Patient- and system-related barriers for the earlier diagnosis of colorectal cancer

BMC Fam Pract. 2009 Sep 15:10:65. doi: 10.1186/1471-2296-10-65.

Abstract

Background: A cohort of colorectal cancer (CRC) patients represents an opportunity to study missed opportunities for earlier diagnosis.

Primary objective: To study the epidemiology of diagnostic delays and failures to offer/complete CRC screening.

Secondary objective: To identify system- and patient-related factors that may contribute to diagnostic delays or failures to offer/complete CRC screening.

Setting: Rural Veterans Administration (VA) Healthcare system.

Participants: CRC cases diagnosed within the VA between 1/1/2000 and 3/1/2007.

Data sources: progress notes, orders, and pathology, laboratory, and imaging results obtained between 1/1/1995 and 12/31/2007. Completed CRC screening was defined as a fecal occult blood test or flexible sigmoidoscopy (both within five years), or colonoscopy (within 10 years); delayed diagnosis was defined as a gap of more than six months between an abnormal test result and evidence of clinician response. A summary abstract of the antecedent clinical care for each patient was created by a certified gastroenterologist (GI), who jointly reviewed and coded the abstracts with a general internist (TW).

Results: The study population consisted of 150 CRC cases that met the inclusion criteria. The mean age was 69.04 (range 35-91); 99 (66%) were diagnosed due to symptoms; 61 cases (46%) had delays associated with system factors; of them, 57 (38% of the total) had delayed responses to abnormal findings. Fifteen of the cases (10%) had prompt symptom evaluations but received no CRC screening; no patient factors were identified as potentially contributing to the failure to screen/offer to screen. In total, 97 (65%) of the cases had missed opportunities for early diagnosis and 57 (38%) had patient factors that likely contributed to the diagnostic delay or apparent failure to screen/offer to screen.

Conclusion: Missed opportunities for earlier CRC diagnosis were frequent. Additional studies of clinical data management, focusing on following up abnormal findings, and offering/completing CRC screening, are needed.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / prevention & control
  • Delayed Diagnosis / statistics & numerical data
  • Diagnostic Errors
  • Early Detection of Cancer / methods*
  • Early Detection of Cancer / standards
  • Early Detection of Cancer / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / methods
  • Medical Records / statistics & numerical data
  • Middle Aged
  • Occult Blood
  • Patient Acceptance of Health Care
  • Physician-Patient Relations
  • Sigmoidoscopy
  • United States / epidemiology
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data