title: Factors influencing time from presentation to treatment of colorectal and breast cancer in urban and rural areas.
abstract: Stage at diagnosis and survival from cancer vary according to where people live, suggesting some may have delays in diagnosis. The aim of this study was to determine if time from presentation to treatment was longer for colorectal and breast cancer patients living further from cancer centres, and identify other important factors in delay. Data were collected on 1097 patients with breast and 1223 with colorectal cancer in north and northeast Scotland. Women with breast cancer who lived further from cancer centres were treated more quickly than those living closer to cancer centres (P=0.011). Multilevel modelling found that this was largely due to them receiving earlier treatment at hospitals other than cancer centres. Breast lump, change in skin contour, lymphadenopathy, more symptoms and signs, and increasing age predicted faster treatment. Screen detected cancers and private referrals were treated more quickly. For colorectal cancer, time to treatment was similar for people in rural and urban areas. Quicker treatment was associated with palpable rectal or abdominal masses, tenesmus, abdominal pain, frequent GP consultations, age between 50 and 74 years, tumours of the transverse colon, and iron medication at presentation. Delay was associated with past anxiety or depression. There was variation between general practices and treatment appeared quicker at practices with more female general practitioners.
authors.affiliation: Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, AB25 2AY Aberdeen, UK.
authors.forename: R
authors.initials: R
authors.lastname: Robertson
authors.forename: N C
authors.initials: NC
authors.lastname: Campbell
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.forename: P T
authors.initials: PT
authors.lastname: Donnan
authors.forename: F
authors.initials: F
authors.lastname: Sullivan
authors.forename: R
authors.initials: R
authors.lastname: Duffy
authors.forename: L D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: D
authors.initials: D
authors.lastname: Millar
authors.forename: J
authors.initials: J
authors.lastname: Cassidy
authors.forename: A
authors.initials: A
authors.lastname: Munro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001007:Anxiety; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002173:Cancer Care Facilities; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D003863:Depression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011379:Prognosis; D012424:Rural Population; D012606:Scotland; D012720:Severity of Illness Index; D013997:Time Factors; D014505:Urban Population; D014850:Waiting Lists