title: Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer.
abstract: BACKGROUND
  Colorectal cancer (CRC) survival depends mostly on stage at the time of diagnosis. However, symptom duration at diagnosis or treatment have also been considered as predictors of stage and survival. This study was designed to: 1) establish the distinct time-symptom duration intervals; 2) identify factors associated with symptom duration until diagnosis and treatment.
  
  
  METHODS
  This is a cross-sectional study of all incident cases of symptomatic CRC during 2006-2009 (795 incident cases) in 5 Spanish regions. Data were obtained from patients' interviews and reviews of primary care and hospital clinical records.
  
  
  METHODS
  CRC symptoms, symptom perception, trust in the general practitioner (GP), primary care and hospital examinations/visits before diagnosis, type of referral and tumor characteristics at diagnosis. Symptom Diagnosis Interval (SDI) was calculated as time from first CRC symptoms to date of diagnosis. Symptom Treatment Interval (STI) was defined as time from first CRC symptoms until start of treatment. Nonparametric tests were used to compare SDI and STI according to different variables.
  
  
  RESULTS
  Symptom to diagnosis interval for CRC was 128 days and symptom treatment interval was 155. No statistically significant differences were observed between colon and rectum cancers. Women experienced longer intervals than men. Symptom presentation such as vomiting or abdominal pain and the presence of obstruction led to shorter diagnostic or treatment intervals. Time elapsed was also shorter in those patients that perceived their first symptom/s as serious, disclosed it to their acquaintances, contacted emergencies services or had trust in their GPs. Primary care and hospital doctor examinations and investigations appeared to be related to time elapsed to diagnosis or treatment.
  
  
  CONCLUSIONS
  Results show that gender, symptom perception and help-seeking behaviour are the main patient factors related to interval duration. Health service performance also has a very important role in symptom to diagnosis and treatment interval. If time to diagnosis is to be reduced, interventions and guidelines must be developed to ensure appropriate examination and diagnosis during both primary and hospital care.
authors: Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain. mesteva@ibsalut.caib.es
authors: Magdalena
authors: M
authors: Esteva
authors: Alfonso
authors: A
authors: Leiva
authors: María
authors: M
authors: Ramos
authors: Salvador
authors: S
authors: Pita-Fernández
authors: Luis
authors: L
authors: González-Luján
authors: Montse
authors: M
authors: Casamitjana
authors: María A
authors: MA
authors: Sánchez
authors: Sonia
authors: S
authors: Pértega-Díaz
authors: Amador
authors: A
authors: Ruiz
authors: Paloma
authors: P
authors: Gonzalez-Santamaría
authors: María
authors: M
authors: Martín-Rabadán
authors: Ana M
authors: AM
authors: Costa-Alcaraz
authors: Alejandro
authors: A
authors: Espí
authors: Francesc
authors: F
authors: Macià
authors: Josep M
authors: JM
authors: Segura
authors: Sergio
authors: S
authors: Lafita
authors: Francisco
authors: F
authors: Arnal-Monreal
authors: Isabel
authors: I
authors: Amengual
authors: Marta M
authors: MM
authors: Boscá-Watts
authors: Angels
authors: A
authors: Hospital
authors: Hermini
authors: H
authors: Manzano
authors: Rosa
authors: R
authors: Magallón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D035502:Trust