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Patient- and system-related barriers for the earlier diagnosis of colorectal cancer
BMC Family Practice, 09/16/09

Wahls TL et al. – Opportunities for earlier CRC diagnosis were frequent. Additional study of clinical data management, focusing on follow up to abnormal findings, and offering and completion of CRC screening is needed.

• Participants: CRC cases diagnosed between 1/1/2000 and 3/1/2007 within the Rural Veterans Administration (VA) Healthcare system.
• Data sources: progress notes, orders, pathology, laboratory, and imaging results between 1/1/1995 and 12/31/2007.
• CRC screening was defined as a completed fecal occult blood test, flexible sigmoidoscopy (both within 5 years) or colonoscopy (within 10 years); delay: greater than or equal to 6 months.
• A summary abstract of the antecedent clinical care was created by certified gastroenterologists (GI) who then jointly reviewed and coded the abstracts with a general internist (TW).

• In total, 150 CRC cases met inclusion criteria.
• Mean age was 69.04 (range 35 to 91); 99(66%) diagnosed due to symptoms; 69 cases (46%) had delays associated with system factors (61), delayed response to abnormal findings (57), or patient factors (32).
• 15 cases (10%) had prompt evaluation of symptoms, but received no CRC screening, and had no contributory patient factors identified.
• In total, 97 cases (65%) had missed opportunities for early diagnosis, of which 47 (48%) also had patient factors, likely contributing to delay or lack of screening.

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