Influence of Patient Demographics, Symptoms, and Initial Provider Type on Timeliness of Rectal Cancer Diagnosis

Early detection of rectal cancer improves outcomes, yet delays in presentation and diagnosis remain common. We examined whether the type of initial health care provider, presenting symptoms, and patient characteristics contributed to the delayed detection and diagnosis of rectal cancer.

We conducted a retrospective cohort study of patients undergoing surgical resection for rectal cancer at a single institution (2015-2022) using the American College of Surgeons' National Surgical Quality Improvement Program database with supplemental chart review. Socioeconomic distress was measured using the Distressed Communities Index. The primary outcome was presentation delay, defined as >30 days from symptom onset to first medical evaluation. Secondary outcomes included diagnosis delay, defined as >30 days from symptom onset to tissue diagnosis, and comparisons between emergency department versus primary care physician (PCP) for initial medical presentation. Univariable analyses and multivariable logistic regression were performed.

Among 205 patients with available data, 147 (72%) experienced presentation delay. Patients younger than 50 y (29% versus 12%, P = 0.012) and those presenting with changes in bowel habits were more likely to experience delayed presentation (27% versus 5%, P = 0.004). Patients presenting to a PCP were more likely to experience diagnosis delay compared to those presenting to the emergency department (75% versus 55%, P = 0.012). On multivariable analysis, change in bowel habits (odds ratio (OR) 6.45, 95% confidence interval (CI): 1.54-34.83) and age <50 y (OR 3.93, 95% CI: 1.38-12.94) were associated with presentation delay, while diagnosis delay (OR 3.55, 95% CI: 1.47-9.07) and insurance status were associated with presentation to a PCP.

Delayed presentation of rectal cancer is associated with younger age and indolent symptoms, while delays in diagnosis appear to be influenced by health care access pathways. Patients entering care through primary care settings may experience longer time to diagnosis. Efforts should be made to recognize more indolent symptoms, such as rectal bleeding and bowel habit changes, as potential signs of rectal cancer and improve referral processes to expedite evaluation of concerning symptoms.