Published in Cancer Detection and Prevention 2001; 25(5):420-429.

Determinants of the Interval Between the Onset of Symptoms and Diagnosis in Patients with Digestive Tract Cancers

Marcial Mariscal, MD, PhD,a,b J. Liorca, MD,c D. Prieto, MD,c and M. Delgado-Rodriguez, MDd

aGeneral Hospital "Ciudad de Jaén," bOffice for Health, District of Jaen, Jaen cDivision of Preventive Medicine and Public Health, University of Cantabria, Cantabria, and dDivision of Preventive Medicine and Public Health, University of Jaen, Jaen, Spain

Address all correspondence and reprint requests to Marcial Mariscal. MD. PhD, Distrito Sanitario de Jaén, C/ Arquitecto Berges 10, 23007 Jaén, Spain.

ABSTRACT: The main objective of this cohort study was to analyze the influence of social factors on the interval from the onset of symptoms to diagnosis in the 217 patients with digestive tract cancer. From the clinical charts, the following information was extracted: date of the beginning of illness, dates of medical attendance, type and date of diagnostic tests, characteristics of the disease (symptoms, stage), and date of treatment. From personal interviews we gathered the data not present in the clinical chart: socio-demographic data, information about other underlying diseases, and variables related to lifestyle. The time periods considered were from onset of symptoms to initial consultation (S-C); from initial consultation to hospital admission (C-H); and from hospital admission to diagnosis (H-D). The information on hospital admission, diagnosis, and treatment was prospectively gathered, whereas data before hospitalization were assessed retrospectively. For statistical analysis, we used Kruskal-Wallis' test and Cox regression. Pain was the only predictor associated with a shorter S-C period. Hemorrhage, number of symptoms, and hospital consultation significantly shortened the interval C-H. Both hemorrhage and pain, and an initial visit at private primary care were the independent predictors that decreased the period H-D. In conclusion, sociodemographic factors did not influence healthcare attendance.

KEY WORDS: gastrointestinal neoplasm, diagnostic delay, determinants of diagnosis, colorectal cancer, sociodemographics factors, helthcare attendance.