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

effect on disease stage and survival

P. Murchie (Lead / Corresponding author), 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

    23 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
    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

    Cite this

    Murchie, P., Raja, E. A., Brewster, D. H., Campbell, N. C., Ritchie, L. D., Robertson, R., ... Lee, A. J. (2014). Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival. British Journal of Cancer, 111(3), 461-469. https://doi.org/10.1038/bjc.2014.352
    Murchie, P. ; Raja, E. A. ; Brewster, D. H. ; Campbell, N. C. ; Ritchie, L. D. ; Robertson, R. ; Samuel, L. ; Gray, N. ; Lee, A. J. / Time from first presentation in primary care to treatment of symptomatic colorectal cancer : effect on disease stage and survival. In: British Journal of Cancer. 2014 ; Vol. 111, No. 3. pp. 461-469.
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    title = "Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival",
    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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    Murchie, P, Raja, EA, Brewster, DH, Campbell, NC, Ritchie, LD, Robertson, R, Samuel, L, Gray, N & Lee, AJ 2014, 'Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival', British Journal of Cancer, vol. 111, no. 3, pp. 461-469. https://doi.org/10.1038/bjc.2014.352

    Time from first presentation in primary care to treatment of symptomatic colorectal cancer : effect on disease stage and survival. / Murchie, P. (Lead / Corresponding author); 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

    TY - JOUR

    T1 - Time from first presentation in primary care to treatment of symptomatic colorectal cancer

    T2 - effect on disease stage and survival

    AU - Murchie, P.

    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 - Export Date: 12 April 2015

    PY - 2014/7/29

    Y1 - 2014/7/29

    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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    DO - 10.1038/bjc.2014.352

    M3 - Article

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    SP - 461

    EP - 469

    JO - British Journal of Cancer

    JF - British Journal of Cancer

    SN - 0007-0920

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    ER -