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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.

Methods

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).

Results

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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