| アブストラクト | BACKGROUND: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD: Incident cases (aged 40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS: Out of the 4512 patients included, 72.9% had 1 competing demand and 31.3% had 1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS: The burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged 80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity. |
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| 組織名 | Research Fellow, Health Services and Policy Research Group, Exeter Collaboration;for Academic Primary Care (APEx), University of Exeter Medical School, South;Cloisters, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK.;Research Fellow, Diagnosis of Symptomatic Cancer Optimally (DISCO) and Exeter;Collaboration for Academic Primary Care (APEx), University of Exeter Medical;School, College House, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK.;Professor of Health Services and Policy Research, Health Services and Policy;Research Group, Exeter Collaboration for Academic Primary Care (APEx), University;of Exeter Medical School, Smeall Building, St Luke's Campus, Magdalen Road,;Exeter EX1 2LU, UK.;Professor of Primary Care Diagnostics, Diagnosis of Symptomatic Cancer Optimally;(DISCO) and Exeter Collaboration for Academic Primary Care (APEx), University of;Exeter Medical School, College House, St Luke's Campus, Magdalen Road, Exeter EX1;2LU, UK. |
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