title: Determinants of patient's and doctor's delay in diagnosis and treatment of colorectal cancer.
abstract: BACKGROUND
  Early detection and treatment is important for the management of colorectal cancer (CRC).
  
  
  OBJECTIVE
  To assess patient and doctor delay and their determinants.
  
  
  METHODS
  A retrospective observational study in a primary care setting concerning 197 patients with CRC. The time between initial symptoms and the onset of treatment was categorized into four periods. With multivariable logistic regression analysis, determinants of delay were investigated.
  
  
  RESULTS
  The median time from onset of symptoms until the start of treatment was 138 days. Median time for the four periods to: first general practitioner consult, first specialist consult, histological diagnosis, and start treatment were 30, 14, 27, and 18 days, respectively. Rectal blood loss and weight loss were significantly related to patient delay, whereas psychiatric comorbidity was related to delay in referral by the general practitioner. For delay in histological diagnosis and start of definitive treatment no determinants were found. Delay was not associated with more advanced disease stages.
  
  
  CONCLUSIONS
  There is considerable delay in the management of CRC, especially in time to consultation and time to onset of clinical treatment. Education among the general public about the importance of alarm symptoms and increasing efficiency of the diagnostic process in hospital setting are a key in improving CRC disease management.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Afke M G H
authors.initials: AM
authors.lastname: Van Hout
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D057210:Delayed Diagnosis; D005194:Family Practice / Q000592:standards; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors