Open Access Open Badges Research article

Factors related with symptom duration until diagnosis and treatment of symptomatic colorectal cancer

Magdalena Esteva1*, Alfonso Leiva1, María Ramos2, Salvador Pita-Fernández3, Luis González-Luján4, Montse Casamitjana5, María A Sánchez6, Sonia Pértega-Díaz3, Amador Ruiz1, Paloma Gonzalez-Santamaría3, María Martín-Rabadán7, Ana M Costa-Alcaraz8, Alejandro Espí9, Francesc Macià10, Josep M Segura11, Sergio Lafita12, Francisco Arnal-Monreal13, Isabel Amengual14, Marta M Boscá-Watts9, Angels Hospital10, Hermini Manzano15, Rosa Magallón16 and DECCIRE GROUP*

Author Affiliations

1 Unit of Research, Majorca Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003, Palma de Mallorca, Spain

2 Department of Public Health, Balearic Department of Health, Majorca Cancer Registry, C/ Jesus n 33, 07001, Palma de Mallorca, Spain

3 Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006, A Coruña, Spain

4 Serreria II Primary Care Centre, Valencia Institute of Health, C/ Pedro de Valencia 28, 46022, Valencia, Spain

5 Health Consorcium of Barcelona, Parc Sanitari Pere Virgili - Edifici Mestral, Esteve Terrades, 30, 08023, Barcelona, Spain

6 Canal Imperial Primary Care Centre, Paseo Colon 4, 50006, Zaragoza, Spain

7 Can Misses Primary Care Centre, Primary Health Care Eivissa Department, Avinguda de la Pau s/n, 07800, Eivissa, Spain

8 Nazareth Primary Care Centre, Parque Nazareth 16, 46024, Valencia, Spain

9 Department of Gastroenterology, University Clinic Hospital of Valencia, Avenida Blasco Ibañez 17, 46010, Valencia, Spain

10 Evaluation and Clinical Epidemiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain

11 Lluis Saye Primary Care Centre, C/ Torres i Amat 8, 08001, Barcelona, Spain

12 Pirinees High Resolution Hospital, Calzada de Rapit s/n, 22700, Jaca, Spain

13 Department of Anatomical Pathology, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006, A Coruña, Spain

14 Department of Anatomical Pathology, Hospital Universitario Son Espases, Carretera Valldemosa, Palma, Spain

15 Department of Oncology, Hospital Universitario Son Espases, Carretera Valldemosa, Palma, Spain

16 Primary Care Research Unit, Arrabal Health Centre, Gracia Gazulla, 50015, Zaragoza, Spain

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BMC Cancer 2013, 13:87  doi:10.1186/1471-2407-13-87

Published: 23 February 2013



Colorectal cancer (CRC) survival depends mostly on stage at the time of diagnosis. However, symptom duration at diagnosis or treatment have also been considered as predictors of stage and survival. This study was designed to: 1) establish the distinct time-symptom duration intervals; 2) identify factors associated with symptom duration until diagnosis and treatment.


This is a cross-sectional study of all incident cases of symptomatic CRC during 2006–2009 (795 incident cases) in 5 Spanish regions. Data were obtained from patients’ interviews and reviews of primary care and hospital clinical records. Measurements: CRC symptoms, symptom perception, trust in the general practitioner (GP), primary care and hospital examinations/visits before diagnosis, type of referral and tumor characteristics at diagnosis. Symptom Diagnosis Interval (SDI) was calculated as time from first CRC symptoms to date of diagnosis. Symptom Treatment Interval (STI) was defined as time from first CRC symptoms until start of treatment. Nonparametric tests were used to compare SDI and STI according to different variables.


Symptom to diagnosis interval for CRC was 128 days and symptom treatment interval was 155. No statistically significant differences were observed between colon and rectum cancers. Women experienced longer intervals than men. Symptom presentation such as vomiting or abdominal pain and the presence of obstruction led to shorter diagnostic or treatment intervals. Time elapsed was also shorter in those patients that perceived their first symptom/s as serious, disclosed it to their acquaintances, contacted emergencies services or had trust in their GPs. Primary care and hospital doctor examinations and investigations appeared to be related to time elapsed to diagnosis or treatment.


Results show that gender, symptom perception and help-seeking behaviour are the main patient factors related to interval duration. Health service performance also has a very important role in symptom to diagnosis and treatment interval. If time to diagnosis is to be reduced, interventions and guidelines must be developed to ensure appropriate examination and diagnosis during both primary and hospital care.

Colorectal cancer; Early diagnosis; Primary health care; Delay