Why so late?!—delay in treatment of colorectal cancer is socially determined

Treatment delay significantly increases mortality in colorectal cancer: a meta-analysis

Delaying the initiation of cancer treatment increases the risk of mortality, particularly in colorectal cancer (CRC), which is among the most common and deadliest malignancies. This study aims to explore the impact of treatment delays on mortality in CRC. A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between 2000 and 2025. Meta-analyses were performed using random-effects models with inverse variance method to calculate hazard ratios (HRs) for both overall and cancer-specific survival at 4-, 8-, and 12-week treatment delay intervals, with heterogeneity assessed through I2-statistics and publication bias evaluated using funnel plots and Egger's test. A total of 20 relevant studies were included in the meta-analysis. The analyses of all patients demonstrated a progressively increasing risk of 12-39% with longer treatment delays (4 weeks, HR = 1.12; 95% CI, 1.08-1.16; 8 weeks, HR = 1.24; 95% CI, 1.16-1.34; 12 weeks, HR = 1.39; 95% CI, 1.25-1.55). In particular, incrementally higher hazard ratios were observed for all-cause mortality at 4 weeks (HR = 1.14; 95% CI, 1.09-1.18), 8 weeks (HR = 1.29; 95% CI, 1.20-1.39), and 12 weeks (HR = 1.47; 95% CI, 1.31-1.64). In contrast, cancer-specific survival analysis showed a similar trend but did not reach statistical significance (4 weeks, HR = 1.07; 95% CI, 0.98-1.18; 8 weeks, HR = 1.15; 95% CI, 0.95-1.39; 12 weeks, HR = 1.23; 95% CI, 0.93-1.63). Treatment delays in colorectal cancer patients were associated with progressively worsening overall survival, with each 4-week delay increment leading to a substantially higher mortality risk. This study suggests that timely treatment initiation should be prioritized in clinical practice, as these efforts can lead to substantial improvements in survival rates.

Inequalities in treatment among patients with colon and rectal cancer: a multistate survival model using data from England national cancer registry 2012-2016

BACKGROUND

Individual and tumour factors only explain part of observed inequalities in colorectal cancer survival in England. This study aims to investigate inequalities in treatment in patients with colorectal cancer.

METHODS

All patients diagnosed with colorectal cancer in England between 2012 and 2016 were followed up from the date of diagnosis (state 1), to treatment (state 2), death (state 3) or censored at 1 year after the diagnosis. A multistate approach with flexible parametric model was used to investigate the effect of income deprivation on the probability of remaining alive and treated in colorectal cancer.

RESULTS

Compared to the least deprived quintile, the most deprived with stage I-IV colorectal cancer had a lower probability of being alive and treated at all the time during follow-up, and a higher probability of being untreated and of dying. The probability differences (most vs. least deprived) of being alive and treated at 6 months ranged between -2.4% (95% CI: -4.3, -1.1) and -7.4% (-9.4, -5.3) for colon; between -2.0% (-3.5, -0.4) and -6.2% (-8.9, -3.5) for rectal cancer.

CONCLUSION

Persistent inequalities in treatment were observed in patients with colorectal cancer at every stage, due to delayed access to treatment and premature death.

The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose-response meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to evaluate existing evidence on the relationship between diagnostic and treatment intervals and outcomes for colorectal cancer.

METHODS

Four databases were searched for English language articles assessing the role of time before initial treatment in colorectal cancer on any outcome, including stage and survival. Two reviewers independently screened articles for inclusion and data were synthesised narratively. A dose-response meta-analysis was performed to examine the association between treatment interval and survival.

RESULTS

One hundred and thirty papers were included in the systematic review, eight were included in the meta-analysis. Forty-five different intervals were considered in the time from first symptom to treatment. The most common finding was of no association between the length of intervals on any outcome. The dose-response meta-analysis showed a U-shaped association between the treatment interval and overall survival with the nadir at 45 days.

CONCLUSION

The review found inconsistent, but mostly a lack of, association between interval length and colorectal cancer outcomes, but study design and quality were heterogeneous. Meta-analysis suggests survival becomes increasingly poorer for those commencing treatment more than 45 days after diagnosis.

REGISTRATION

This review was registered, and the protocol is available, in PROSPERO, the international database of systematic reviews, with the registration ID CRD42021255864.

The impact of time to surgery on oncological outcomes in stage I-III dMMR colon cancer - A nationwide cohort study

INTRODUCTION

One of the considerations when investigating neoadjuvant interventions is the prolonging of time from diagnosis to curative surgery (i.e. the treatment interval [TI]). The aim of this study was to investigate the association between the length of TI and overall survival and disease-free survival in patients with deficient mismatch repair (dMMR) colon cancer.

MATERIALS AND METHODS

This retrospective propensity score-adjusted study included all patients of ≥18 years of age undergoing elective curative surgery for stage I-III, dMMR colon cancer. Data were extracted from four Danish patient databases. Outcomes were investigated in groups with TIs of ≤14 days versus >14 days. Propensity scores were computed using all demographics, diagnoses and measurements. Matching was done in a 1:1 ratio.

RESULTS

A total of 4130 patients were included in the study with a mean age of 73.8 years and a median follow-up time of 43.9 months. After matching, 2794 patients were included in the analysis of overall survival. No significant difference in overall survival was seen between patients with TIs of ≤14 days versus >14 days (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.81-1.17; p = 0.78). In the analysis of disease-free survival, 1798 patients were included after matching. This showed no significant difference between patients with TIs of ≤14 days versus >14 days (HR, 0.85; 95% CI, 0.69-1.06; p = 0.14).

CONCLUSION

No associations were found between TI and overall survival and disease-free survival in patients with stage I-III, dMMR colon cancer undergoing elective curative surgery.

A systematic review of methodological considerations in time to diagnosis and treatment in colorectal cancer research

Research focusing on timely diagnosis and treatment of colorectal cancer is necessary to improve outcomes for people with cancer. Previous attempts to consolidate research on time to diagnosis and treatment have noted varied methodological approaches and quality, limiting the comparability of findings. This systematic review was conducted to comprehensively assess the scope of methodological issues in this field and provide recommendations for future research. Eligible articles had to assess the role of any interval up to treatment, on any outcome in colorectal cancer, in English, with no limits on publication time. Four databases were searched (Ovid Medline, EMBASE, EMCARE and PsycInfo). Papers were screened by two independent reviewers using a two-stage process of title and abstract followed by full text review. In total, 130 papers were included and had data extracted on specific methodological and statistical features. Several methodological problems were identified across the evidence base. Common issues included arbitrary categorisation of intervals (n = 107, 83%), no adjustment for potential confounders (n = 65, 50%), and lack of justification for included covariates where there was adjustment (n = 40 of 65 papers that performed an adjusted analysis, 62%). Many articles introduced epidemiological biases such as immortal time bias (n = 37 of 80 papers that used survival as an outcome, 46%) and confounding by indication (n = 73, 56%), as well as other biases arising from inclusion of factors outside of their temporal sequence. However, determination of the full extent of these problems was hampered by insufficient reporting. Recommendations include avoiding artificial categorisation of intervals, ensuring bias has not been introduced due to out-of-sequence use of key events and increased use of theoretical frameworks to detect and reduce bias. The development of reporting guidelines and domain-specific risk of bias tools may aid in ensuring future research can reliably contribute to recommendations regarding optimal timing and strengthen the evidence base.

Applying Latent Class Analysis on Cancer Registry Data to Identify and Compare Health Disparity Profiles in Colorectal Cancer Surgical Treatment Delay

CONTEXT

Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown.

OBJECTIVES

This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics.

DESIGN

We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian).

SETTING

The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties.

PARTICIPANTS

Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126).

MAIN OUTCOME MEASURE

The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment.

RESULTS

Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively.

CONCLUSIONS

While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.

Conflicting Guidelines: A Systematic Review on the Proper Interval for Colorectal Cancer Treatment

BACKGROUND

Timely treatment for colorectal cancer (CRC) is a quality indicator in oncological care. However, patients with CRC might benefit more from preoperative optimization rather than rapid treatment initiation. The objectives of this study are (1) to determine the definition of the CRC treatment interval, (2) to study international recommendations regarding this interval and (3) to study whether length of the interval is associated with outcome.

METHODS

We performed a systematic search of the literature in June 2020 through MEDLINE, EMBASE and Cochrane databases, complemented with a web search and a survey among colorectal surgeons worldwide. Full-text papers including subjects with CRC and a description of the treatment interval were included.

RESULTS

Definition of the treatment interval varies widely in published studies, especially due to different starting points of the interval. Date of diagnosis is often used as start of the interval, determined with date of pathological confirmation. The end of the interval is rather consistently determined with date of initiation of any primary treatment. Recommendations on the timeline of the treatment interval range between and within countries from two weeks between decision to treat and surgery, to treatment within seven weeks after pathological diagnosis. Finally, there is no decisive evidence that a longer treatment interval is associated with worse outcome.

CONCLUSIONS

The interval from diagnosis to treatment for CRC treatment could be used for prehabilitation to benefit patient recovery. It may be that this strategy is more beneficial than urgently proceeding with treatment.

Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis

BACKGROUND

Poorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer.

METHODS

We identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18-C20; n=35 142) diagnosed in the period 2001-2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile.

RESULTS

48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60-69, 70-79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91).

CONCLUSIONS

Older patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.

Overall survival of patients with colon cancer and a prolonged time to surgery

BACKGROUND

Factors associated with the time to surgery (TTS) and survival in colon cancer (CC) have not been well studied. Our aim was to find if the TTS has changed in our institution over time and to determine if it influences the survival.

METHODS

Retrospective cross-section study of 266 CC analyzed between two periods, and according to the quartiles of TTS, we performed a survival analysis.

RESULTS

The median age was 57 years; there was no predominance of sex, and about half of the patients were in stage III. The median TTS was 38 days, and 75% of the cases were operated before 60 days. The median TTS for 2005 to 2010 was 36 days, while for 2011 to 2015 was 41 days (P = 0.107). The survival was not statistically different between cases (1) operated with a delayed TTS or not, (2) operated in four cut-off points of TTS, (3) two different periods of attention, and (4) according to the clinical stage.

CONCLUSION

We did not find an association between the TTS with low survival. TTS has increased in the last period so we must work to make the diagnostic process more efficient in our patients to meet international quality standards.

Pre-to-post diagnosis weight trajectories in colorectal cancer patients with non-metastatic disease

PURPOSE

Previous studies have shown that > 50% of colorectal cancer (CRC) patients treated with adjuvant chemotherapy gain weight after diagnosis. This may affect long-term health. Therefore, prevention of weight gain has been incorporated in oncological guidelines for CRC with a focus on patients that undergo adjuvant chemotherapy treatment. It is, however, unknown how changes in weight after diagnosis relate to weight before diagnosis and whether weight changes from pre-to-post diagnosis are restricted to chemotherapy treatment. We therefore examined pre-to-post diagnosis weight trajectories and compared them between those treated with and without adjuvant chemotherapy.

METHODS

We included 1184 patients diagnosed with stages I-III CRC between 2010 and 2015 from an ongoing observational prospective study. At diagnosis, patients reported current weight and usual weight 2 years before diagnosis. In the 2 years following diagnosis, weight was self-reported repeatedly. We used linear mixed models to analyse weight trajectories.

RESULTS

Mean pre-to-post diagnosis weight change was -0.8 (95% CI -1.1, -0.4) kg. Post-diagnosis weight gain was + 3.5 (95% CI 2.7, 4.3) kg in patients who had lost ≥ 5% weight before diagnosis, while on average clinically relevant weight gain after diagnosis was absent in the groups without pre-diagnosis weight loss. Pre-to-post diagnosis weight change was similar in patients treated with (-0.1 kg (95%CI -0.8, 0.6)) and without adjuvant chemotherapy (-0.9 kg (95%CI -1.4, -0.5)).

CONCLUSIONS

Overall, hardly any pre-to-post diagnosis weight change was observed among CRC patients, because post-diagnosis weight gain was mainly observed in patients who lost weight before diagnosis. This was observed independent of treatment with adjuvant chemotherapy.

Extensive screening of microRNA populations identifies hsa-miR-375 and hsa-miR-133a-3p as selective markers for human rectal and colon cancer

MicroRNAs (miRNAs) are ∼22-nt molecules exerting control of protein expression in cancer tissues. The current study determined the full spectrum of miRNA dysregulation in freshly isolated human colon or rectal cancer biopsies as well as in controls of healthy adjacent tissue (total of n = 100) using an Illumina sequencing technology. In this work, we aimed to identify miRNAs that may serve as future marker to discern between these two subtypes. DESeq2 analysis revealed 53 significantly dysregulated miRNAs in colon cancer, 67 miRNAs in rectal cancer, and 97 miRNAs in both at a P_adj value < 0.05 and ≥ 10 read counts. 65% of miRNAs were upregulated in colon as well as rectal cancer. Highest significant dysregulation (P_adj < 0.00001) was detected for hsa-miR-21-5p, -215-5p and -378a in both colon and rectal cancer. Among the group of miRNAs with P_adj < 0.05 and more than 2-fold expression differences, hsa-miR-375 was detected in rectal cancer only, and hsa-miR-133a-3p only in colon cancer. Receiver operating characteristic (ROC) analysis confirmed highly distinct sensitivities for hsa-miR-375 to detect rectal cancer (area under the curve (AUC): 0.9), while hsa-miR-133a-3p (AUC: 0.89) had the highest sensitivity for detecting colon cancer. We conclude that hsa-miR-375 and hsa-miR-133a-3p may serve as new markers of rectal or colon cancer and should be further investigated to search for different etiologies of colorectal cancer.

Timely access to care in the treatment of rectal cancer and the effect on quality of life

AIM

The aim of this study was to investigate if a delay in a patient's first contact with a healthcare professional, and any subsequent delay in diagnosis, affected self-assessed quality of life prior to start of treatment for rectal cancer.

METHOD

Questionnaires were administered when patients had been informed of the diagnosis and planned treatment. The primary end-point was self-assessed quality of life according to a seven-point Likert scale. The response variables were dichotomized and analysed by unadjusted and adjusted binary logistic regression.

RESULTS

A reported duration of symptoms longer than 4 months was found to be associated with a lower quality of life than a reported duration of symptoms of less than 3 months. Furthermore, a reported period of longer than 2 months from first contact with a healthcare professional to a diagnosis was found to correlate with lower quality of life compared with a period shorter than 2 months. However, when adjusting for possible confounding variables the duration of symptoms and time to diagnosis were not found to affect self-assessed quality of life. Several variables were found to have significant influence in the statistical model, including sense of coherence, the presence of negative intrusive thoughts, comorbidity, depressed mood, male sex and comorbidity.

CONCLUSION

One conclusion of our study is that further efforts to shorten delay in rectal cancer care with the aim of improving quality of life may be futile. To improve the patient's quality of life at diagnosis other interventions should be considered, such as screening for depression and/or negative intrusive thoughts.

Socioeconomic disparities affect survival in malignant ovarian germ cell tumors in AYA population

BACKGROUND

Malignant ovarian germ cell tumors (MOGCTs) are a rare form of ovarian malignancy. Socioeconomic status (SES) has been shown to affect survival in several gynecologic cancers. We examined whether SES impacted survival in adolescent and young adults (AYAs) with MOGCT.

MATERIALS AND METHODS

The National Cancer Data Base was used to identify AYAs (aged 15-39 years) with MOGCT from 1998 to 2012. Three SES surrogate variables identified were as follows: insurance type, income quartile, and education quartile. Pooled variance t-tests and chi-square tests were used to compare tumor characteristics, the time from diagnosis to staging/treatment, and clinical outcome variables for each SES surrogate variable, while controlling for age and race/ethnicity in a multivariate model. Kaplan-Meier survival estimates were calculated using the log-rank test.

RESULTS

A total of 3125 AYAs with MOGCT were identified. Subjects with lower SES measures had higher overall stage and T-stage MOGCTs at presentation. There was no significant difference in the time to staging/treatment, extent of surgery, or use of chemotherapy by SES. Subjects from a lower education background, from a lower income quartile, and without insurance had decreased survival (P ≤ 0.02 for all). Controlling for overall stage and T-stage, the difference in survival was no longer significant.

CONCLUSIONS

AYAs with MOGCT from lower SES backgrounds presented with more advanced stage disease. Further studies that focus on the underlying reasons for this difference are needed to address these disparities.

[Social disparities in outpatient and inpatient care: An overview of current findings in Germany]

There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.

Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study

BACKGROUND

Colorectal cancer is the third most common cancer worldwide and second most common in Europe. Despite screening, it is often diagnosed at an unfavourable stage.

AIM

To identify and quantify features of non-metastatic colorectal cancer in primary care to enable earlier diagnosis by GPs.

DESIGN AND SETTING

A case-control study was conducted using diagnostic codes from national and regional healthcare databases in Sweden.

METHOD

A total of 542 patients diagnosed with non-metastatic colorectal cancer in 2011 and 2139 matched controls were selected from the Swedish Cancer Register (SCR) and a regional healthcare database respectively. All diagnostic codes (according to ICD-10) from primary care consultations registered the year before the date of cancer diagnosis (according to the SCR) were collected from the regional database. Odds ratios were calculated for variables independently associated with non-metastatic colorectal cancer using multivariable conditional logistic regressions. Positive predictive values (PPVs) of these variables were calculated, both individually and in combination with each other.

RESULTS

Five features were associated with colorectal cancer before diagnosis: bleeding, including rectal bleeding, melaena, and gastrointestinal bleeding (PPV 3.9%, 95% confidence interval [CI] = 2.3 to 6.3); anaemia (PPV 1.4%, 95% CI = 1.1 to 1.8); change in bowel habit (PPV 1.1%, 95% CI = 0.9 to 1.5; abdominal pain (PPV 0.9%, 95% CI = 0.7 to 1.1); and weight loss (PPV 1.0%, 95% CI = 0.3 to 3.0); all P-value <0.05. The combination of bleeding and change in bowel habit had a PPV of 13.7% (95% CI = 2.1 to 54.4); for bleeding combined with abdominal pain this was 12.2% (95% CI = 1.8 to 51.2). A risk assessment tool for non-metastatic colorectal cancer was designed.

CONCLUSION

Bleeding combined with either diarrhoea, constipation, change in bowel habit, or abdominal pain are the most powerful predictors of non-metastatic colorectal cancer and should result in prompt referral for colorectal investigation.

Rectal cancer in patients under the age of 50 years: the delayed diagnosis

BACKGROUND

The incidence of rectal cancer in younger patients continues to increase. Because most of these patients do not meet criteria for routine colorectal cancer screening, diagnosis may be delayed, potentially resulting in adverse outcomes. The aim of this study was to determine whether patients under the age of 50 years with rectal cancer have a delay in diagnosis and treatment leading to a worse overall prognosis.

METHODS

A case control study of patients diagnosed with rectal adenocarcinoma in an academic medical center from 1997 to 2007 under 50 years of age were matched 1:1 to randomly selected patients over the age of 50 years by sex and date of diagnosis. Time to diagnosis, time to treatment, staging of the American Joint Committee on Cancer, and 5-year overall survival were compared.

RESULTS

The overall time to treatment from symptom onset was 217 days for patients under the age of 50 years versus 29.5 days if over 50 years of age (P < .0001). The primary delay occurred between the onset of symptoms and presentation to the initial physician. There was no difference in stage at the time of diagnosis or 5-year survival (64% vs 71%, P = .39 and P = .54, respectively).

CONCLUSIONS

Patients with rectal cancer under the age of 50 years have symptoms for a considerable period of time before seeking medical care and are referred in less timely manner to specialists. However, the delay in diagnosis did not adversely impact stage on presentation or 5-year survival.

Prognosis, Cost, and Occurrence of Colorectal, Lung, Breast, and Prostate Cancer in Hungary

BACKGROUND

There is an increasing social debate on expenditures on the care of patients with malignant diseases, especially in Central Eastern European countries with limited health resources.

OBJECTIVES

The aim of this research was to estimate the epidemiological and quality measures and resource use indicators in Hungary in four malignant conditions (breast, colorectal, lung, and prostate cancer) from the National Health Insurance Fund (NHIF) database.

METHODS

Survival and cost analyses were performed on the NHIF database. Patient records containing the International Classification of Diseases (ICD) codes C50 (breast cancer), C18-C20 (colorectal cancer), C33-C34 (lung cancer), and C61 (prostate cancer) were considered eligible. Inclusion criteria were at least two consecutive ICD codes between 2000 and 2012, with a minimum of 30-day difference, or one ICD code, followed by patient death within 60 days. A total of 428,860 social insurance numbers met inclusion criteria.

RESULTS

The number of new cases was 6381 for breast cancer, 8457 for colorectal cancer, 8902 for lung cancer, and 3419 for prostate cancer. The probability of 5-year overall survival from the first diagnosis was 75.2%, 41.3%, 17.1%, and 62.1%, respectively. Median time from first diagnosis to treatment initiation was less than 1 month in all conditions except for lung cancer. The annual cost of treatment was €2585, €3165, €4157, and €2834, respectively. Cost figures were compared with hemophilia as benchmark (€8284).

CONCLUSIONS

The results indicated that the database of the Hungarian NHIF is suitable for real-world data analysis in the field of oncology and can support long-term evidence-based policymaking.

Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours

The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.

Psychological, physical, and social situation of Polish patients with colorectal cancer undergoing first-line palliative chemotherapy

PURPOSE/OBJECTIVES

To assess the psychological, physical, and social situations and needs of patients with colorectal cancer (CRC) diagnosed at an advanced stage of the disease.

DESIGN

Quantitative, descriptive.

SETTING

An urban comprehensive cancer center in northeastern Poland.

SAMPLE

50 patients undergoing first-line palliative chemo-therapy.

METHODS

Participants were asked to fill out an institution-developed questionnaire assessing personal, emotional, physical, and social data.

MAIN RESEARCH VARIABLES

Psychological, physical, and social characteristics.

FINDINGS

The most frequently reported side effects of chemotherapy were asthenia, loss of taste, and nausea and vomiting. In addition, about 54% of patients were unable to work during treatment. Chemotherapy administration resulted in severe or moderate impediment of activities of daily living in 74% of the patients and negatively influenced their financial situation. About 25% of the patients were reluctant to share the news of their disease with their coworkers; however, most revealed their diagnosis to friends and family. The majority (62%) of patients expected help from family members. Nurses provided emotional support to a much lesser extent than patients' immediate relatives. The majority of patients (80%) needed to express their feelings by talking, but only about 30% considered a nurse to be the preferred person with whom to discuss their disease.

CONCLUSIONS

Patients with CRC diagnosed at an advanced stage require considerably more emotional, informative, and instrumental support from nurses, doctors, family, other patients, and priests than was anticipated by the authors.

IMPLICATIONS FOR NURSING

Extending routine history taking via the addition of questions to the proposed questionnaire may help to better recognize a particular patient's situation and unique needs. An increasingly patient-focused approach could improve the individual nursing care in this region of Europe. Ultimately, a multidisciplinary team would be required to meet the needs of patients with CRC undergoing chemotherapy.