Psychosocial predictors of delay: Impact on stage at diagnosis of colorectal cancer.

摘要

Although colorectal cancer is the second leading cause of cancer-related deaths in the United States, the majority of diagnoses are made at an advanced stage. In the absence of more effective treatment for advanced tumors or effective primary prevention strategies, the evidence suggests that diagnosis at an early stage and prompt treatment are the only practical means of significantly reducing colorectal cancer mortality. However, patient delay in seeking medical consultation for symptoms of colorectal cancer may be a major impediment to early stage disease.; This study used data from the investigation "Effects of Race and Social Factors on Stage at Diagnosis" to determine how health attitudes and beliefs may lead to delay (or no delay) in seeking medical attention and how delay, in turn, may influence stage at diagnosis for patients with colorectal cancer. Aspects from the Health Belief Model were utilized to provide a basis for a theoretical framework. Logistic regression was employed to model the relationship between patient delay and stage at diagnosis including covariates such as sociodemographic factors, clinical and biological factors, psychosocial factors, and general health care factors.; No significant linear association between patient delay and stage at diagnosis was found. Those subjects who had no symptoms, and thus did not delay, were diagnosed with early stage disease. Beyond that no differences in stage at diagnosis between cases who delayed less than three months compared with those reporting more than three months' delay were observed.; Histopathologic grade of the tumor was found to be significantly associated with stage at diagnosis of colorectal cancer. However, the association was not linear with the majority of Stage IV tumors moderately differentiated as opposed to poorly or undifferentiated.; The most commonly reported symptoms were weakness, constipation and abdominal pain. Subjects who reported bleeding as the initial presenting symptom were more likely to delay seeking medical consultation.; Those subjects who reported ever having had a proctoscopy or sigmoidoscopy exam, or seeing a physician for a general check-up before the diagnosis of cancer, were more likely to be diagnosed with early stage disease.