Patient and Presentation Characteristics of Symptomatic CRC Patients, Duration of Primary Care Interval, and Log-Binomial Regression Analysis for 75th Percentile (N = 309)
| Characteristic | No. | Duration, d, Median (IQR) | P Valuea | P90b | Univariable RR (95% CI) | Multivariable RR (95% CI) |
|---|---|---|---|---|---|---|
| Age, y | ||||||
| ≤50 | 35 | 34 (1-233) | 491 | 1.5 (0.8-3.0) | ||
| 51-60 | 47 | 3 (1-15) | 408 | 0.6 (0.3-1.4) | ||
| 61-70 | 100 | 14 (1-47) | 94 | 0.8 (0.4-1.4) | ||
| 71-80 | 91 | 6 (1-61) | 204 | 0.9 (0.5-1.7) | ||
| 81-90 | 36 | 8 (1-68) | .154 | 150 | 1 (ref) | |
| Sex | ||||||
| Male | 155 | 4 (1-47) | 101 | 1 (ref) | 1 (ref) | |
| Female | 154 | 13 (1-78) | .004 | 321 | 1.6 (1.1-2.4) | 1.4 (0.9-2.1) |
| SES 2010c | ||||||
| Low | 81 | 12 (1-72) | 240 | 1 (ref) | ||
| Medium-low | 79 | 9 (1-63) | 239 | 0.9 (0.5-1.5) | ||
| Medium-high | 73 | 7 (1-51) | 118 | 0.7 (0.4-1.3) | ||
| High | 76 | 6 (1-47) | .551 | 223 | 0.7 (0.4-1.2) | |
| Registered comorbidityd | ||||||
| Chronic somatic | ||||||
| No | 62 | 5 (1-48) | 326 | 1 (ref) | ||
| Yes | 247 | 10 (1-61) | .317 | 198 | 1.1 (0.7-1.9) | |
| ≥2 | 181 | 9 (1-58) | 203 | 1.1 (0.6-1.8) | ||
| ≥4 | 70 | 8 (1-43) | 98 | 0.9 (0.5-1.7) | ||
| Gastrointestinal | ||||||
| No | 256 | 8 (1-63) | 219 | 1 (ref) | ||
| Yes | 53 | 15 (2-48) | .622 | 119 | 0.7 (0.4-1.3) | |
| Psychiatric | ||||||
| No | 290 | 8 (1-58) | 204 | 1 (ref) | ||
| Yes | 19 | 22 (2-84) | .203 | 538 | 1.1 (0.5-2.3) | |
| Registered family history of CRCe | ||||||
| Not registered | 267 | 11 (1-65) | 233 | 1 (ref) | ||
| Negative | 30 | 1 (1-13) | 87 | 0.5 (0.2-1.3) | ||
| Positive | 12 | 2 (1-34) | .003 | 87 | 0.3 (0.1-2.0) | |
| Consultation frequency for year prior to first CRC consultation | ||||||
| ≤2 | 56 | 2 (1-29) | 117 | 1 (ref) | ||
| 3-11 | 188 | 11 (1-64) | 235 | 1.4 (0.8-2.5) | ||
| ≥12 | 65 | 12 (1-54) | .093 | 120 | 1.2 (0.6-2.3) | |
| History of malignancy | ||||||
| No | 267 | 7 (1-50) | 219 | 1 (ref) | 1 (ref) | |
| Yes | 42 | 18 (2-84) | .101 | 178 | 1.7 (1.1-2.6) | 1.5 (0.9-2.2) |
| Main registered symptom at first CRC consultationf | ||||||
| Alarm GI symptom(s) | 168 | 2 (1-28) | 123 | 1 (ref) | 1 (ref) | |
| Nonalarm GI symptom(s) | 113 | 26 (5-87) | 257 | 1.9 (1.2-2.8) | 1.7 (1.1-2.6) | |
| Other symptom(s) | 28 | 13 (2-43) | .000 | 273 | 0.9 (0.4-2.2) | 0.9 (0.4-2.1) |
| Hemorrhoids at physical examinationg | ||||||
| No | 298 | 8 (1-54) | 219 | 1 (ref) | ||
| Yes | 11 | 69 (1-115) | .192 | 213 | 2.3 (1.3-4.1) | |
| TNM stage at diagnosis | ||||||
| 0 | 1 | 87 | … | … | ||
| I | 41 | 2 (1-42) | 83 | 1 (ref) | ||
| II | 83 | 7 (1-48) | 213 | 1.1 (0.5-2.3) | ||
| III | 114 | 7 (1-48) | 159 | 1.1 (0.5-2.2) | ||
| IV | 65 | 23 (3-92) | 502 | 1.9 (0.9-3.8) | ||
| Unknown | 5 | 5 (1-246) | .013 | … | … | |
CRC = colorectal cancer; GI = gastrointestinal; GP = general practitioner; IPC = primary care interval; IQR = interquartile range; P75 = 75th percentile value of the duration distribution; P90 = 90th percentile value of the duration distribution; RR = relative risk; SES = socioeconomic status score; TNM = tumor, nodes, metastases.
↵a P values based on Mann-Whitney U tests for variables with 2 categories and Kruskall-Wallis tests for variables with 3 or more categories.
↵b P90 value = 90th percentile value of the duration distribution; that is the IPC duration time in days where 90% of the population was below and 10% above.
↵c Socioeconomic status scores 2010 were retrieved from publicly available data from the Netherlands Institute for Social Research.16 Lowest SES score was defined as: SES score of <1 SD than the Dutch mean of 2010, Medium-low: 1 SD to mean SES score, Medium-high: mean SES score to +1 SD and Highest: > +1 SD higher than Dutch mean.
↵d Chronic somatic comorbidities were defined according to O’Halloran et al.17 Gastrointestinal comorbidities were all relevant GI-related registered comorbidities or conditions in either episode list or mentioned during GP consultations: irritable bowel syndrome, reflux disease, esophagitis, dyspepsia, abdominal pain, peptic ulcer, hiatus or abdominal hernia, benign GI neoplasms/polyps, constipation, chronic diarrhea, cholelithiasis, diverticulosis, anal fissures. Psychiatric comorbidities were all chronic psychiatric comorbidities according to O’Halloran et al.17
↵e Registered occurrence of colorectal cancer in a first degree family member.
↵F Alarm symptoms for colorectal cancer were defined as rectal blood loss, unintended weight loss, anemia, and a palpable tumor. GI symptoms include all GI-related, nonalarming symptoms. Other symptoms are all remaining, nonalarming, non-GI symptoms.
↵g Multivariable model excludes this factor due to low patient numbers.