Diagnostic interval and mortality in colorectal cancer: U-shaped association demonstrated for three different datasets

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• 作者：Marie Louise Tø ; rring^a ; ^b ; ^{mlt@alm.au.dk} ; Morten Frydenberg^c ; William Hamilton^d ; Rikke P. Hansen^a ; Marianne D. Lautrup^e ; Peter Vedsted^a
• 关键词：Delayed diagnosis ; Waiting lists ; Mortality ; Colorectal cancer ; Primary health care ; Bias
• 刊名：Journal of Clinical Epidemiology
• 出版年：2012
• 期刊代码：148_08954356
• 类别：med
• 出版时间：June, 2012
• 卷：65
• 期：6
• 页码：669-678
• 文件大小：283 K

摘要

Objective

To test the theory of a U-shaped association between time from the first presentation of symptoms in primary care to the diagnosis (the diagnostic interval) and mortality after diagnosis of colorectal cancer (CRC).

Study Design and Setting

Three population-based studies in Denmark and the United Kingdom using data from general practitioner鈥檚 questionnaires, interviewer-administered patient questionnaires, and primary care records, respectively.

Results

Despite variations in the potential selection and information bias when using different methods of identifying the date of first presentation, the association between the length of the diagnostic interval and 5-year mortality rate after the diagnosis of CRC was the same for all three types of data: displaying a U-shaped association with decreasing and subsequently increasing mortality with longer diagnostic intervals.

Conclusion

Unknown confounding and in particular confounding by indication is likely to explain the counterintuitive findings of higher mortality among patients with very short diagnostic intervals, but cannot explain the increasing mortality with longer diagnostic intervals. The results support the theory that longer diagnostic intervals cause higher mortality in patients with CRC.