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. 2021 Oct 21;27(39):6689-6700.
doi: 10.3748/wjg.v27.i39.6689.

Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer

Joaquin Cubiella  1 , María Lorenzo  2 , Franco Baiocchi  3 , Coral Tejido  4 , Alejandro Conde  2 , María Sande-Meijide  2 , Margarita Castro  5
Affiliations

Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer

Joaquin Cubiella et al. World J Gastroenterol. .

Abstract

Background: The implementation of a colorectal cancer (CRC) screening programme may increase the awareness of Primary Care Physicians, reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.

Aim: To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.

Methods: We performed a retrospective intervention study with a pre-post design. We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort (June 2014 - May 2015) and 285 in the post-implantation cohort (June 2017 - May 2018) in the Cancer Registry detected outside the scope of a CRC screening programme. In each patient we calculated the different healthcare diagnostics delays: global, primary and secondary healthcare, referral and colonoscopy-related delays. In addition, we collected the initial healthcare that evaluated the patient, the home location (urban/rural), and the CRC stage at diagnosis. We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.

Results: We did not detect any differences in the patient or CRC baseline-related variables. A total of 20.1% of patients was detected with metastatic disease. There was a significant increase in direct referral to colonoscopy from primary healthcare (25.5%, 35.8%; P = 0.04) in the post-implantation cohort. Diagnostic delay was reduced by 24 d (106.64 ± 148.84 days, 82.84 ± 109.31 d; P = 0.02) due to the reduction in secondary healthcare delay (46.01 ± 111.65 d; 29.20 ± 60.83 d; P = 0.02). However, we did not find any differences in CRC stage at diagnosis or in two-year survival (70.3%; P = 0.9). Variables independently associated with two-year risk of death were age (Hazard Ratio-HR: 1.06, 95%CI: 1.04-1.07), CRC stage (II HR: 2.17, 95%CI: 1.07-4.40; III HR: 3.07, 95%CI: 1.56-6.08; IV HR: 19.22, 95%CI: 9.86-37.44; unknown HR: 9.24, 95%CI: 4.27-19.99), initial healthcare consultation (secondary HR: 2.93, 95%CI: 1.01-8.55; emergency department HR: 2.06, 95%CI: 0.67-6.34), hospitalization during the diagnostic process (HR: 1.67, 95%CI: 1.17-2.38) and urban residence (HR: 1.44, 95%CI: 1.06-1.98).

Conclusion: Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients, this has no effect on CRC stage or survival.

Keywords: Colorectal cancer; Diagnostic delay; Population based screening; Primary healthcare; Prognosis.

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Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest to report.

Figures

Figure 1
Figure 1
Flowchart of the referral and diagnostic pathways.
Figure 2
Figure 2
Flowchart of the patients included in the analysis.
Figure 3
Figure 3
Healthcare diagnostic delays. We show the distribution of the primary and secondary healthcare, referral and colonoscopy delays expressed in days.
Figure 4
Figure 4
Survival curves of the pre and post-implantation cohorts. Survival curves were calculated using the Kaplan-Meier method.
See this image and copyright information in PMC

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