Factors associated with the delay in the diagnosis of colorectal carcinoma

Introduction: Delay in diagnosing colorectal carcinoma results in an increase in morbidity and mortality.
Methods: Data from 155 consecutive colorectal cancer patients presenting to the unit from December 2016 to June 2020 was included in the study. Data were collected using a structured pre-tested questionnaire. Specific symptoms, time gap from the first symptom to the first consultation and the time taken from the first consultation to diagnosis (diagnostic delay) were recorded. Non-parametric tests were used to study the significance of the associations between the delay and associated factors.
Results: The median delay in presentation and the median diagnostic delay of the doctor were both 2.0 months. The corresponding mean delays were 3.7 months and 2.4 months respectively. 79.2 % of patients first presented to allopathic medical services. The first doctor consulted referred only 30.1 % of the patients for lower alimentary endoscopy. On average, a patient consulted 3 doctors before diagnosis. There was no significant association between patients' age, gender, educational level, occupation and delay in presentation (p>0.05). Rectal bleeding was not associated with reduction of delay in presentation or diagnosis (p=0.5). Diagnostic delay was greater in patients who had abdominal pain (median 2.0 months) than those who did not have pain (median=1.0 month), and the difference was statistically significant (p=0.03). There was no association between the delay and tumour site or tumour stage at diagnosis (p>0.05).
Conclusions: Delay in presentation and diagnostic delay both contribute to the delay in the diagnosis of colorectal carcinoma. Delays could be decreased by early referral for endoscopy by first contact doctors and increasing the awareness on colorectal cancer symptoms among the public.