Comorbid conditions may impede diagnosis of colorectal cancer
There appears to be a clear association between increasing comorbidity and delayed diagnosis in colorectal cancer, specifically in patients aged 80 years or above, a study has found.
Researchers examined 4,512 colorectal cancer patients (median age 84 years; 54 percent male). Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were evaluated and classified as ‘competing demands’ (unrelated to colorectal cancer) or ‘alternative explanations’ (sharing symptoms with colorectal cancer).
Of the patients, 72.9 percent had ≥1 competing demand and 31.3 percent had ≥1 alternative explanation. Linear regression analysis found the numbers of both types of comorbid conditions to be independently associated with longer diagnostic interval. A single competing demand pushed back diagnosis by 10 days, while ≥4 competing demand by 32 days. Moreover, a single alternative explanation was associated with a 9-day delay in diagnosis. With respect to individual conditions, the longest delay was observed for inflammatory bowel disease (IBD; 26 days; 95 percent CI, 14 to 39).
Researchers said the increases in time to diagnosis have clinical significance, corresponding to an increase of 13 percent for individuals with a single 'competing demand' condition and 12 percent for those with a single ‘alternative explanation’ condition.
“For those with four or more ‘competing demand’ conditions, the increase amounts to 41 percent, and for the single condition of IBD the increase is 34 percent. In addition, it is important to note that these effects are independent and that a quarter of patients had both types of conditions,” they added.
The fundamental concern, though, is whether the observed delays in diagnosis carry some weight in terms of reducing survival or delaying treatment of symptoms, researchers said, adding that for some patients a delay may lead to tumour progression or a complication.
Additional studies are therefore needed to further investigate the impact of the burden and nature of comorbidity on cancer diagnosis, as well as to account for the possible different mechanisms that may operate simultaneously, researchers said.
The results should be replicated in order to create effective interventions that focus on the burden and nature of comorbid conditions for minimizing diagnostic delays especially in patients aged over 80 years, they added.