Symptom duration versus survival in non-emergency colorectal cancer

Morbidity and mortality from colorectal cancer remain as major public health problems. Previous studies have demonstrated a lack of association between symptom duration and stage. Emergency cases are, however, known to present with a more advanced disease stage. This study was set up to define the effect of symptom duration on stage and survival separately in the elective population.

Between 1998 and 1999, 228/235 (97%) eligible patients with recently diagnosed colorectal cancer in Västmanland County, Sweden were included in the study. A questionnaire was designed to collect information on the nature and date of first symptoms within two weeks' accuracy. Symptom duration could be categorized as more or less than 26 weeks for 164 (70%) patients. Data on type of admittance (elective or emergent), date of surgery, site and stage were retrieved from the surgical records. Survival was checked in November 2003 and Kaplan-Meier survival estimates were calculated.

Median symptom duration was 17 weeks, 20 in the elective and 13 in the emergency population (P < 0.01). In the elective population, median symptom duration for Dukes' A and B cancer was 19 compared with 21 weeks for Dukes' C and D cancer (mean difference in symptom duration 0.04 (95% CI-0.31; 0.23). Symptom duration did not influence overall survival in the non-emergency group (log rank 2.8; P = 0.09).

To diminish the impact of colorectal cancer on public health, strategies other than a shortening of symptom duration are needed.