DO NOT DELAY TREATMENT FOR RECTAL CANCER

NEW YORK (Reuters Health) Nov 13 - A therapeutic delay of 60 days or longer is associated with decreased survival from rectal cancer, say researchers from Denmark in the October issue of the British Journal of Surgery.

"It has been shown previously that a therapeutic delay of 60 days or more is associated with an increased risk of advanced stage (stages III and IV) for rectal cancer, but not for colonic cancer," Dr. Lene H. Iversen and colleagues from Aarhus University Hospital, write. "Others have reported similar findings, although there is no overall consistency."

In a prospective, population-based study, the researchers examined the association between therapeutic delay and survival from these two malignancies. Included in the study were 740 patients seen in one of 13 hospitals in three Danish counties between January 2001 and July 2002. Of the 740 patients, 458 (61.9%) had colonic cancer and 282 (38.1%) had rectal cancer.

Therapeutic delay was determined by self-report during a standardized interview. The authors examined three types of delay: total therapeutic delay, defined as the interval from symptom onset to treatment initiation; provider delay, defined as the interval from first physician contact until treatment initiation; and hospital delay, defined as the interval from referral to a hospital until treatment initiation.

In patients with colon cancer, the median total therapeutic delay was 116 days, median provider delay was 52 days, and median hospital delay was 28 days. No therapeutic delay of any kind had any impact on survival in this population.

The median total therapeutic delay in patients with rectal cancer was 134 days. The median provider delay was 49 days, and the median hospital delay was 28 days. A total therapeutic delay of 60 days or more was associated with a 69% higher risk of mortality compared to less than 60 days. Provider delay and hospital delay had no impact on survival.

"An early diagnosis of rectal cancer has significant effect on survival," Dr. Iversen explained. "Patient delay was the longest delay," she said. "Therefore, efforts should be directed to increase the general population's awareness on symptoms which might be suspicious...and to contact their GP in time."

"Of course, (physicians) must refer the patients immediately to the hospital for further evaluation, and the hospitals must have a package of routine investigations to be performed as quickly as possible, i.e., endoscopic examination, CT of thorax and abdomen, and MRI of pelvis," Dr. Iversen said.

Br J Surg 2009;96:1183-1189.