Skip to main content

Symptom-to-Diagnosis Interval and Survival in Cancers of the Digestive Tract

Digestive Diseases and Sciences volume 47, pages 2434–2440 (2002)Cite this article

Abstract

The objective was to identify the main correlates of the symptom-to-diagnosis interval (SDI) and to analyze their influence upon the survival in patients with cancers of the digestive tract. Two hundred forty-eight symptomatic patients with cancer of the esophagus (N = 31), stomach (N = 70), colon (N = 84), and rectum (N = 66) were interviewed and prospectively followed (median follow-up of 77 months). Cox's regression was used to assess the relative risk (RR) of death according to SDI. The median SDI was about 4 months, with nonsignificant differences by sex, age, social class, family history of cancer, or tumor site. The RR of death varied significantly by age (P = 0.012), tumor site (P < 0.01), tumor stage (P < 0.01), and type of hospital admission (P < 0.01). After adjustment for known and potential predictors of survival and as compared to an SDI < 2.5 months, the RR of death was 0.89 (95% CI: 0.61–1.32) for an SDI of 2.5–6 months, 0.78 (95% CI: 0.49–1.26) for SDI > 6–12 months, and 0.81 (95% CI: 0.44–1.49) for SDI > 12 months. These results do not imply that specific actions to hasten diagnosis must of necessity be ineffective, but underscore what a challenging task the secondary prevention of cancer remains.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

REFERENCES

  1. Kutner B, Makover HB, Oppenheim A: Delay in the diagnosis and treatment of cancer: a critical analysis of the literature. J Chron Dis 7:95–120, 1958.

    Google Scholar 

  2. Porta M, Gallén M, Malats N, Planas J: Influence of “diagnostic delay” upon cancer survival: an analysis of five tumour sites. J Epidemiol Community Health 45:225–230, 1991.

    Google Scholar 

  3. Porta M, Fernandez E, Belloc J, Malats N, Gallén M, Alonso J: Emergency admission for cancer: a matter of survival? Br J Cancer 77:477–484; 1998.

    Google Scholar 

  4. Auvinen A: Social class and colon cancer survival in Finland. Cancer 70:402–409; 1992.

    Google Scholar 

  5. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353:1119–1126; 1999.

    Google Scholar 

  6. Mulcahy HE, O'Donoghue DP: Duration of colorectal cancer symptoms and survival: the effect of confounding clinical and pathological variable. Eur J Cancer 33:1461–1467, 1997.

    Google Scholar 

  7. Younghusband JD, Aluwihare APR: Carcinoma of the oesophagus: factors influencing survival. Br J Surg 57:422–430, 1970.

    Google Scholar 

  8. Faivre J, Milan C, Hillon MC, Martin F, Klepping C: Incidence of digestive tract cancers in a well-defined population in France. Int J Epidemiol 9:225–226, 1980.

    Google Scholar 

  9. Ziliotto A, Kunzle JE, De Souza A, Colicchio-Filho O: Evolutive and prognostic aspects in gastric cancer. Cancer 59:811–817, 1987.

    Google Scholar 

  10. Appelqvist P: Carcinoma of the oesophagus and gastric cardia. Acta Chir Scand (suppl) 430:1–92, 1972.

    Google Scholar 

  11. Cancer guidelines sub-group of the COG (1997): Guidance on commissioning cancer services: Improving outcomes in colorectal cancer: the research evidence. Leeds: NHS Executive,pp. 24–41. URL: http://www.doh.gov.uk/canc/colrecs.htm (accessed: 24 February 2002)

  12. Zilling TL, Walther BS, Ahren B: Delay in diagnosis of gastric cancer: A prospective study evaluating doctors' and patients' delay and its influence on five year survival. Anticancer Res 10:411–416, 1990.

    Google Scholar 

  13. Wile AG, Hourani L, Schell MJ: The contributions of patient factors, physician delay, and tumor biology to the outcome of gastric cancer. Am Surgeon 59:850–854, 1993.

    Google Scholar 

  14. Maguire A, Porta M, Malats N, Gallén M, Piñol JL, Fernandez E for the ISDS II Project Investigators: Cancer survival and the duration of symptoms. An analysis of possible forms of the risk function. Eur J Cancer 30A:785–792, 1994.

    Google Scholar 

  15. Polissar L, Sim D, Francis A: Survival of colorectal cancer patiens in relation to duration of symptoms and other prognostic factors. Dis Col Rectum 24:364–369, 1981.

    Google Scholar 

  16. Ponz de Leon M, Sant M, Micheli A, Sachetti C, Di Gregorio C, Faute R, Zanchieri G, Melotti G, Gatta G: Clinical and pathologic prognostic indicators in colorectal cancer. A population-based study. Cancer 69:626–635, 1992.

    Google Scholar 

  17. Joint Council for Clinical Oncology: Reducing delays in cancer treatment. Some targets. London, Royal College of Physicians and Royal College of Radiologists, 1993

    Google Scholar 

  18. Calman K (chairman): A policy framework for commisioning cancer services. A report by the Expert Advisory Group on cancer to the Chief Medical Officers of England and Wales. London, Department of Health, 1995, pp. 7–9, 27-29, 1995.

    Google Scholar 

  19. Spurgeon D. Canada sends patients with cancer to United States. BMJ 318:1507, 1999.

    Google Scholar 

  20. Jones R, Rubin G, Hungin P: Is the two week rule for cancer referrals working? Not too well. BMJ 322:1555–1556, 2001.

    Google Scholar 

  21. Porta M, Gallén M, Belloc J, Malats N: Predictors of the interval between onset of symptoms and first medical visit in patients with digestive tract cancer. Int J Oncol 8:941–949, 1996.

    Google Scholar 

  22. Molina MC, Porta M, Malats N, Jariod M, Piñol JL, Fernandez E: Percepción del inicio y la evolución de la sintomatología en pacientes hospitalizados con cáncer del tubo digestivo. Neoplasia 11:119–125, 1994.

    Google Scholar 

  23. Porta M, Malats N, Belloc J, Gallén M, Fernandez E: Do we believe what patients say about their neoplastic symptoms? An analysis of factors that influence the interviewer's judgement. Eur J Epidemiol 12:553–562, 1996.

    Google Scholar 

  24. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Statist Assoc 53:457–481, 1958.

    Google Scholar 

  25. Cox DR: Regression models and life-tables (with discussion). J R Statist Soc (B) 34:187–220, 1972

    Google Scholar 

  26. Cox DR, Oakes D: Analysis of survival data. London, Chapman & Hall, pp. 1–28, 91-139, 1984.

    Google Scholar 

  27. Clayton D, Hills M: Statistical models in epidemiology. Oxford, Oxford University Press, pp 271–306, 1993.

    Google Scholar 

  28. Kalbfleish JD, Prentice RL: The statistical analysis of failure time data. New York, John Wiley & Sons, 1980

    Google Scholar 

  29. Morrison AS: Screening in chronic disease. New York, Oxford University Press, 1985

    Google Scholar 

  30. Majumdar SR, Fletcher RH, Evans AT: How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol 94:3039–3045, 1999.

    Google Scholar 

  31. Gómez G, Porta M, Griful E, et al: Modelling breast cancer survival and the symptom-to-treatment interval. J Epidemiol Biostat 1:175–182, 1996.

    Google Scholar 

  32. Funch DP: Diagnostic delay in symptomatic colorectal cancer. Cancer 56:2120–2124, 1985.

    Google Scholar 

  33. Irvin TT, Greaney MG: Duration of symptoms and prognosis of carcinoma of the colon and rectum. Surg Gynecol Obstet 144:883–886, 1977.

    Google Scholar 

  34. Charlson ME, Feinstein AR: A new clinical index of growth rate in the staging of breast cancer. Am J Med 69:527–536, 1980.

    Google Scholar 

  35. Twaddle AC: Sickness and the sickness career: some implications. In L Eisenberg, A Kleinman (eds). The Relevance of Social Science for Medicine. Dordrecht; Reidel, pp 111–133, 1981.

    Google Scholar 

  36. Feigl P, Glaefke G, Ford L, Diehr P, Chu J: Studying patterns of cancer care: how useful is the medical record? Am J Public Health 78:526–533, 1988.

    Google Scholar 

  37. Basnett I, Pollock AM, Gill M: Collecting data on cancer. BMJ 308:791, 1994.

    Google Scholar 

  38. Malats N, Belloc J, Gallén M, Porta M: Disagreement between hospital medical records and a structured patient interview on the type and date of the first symptom in cancers of the digestive tract. Rev Epidemiol Sante Publique 43:533–540, 1995.

    Google Scholar 

  39. Ionescu MV, Carey F, Tait IS, Steele RJ: Socioeconomic status and stage at presentation of colorectal cancer. Lancet 352:1439, 1998.

    Google Scholar 

  40. Brewster DH, Thomson CS, Hole DJ, Black RJ, Straner PL, Gillis CR: Relation between socioeconomic status and tumour stage in patients with breast, colorectal, ovarian, and lung cancer: results from four national, population based studies. BMJ 322:830–831, (2001).

    Google Scholar 

  41. Kogevinas M, Porta M: Socioeconomic differences in cancer survival: a review of the evidence. IARC Sci Publ; 138:177–206, (1997).

    Google Scholar 

  42. Fernandez E, Borrell C: Cancer mortality by educational level in the city of Barcelona. Br J Cancer 79:684–689, (1999).

    Google Scholar 

  43. Peckman C, Dezateux C, (eds): Screening. Br Med Bull 54:791–838, 1998.

Download references

Author information

Affiliations

  1. Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain

    Esteve Fernandez

  2. Universitat de Barcelona, Barcelona, Spain

    Esteve Fernandez

  3. Universitat Autònoma de Barcelona, Barcelona, Spain

    Miquel Porta

  4. Institut Municipal d'Investigació Mèdica, Barcelona, Spain

    Núria Malats

  5. Univesitat Pompeu Fabra, Barcelona, Spain

    Núria Malats

  6. Department of Gastroenterology, Hospital del Mar, Barcelona, Spain

    Josep Belloc

  7. Department of Oncology, Hospital del Mar, Barcelona, Spain

    Manuel Gallén

Authors
  1. Esteve Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miquel Porta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Núria Malats
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josep Belloc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manuel Gallén
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fernandez, E., Porta, M., Malats, N. et al. Symptom-to-Diagnosis Interval and Survival in Cancers of the Digestive Tract. Dig Dis Sci 47, 2434–2440 (2002). https://doi.org/10.1023/A:1020535304670

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1020535304670

  • gastrointestinal neoplasms
  • diagnosis
  • symptom duration
  • delay, prognosis
  • survival
  • healthcare-seeking behavior