title: Perceived diagnostic delay and cancer-related distress: a cross-sectional study of patients with colorectal cancer.
abstract: This study aimed to examine the effect of perceived diagnostic delay on cancer-related distress and determine whether fear of cancer-recurrence and quality of life mediate this relationship.
  
  
  
  Cross-sectional study in which 311 colorectal cancer (CRC) survivors in Scotland completed a survey, which included questions on cancer-related distress (IES-R), perceived diagnostic delay, quality of life (trial outcome index of the FACT-C: FACT-C TOI) and fear of cancer recurrence. Fifteen patients withheld consent to data matching with medical records, leaving a sample size of 296. Participants were an average of 69 years old (range 56 to 81) and between 3.5 and 12 years post-diagnosis. Multiple regressions were used to test predictors of distress and regression and bootstrapping to test for mediation.
  
  
  
  Perceived diagnostic delay was correlated with higher cancer-related distress, while objective markers of diagnostic delay (disease stage at diagnosis and treatment received) were not. Some of the relationship between perceived diagnostic delay and cancer-related distress was mediated by quality of life, but not by fear of cancer recurrence.
  
  
  
  Perceived diagnostic delay was associated with higher cancer-related distress among CRC survivors. While poorer quality of life partly explained such associations, fear of cancer recurrence, stage at diagnosis and treatment did not. The exact features of diagnostic delay that are associated with cancer-related distress remain unclear. Future research should examine the experiences patients go through prior to diagnosis that may increase distress, in an effort to improve our understanding of the factors affecting emotional wellbeing among CRC survivors. Copyright © 2016 John Wiley & Sons, Ltd.
authors: Department of Psychological Sciences, Birkbeck, University of London, London, UK.
authors: Anne
authors: A
authors: Miles
authors: Information Services Division, NHS National Services Scotland, Edinburgh, UK.
authors: Paula L
authors: PL
authors: McClements
authors: Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK.
authors: Robert J C
authors: RJ
authors: Steele
authors: Department of Psychological Sciences, Birkbeck, University of London, London, UK.
authors: Claudia
authors: C
authors: Redeker
authors: Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors: Nick
authors: N
authors: Sevdalis
authors: Health Behaviour Research Centre, Institute of Epidemiology and Public Health, University College London, London, UK.
authors: Jane
authors: J
authors: Wardle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000523:psychology*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000523:psychology*; D005239:Fear / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000523:psychology; D010465:Perception; D011788:Quality of Life / Q000523:psychology*; D012606:Scotland; D013315:Stress, Psychological / Q000523:psychology*