OR = 0.52, 95% confidence interval (CI) 0.28-0.95, = 0.035), as opposed to those who were younger. The absence of red flag symptoms at presentation (OR = 2.73, 95% CI 1.47-5.10, = 0.002), the utilisation of complementary and alternative medicine (OR = 2.01, 95% CI 1.12-3.61, = 0.019) and ≥3 distinct healthcare facility visits before diagnosis (OR = 3.51, 95% CI 1.95-6.29, < 0.001) were associated with an increased risk of diagnosis delays. Diagnosis delays were also correlated with a higher risk of metastatic disease at diagnosis (OR = 2.04, 95% CI 1.17-3.53, = 0.011).
Our CRC patients experience considerable delays in their presentation and diagnosis. Diagnosis delays were observed to increase the likelihood of presenting with metastatic disease. Given the determinants and the patients' perspectives revealed in this study, future research to explore evidence-based approaches to reducing these delays is warranted.
早期结直肠癌（CRC）症状的识别和及时诊断对于早期病例的识别以及提高生存率至关重要。本研究调查了就诊延迟和诊断延迟的发生率、其影响因素以及它们对诊断时癌症分期的影响。
这项横断面研究在2022年11月至2023年10月期间招募了227例CRC患者。我们编制了一份半结构化问卷，以收集与就诊和诊断延迟相关因素的信息。就诊延迟定义为初始症状出现至首次就诊的时间超过1个月，而诊断延迟定义为就诊至病理诊断确诊的时间超过4个月。我们研究了这些延迟对转移性疾病状态的影响，并确定了就诊和诊断延迟的影响因素。
就诊延迟和诊断延迟的中位数分别为1个月和4个月。与年轻患者相比，年龄≥60岁的患者经历诊断延迟的可能性较小（比值比[OR]=0.52，95%置信区间[CI]0.28-0.95，P=0.035）。就诊时无警示症状（OR=2.73，95%CI 1.47-5.10，P=0.002）、使用补充和替代医学（OR=2.01，95%CI 1.12-3.61，P=0.019）以及诊断前就诊≥3家不同的医疗机构（OR=3.51，95%CI 1.95-6.29，P<0.001）与诊断延迟风险增加相关。诊断延迟还与诊断时发生转移性疾病的较高风险相关（OR=2.04，95%CI 1.17-3.53，P=0.011）。
我们的CRC患者在就诊和诊断方面经历了相当长的延迟。观察到诊断延迟会增加出现转移性疾病的可能性。鉴于本研究揭示的影响因素和患者观点，有必要开展未来研究以探索基于证据的减少这些延迟的方法。
