Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer  

作　　者：Joaquin Cubiella María Lorenzo Franco Baiocchi Coral Tejido Alejandro Conde María Sande-Meijide Margarita Castro 

机构地区：[1]Department of Gastroenterology,Complexo Hospitalario Universitario de Ourense,Ourense 32005,Orense,Spain [2]Department of Preventive Medicine,Complexo Hospitalario Universitario de Ourense,Ourense 32003,Orense,Spain [3]Department of Gastroenterology,Hospital del Bierzo,Ponferrada 24404,Leon,Spain [4]Dirección Xeral de Saúde Pública,Conselleria de Sanidade,Santiago de Compostela 15703,Spain

出　　处：《World Journal of Gastroenterology》2021年第39期6689-6700,共12页世界胃肠病学杂志（英文版）

基　　金：by the Spain’s Carlos III Health Care Institute by means of project PI17/00837(Co-funded by European Regional Development Fund/European Social Fund"A way to make Europe"/"Investing in your future").

摘　　要：BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2

关 键 词：Colorectal cancer Population based screening Primary healthcare Diagnostic delay PROGNOSIS 

分 类 号：R735.34[医药卫生—肿瘤]