Multilevel Approaches to Reducing Diagnostic and Treatment Delay in Colorectal Cancer
| العنوان: | Multilevel Approaches to Reducing Diagnostic and Treatment Delay in Colorectal Cancer |
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| المؤلفون: | Sherri Sheinfeld Gorin |
| المصدر: | The Annals of Family Medicine. 17:386-389 |
| بيانات النشر: | Annals of Family Medicine, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Oncology, medicine.medical_specialty, Screening test, Colorectal cancer, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Global health, Humans, Medicine, 030212 general & internal medicine, Stage (cooking), Referral and Consultation, neoplasms, Original Research, Primary Health Care, business.industry, Crc screening, Treatment delay, medicine.disease, digestive system diseases, Colonic Neoplasms, Risk of death, Colorectal Neoplasms, Family Practice, business, Stage at diagnosis |
| الوصف: | PURPOSE: An optimal diagnostic process in primary care is pivotal for reducing cancer-related disease burden. This study aims to explore reasons for long times to referral for Dutch colorectal cancer (CRC) patients in primary care. METHODS: A retrospective cohort study of anonymized free-text primary care records from the Julius General Practitioners’ Network database, linked to the Netherlands Cancer Registry. Patients with a confirmed CRC diagnosis from 2007 through 2011 that symptomatically presented in primary care were included. Median time and interquartile ranges from presentation in primary care to referral were calculated for multiple patient and presentation characteristics. Associations of these characteristics with long time to referral (75th percentile was ≥59 days) were examined with log-binomial regression analyses. Routes to referral of patients with the longest times to referral were explored using thematic free-text analyses (90th percentile at ≥219 days). RESULTS: Among the 309 people with CRC, patients who were female, did not have a registered family history, had a history of malignancy, lacked alarm symptoms at presentation, or had hemorrhoids at physical examination were at risk for longer time to referral in univariable analyses (longer median durations and/or univariable association with the 75th percentile). Only presentation without alarm symptoms showed a statistically significant association with long duration (75th percentile) in multivariable analysis (relative risk = 1.7; 95% CI, 1.1-2.6). Thematic exploration of the diagnostic routes to referral of patients with the longest durations (90th percentile) showed 2 dominating themes: “alternative working diagnosis” and “suboptimal diagnostic strategies,” and included the sub-themes “omitting to reconsider an initial diagnosis” and “lacking follow-up.” CONCLUSIONS: Long time to referral for CRC in primary care is mainly related to low cancer suspicion. There is potential for reducing the longest times to referral for patients with CRC in primary care, with earlier reconsideration of the initial hypothesis and implementation of strict follow-up consultations. |
| تدمد: | 1544-1717 1544-1709 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f97a1154378dfebb34a5c966769d49c3Test https://doi.org/10.1370/afm.2454Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....f97a1154378dfebb34a5c966769d49c3 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15441717 15441709 |
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