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

Campbell, N.C., Macdonald, S. , MacLeod, U., Mitchell, E.D. and Weller, D. (2008) Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. British Journal of Cancer, 98(1), pp. 60-70. (doi:10.1038/sj.bjc.6604096)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:MacLeod, Dr Una and Mitchell, Dr Elizabeth and Macdonald, Dr Sara
Authors: Campbell, N.C., Macdonald, S., MacLeod, U., Mitchell, E.D., and Weller, D.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences
Journal Name:British Journal of Cancer
Publisher:Nature Publishing Group
ISSN:0007-0920
ISSN (Online):1532-1827
Published Online:04 December 2007
Copyright Holders:Copyright © 2008 The Authors
First Published:First published in British Journal of Cancer 98(1):60-70
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
309001Factors influencing patient and primary care delay in the diagnosis of cancer: a database of existing research and its implications for...Una MacleodDepartment of Health (DOH-R&D)1217522RI HEALTH & WELLBEING