Women wait longer for bowel cancer treatment

People with early-stage disease and distal tumours also have longer waiting times before treatment begins.

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Women and patients with distal tumours or early-stage bowel cancer wait longest for bowel cancer treatment, and endoscopy wait time accounts for much of the overall delay in treatment, according to a study in BMJ Open Gastroenterology.

An analysis of Canadian health data for 6800 adults under 50, a quarter of whom had stage IV disease, found that the average time from presentation to treatment was 109 days but more than 25% of patients waited around 218 days (more than seven months) for treatment to begin.

Women waited around 26 days longer than men from first presenting to treatment, according to the Canadian and Australian researchers.

Senior author Professor Baxter from the University of Melbourne told The Medical Republic the relationship between female sex and delay – largely due to delayed diagnosis – was an unexpected finding.

“From these data we can’t really say why women seem to wait longer. One potential source may be misinterpretation of signs and symptoms in women, for example anaemia and bleeding attributed to menstrual blood loss and not investigated quickly, but further research is really needed to come to any conclusions,” Professor Baxter said.

The study calculated the intervals between first presentation with a colorectal cancer-related symptom, first investigation, diagnosis date, and treatment start, finding that the average time between presentation and first investigation was only five days.

There was a median of 77 days between first investigation and treatment and a median of 23 days from diagnosis to treatment, researchers noted.

“Our results demonstrate that the period of time most contributory to overall wait time was between the first investigation and diagnosis. For most patients, the date of diagnosis corresponded to the date of endoscopy, indicating that access to endoscopy was a key driver of the overall wait time for patients.”

The researchers said their findings highlighted the need for access to endoscopies.

Professor Nancy Baxter said the similarities between health systems in Ontario and Australia made the findings relevant to Australian patients.

“In particular there are rural and remote areas in Ontario similar to many regions in Australia where access to endoscopy is lower than in more urban regions,” she said.

“Lowered availability of endoscopy was associated with longer delays in our study, and although this study is not able to say that there is a direct causal relationship, it does seem in areas where endoscopy is less available that diagnosis is delayed by a week.

“Waiting an extra week is not ideal, however we had thought that the relationship would be stronger – that the delay would be even greater in areas where endoscopy was less available.”

More advanced stage was consistently associated with shorter delay intervals, the authors said. The median time from presentation to treatment for patients with stage IV disease was more than two months shorter than for patients with stage I disease.

The study also found that older age was associated with short diagnosis intervals of around -3.5 days for every five-year age increase, and was also associated with longer treatment intervals of an average two days per five-year increase.

“We found the median doctor interval was short (five days), suggesting when younger patients seek medical attention, the initial workup is begun in a timely fashion for most patients,” the researchers wrote.

“However, most of these consisted of blood work, ultrasound, and X-rays. Time to more definitive investigations, including CT, MRI or endoscopy took longer.”

After diagnosis, the median time to treatment was one month, which is within the recommended cut-off, they said.

The researchers said first presentations were mainly appointments with physicians for abdominal pain, diarrhoea, constipation/obstruction, and rectal bleeding.

“Codes for abdominal X-ray and general surgery consultations were common,” they said.

Patients being based in local health networks with more frequent lower gastrointestinal endoscopy was associated with significantly shorter diagnostic and system intervals, they said.

“Given the diagnosis of colorectal cancer was commonly made with endoscopy, access to this service is an important target for future research, and potentially intervention for younger patients.”

BMJ Open Gastroenterology 2022, online 21 November