Delays experienced by patients with symptomatic colorectal cancer

To measure delays in diagnosis and treatment of colorectal cancer (CRC), assessing changes since a similar study in 1979. To ascertain whether modern diagnostic techniques have improved Dukes' staging at treatment.

Prospective data collection. All patients diagnosed with CRC at the Oxford Radcliffe Hospital between January 1994 and January 1995 were questioned about their symptoms. Delays between symptom onset and definitive treatment were measured.

On average, patients with colonic carcinoma consulted their general practitioner (GP) 9.6 weeks after symptom onset, whereas those with rectal carcinoma waited 20.8 weeks. GP referral accounted for an average 6.7 and 5.0 week delay for colonic and rectal cancers, respectively. Waiting for out-patient appointments accounted for an average delay of 4.6 weeks for both. Those with non-specific referrals waited an average of 9.0 weeks against 2.0 weeks when GPs mentioned CRC. There was an average 7·7 week delay for treatment of colonic cancer, and 6·3 weeks for rectal cancer. Pre-hospital delays compared favourably with 1979, but post-referral delays were longer. Total delay was unchanged in 15 years, and there was no improvement in Dukes' staging.

Despite prompt GP consultation and out-patient referral, delays in the treatment of CRC now occur after referral to hospital. Patients referred without mention of CRC wait longest. Colonoscopy and double contrast barium enema have not improved tumour staging at treatment.