Symptom-to-diagnosis interval and survival in cancers of the digestive tract.
The objective was to identify the main correlates of the symptom-to-diagnosis interval (SDI) and to analyze their influence upon the survival in patients with cancers of the digestive tract. Two hundred forty-eight symptomatic patients with cancer of the esophagus (N = 31), stomach (N = 70), colon (N = 84), and rectum (N = 66) were interviewed and prospectively followed (median follow-up of 77 months). Cox's regression was used to assess the relative risk (RR) of death according to SDI. The median SDI was about 4 months, with nonsignificant differences by sex, age, social class, family history of cancer, or tumor site. The RR of death varied significantly by age (P = 0.012), tumor site (P < 0.01), tumor stage (P < 0.01), and type of hospital admission (P < 0.01). After adjustment for known and potential predictors of survival and as compared to an SDI < 2.5 months, the RR of death was 0.89 (95% CI: 0.61-1.32) for an SDI of 2.5-6 months, 0.78 (95% CI: 0.49-1.26) for SDI > 6-12 months, and 0.81 (95% CI: 0.44-1.49) for SDI > 12 months. These results do not imply that specific actions to hasten diagnosis must of necessity be ineffective, but underscore what a challenging task the secondary prevention of cancer remains.
Fernandez
Esteve
E
Institut Català d'Oncologia, Cancer Prevention and Control Unit, L'Hospitalet, Barcelona, Spain.
Porta
Miquel
M
Malats
Núria
N
Belloc
Josep
J
Gallén
Manuel
M
D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000401:mortality; D004067:Digestive System Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors