Abstract
Patient delay in presentation of rectal bleeding has been identified as a factor in delayed diagnosis among patients with colo-rectal cancer. The aim of this study was to identify demographic or psychological factors, or beliefs or behaviors related to delay in presentation of rectal bleeding. In 93 patients presenting with this symptom to their general practitioner, delay ranged from 0 to 249 days with a median of 7 days; 27 (29 percent) delayed more than 14 days. Delay was unrelated to age, sex, ethnic origin, competence in English, length of schooling, social status, availability of social support, measured psychologic traits, and to the belief that the cause might be cancer. The proportions delaying more than 14 days were statistically significantly elevated among those who were not worried by the bleeding (47 percent delayed); those who did not regularly look at their feces or the toilet paper after use (37 percent); and those who took some other action before presenting to their general practitioner (43 percent).
Similar content being viewed by others
References
Silman AJ, Mitchell P, Nicholls RJ, et al. Self-reported dark red bleeding as a marker comparable with occult blood testing in screening for large bowel neoplasms. Br J Surg 1983;70:721–4.
Goulston KJ, Cook I, Dent OF. How important is rectal bleeding in the diagnosis of bowel cancer and polyps? Lancet 1986;2:261–3.
Hardcastle JD, Farrands PA, Balfour TW, et al. Controlled trial of faecal occult blood testing in the detection of colorectal cancer. Lancet 1983;2:2–4.
McDermott FT, Hughes ES, Phil E, et al. Symptom duration and survival prospects in carcinoma of the rectum. Surg Gynecol Obstet 1981;153:321–6.
Dent OF, Chapuis PH, Goulston KJ. Relationship of survival to stage of the tumour and duration of symptoms in colorectal cancer. Med J Aust 1983;1:274–5.
Mant A, Bokey EL, Chapuis PH, et al. Rectal bleeding: do other symptoms aid in diagnosis? Dis Colon Rectum 1989 (in press).
Jones IS. An analysis of bowel habit and its significance in the diagnosis of carcinoma of the colon. Am J Proctol 1976;27:45–56.
Farrands PA, Hardcastle JD. Colorectal screening by a self-completed questionnaire. Gut 1984;25:445–7.
Dent OF, Goulston KJ, Zubrzycki J, Chapuis PH. Bowel symptoms in an apparently well population. Dis Colon Rectum 1986;29:243–7.
Chapuis PH, Goulston KJ, Dent OF. Predictive value of rectal bleeding in screening for rectal and sigmoid polyps. Br Med J 1985;290:1546–8.
Broom L, Duncan-Jones P, Jones FL, McDonnell P. Investigating social mobility. Canberra: The Australian National University, Research School of Social Sciences, 1977; Department of Sociology, Departmental Monograph No. 1.
Funch DP, Marshall JR, Gebhardt general practitioner. Assessment of a short scale to measure social support. Soc Sci Med 1986;23:337–44.
Pilowsky I. Dimensions of hypochondriasis. Br J Psychiatry 1967;113:89–93.
Spielberger CD. Manual for the state-trait anxiety inventory. Palo Alto: Consulting Psychologists' Press Inc., 1983.
Spielberger CD, Jacobs G, Russell S, Crane R. Assessment of anger: the state-trait anger scale. In: Butcher JN, Spielberger CD, eds. Advances in personality assessment. Vol 2. Hillsdale, NJ: Lea & Febiger, 1983.
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 1977;106:203–14.
Watson M, Greer S. Development of a questionnaire measure of emotional control. J Psychosom Res 1983;27:299–305.
Grayson DA. A latent trait analysis of the Eysenck personality inventory. J Psychiatr Res 1986;20:217–35.
Folkman S, Lazarus RS. If it changes it must be process: a study of emotions and coping during three stages of a college examination. J Pers Soc Psychol 1985;48:150–70.
SPSS Inc. Statistical package for the social sciences. Chicago: SPSS Inc, 1988.
Hackett TP, Cassem NH, Raker JW. Patient delay in cancer. N Engl J Med 1973;289:14–20.
Holliday HW, Hardcastle JD. Delay in diagnosis and treatment of symptomatic colorectal cancer. Lancet 1979;1:309–11.
MacAdam DB. A study in general practice of the symptoms and delay patterns in the diagnosis of gastrointestinal cancer. J R Coll Gen Pract 1979;29:723–9.
Nilsson E, Bolin S, Sjodahl R. Carcinoma of the colon and rectum: delay in diagnosis. Acta Chir Scand 1982;148:617–22.
MacArthur C, Smith A. Factors associated with speed of diagnosis, referral and treatment in colorectal cancer. J Epidemiol Community Health 1984;38:122–6.
Antonovsky A, Hartman H. Delay in the detection of cancer: a review of the literature. Health Education Monographs 1974;2:98–128.
Author information
Authors and Affiliations
Additional information
Work was conducted at Repatriation General Hospital, Concord, New South Wales, Australia.
Study was supported by a grant from the New South Wales State Cancer Council.
About this article
Cite this article
Dent, O.F., Goulston, K.J., Tennant, C.C. et al. Rectal bleeding. Dis Colon Rectum 33, 851–857 (1990). https://doi.org/10.1007/BF02051921
Issue Date:
DOI: https://doi.org/10.1007/BF02051921