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Vol. 42. Issue 9.
Pages 527-533 (November 2019)
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Vol. 42. Issue 9.
Pages 527-533 (November 2019)
Original article
DOI: 10.1016/j.gastre.2019.03.020
The effect of delay on the prognosis of colorectal cancer
Efecto de la demora atribuible al sistema sanitario en el pronóstico del cáncer colorrectal
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Jesús Daniel Fernández-de Castroa,
Corresponding author
, Franco Baiocchi Uretaa, Raquel Fernández Gonzálezb, Noel Pin Vieitoa, Joaquín Cubiella Fernándeza,c
a Servicio de Aparato Dixestivo, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
b Servicio de Medicina Interna, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
c Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Ourense, Spain
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Figures (1)
Tables (4)
Table 1. Characteristics of the sample of patients obtained in our study.
Table 2. Characteristics of the patients according to the care level requesting the colonoscopy.
Table 3. Association between independent variables and the tumour stage (TNM IV) at diagnosis.
Table 4. Variables associated with mortality, both all-cause mortality and associated with colorectal cancer, in the multivariate proportional hazards regression.
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Resumen
Objetivo

Analizar el efecto de la demora atribuible al sistema sanitario en una cohorte consecutiva de pacientes diagnosticados de forma ambulatoria de cáncer colorrectal (CCR) en el área sanitaria de Ourense.

Pacientes y métodos

Estudio observacional de cohortes retrospectivo en el que se incluyeron los pacientes diagnosticados entre 2009 y 2017. Se definió la demora atribuible al sistema sanitario como el tiempo entre la primera consulta por síntomas y la confirmación diagnóstica. Se determinó si existía una relación independiente entre la demora diagnóstica y el CCR estadio IV mediante una regresión logística. Finalmente, realizamos una regresión de riesgos proporcionales para determinar qué variables se asociaban con la mortalidad global y por CCR.

Resultados

Se incluyeron 575 pacientes (hombres 64.5%, edad 71.9±11.5 años) con una demora atribuible al sistema sanitario de 115±153 días. Ninguna de las variables analizadas se asoció con el estadio tumoral al diagnóstico. Durante un seguimiento de 30.6±21 meses fallecieron 121 pacientes (79.3% en relación al CCR). Las variables asociadas de forma independiente con la mortalidad atribuible al CCR fueron el estadio IV al diagnóstico (HR 50.65, IC 95% 12.28-209), la edad (HR 1.04, IC 95% 1.02-1.05) y la solicitud de la colonoscopia desde Atención Primaria (HR 0.55, IC 95% 0.37-0.88).

Conclusiones

La demora diagnóstica atribuible al sistema sanitario no se relacionó ni con el estadio ni con el pronóstico del CCR. Sin embargo, la solicitud de la colonoscopia desde Atención Primaria se asoció a una reducción en el riesgo de mortalidad.

Palabras clave:
Cáncer colorrectal
Demora diagnóstica
Atención primaria
Pronóstico
Abstract
Objectives

To analyse the effect of a delay attributable to the healthcare system on a consecutive cohort of outpatients diagnosed with colorectal cancer in the healthcare area of Ourense (Spain), covering 274,000 inhabitants.

Patients and Methods

We performed a retrospective cohort study that included patients diagnosed between 2009 and 2017. Delay attributable to the healthcare system was defined as the time between the first consultation with symptoms and the diagnostic confirmation. A logistic regression model was performed to evaluate the relationship between stage IV CRC and diagnostic delay. To analyse which variables were associated independently with overall mortality and mortality due to CRC we used a Cox regression model.

Results

575 patients were included (men 64.5%, age 71.9±11.5 years), with a delay attributable to the healthcare system of 115±153 days. None of the variables analysed were associated with tumour stage at diagnosis. With a mean follow-up of 30.6±21 months, 121 patients died, 79.3% due to CRC. The variables independently associated with CRC-related mortality were metastatic CRC (HR 50.65, 95% CI 12.28–209), age (HR 1.04, 95% CI 1.02–1.05) and colonoscopy requested from the primary healthcare level (HR 0.55, 95% CI 0.36–0.88).

Conclusions

Diagnostic delay attributable to the healthcare system is not related to the prognosis or stage of CRC. However, a direct referral to colonoscopy from the primary healthcare level reduces the risk of mortality in our patients.

Keywords:
Colorectal cancer
Diagnostic delay
Primary care
Prognosis

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