Delays in presentation, diagnosis and treatment stages and affecting factors of gastric and colorectal cancer patients followed by university hospital

Cancer that causing damage at individual and social levels globally is a public health problem that increases its importance each day because of the aging of the population and getting unhealthy lifestyle habits. The aim of cancer control programs is to reduce cancer burden with strategies to prevent cancer development in healthy individuals, to provide early diagnosis in cancer patients and to provide appropriate treatment and post-treatment care services in cancer patients. Early diagnosis and treatment is the most important factor that increases the success of treatment, survival and quality of life of cancer patients. It is important in cancer control to determine the modifiable factors that increase the time of presentation, diagnosis and treatment and shorten these times with required interventions. The aim of this study was to determine the time of presentation, diagnosis and treatment and affecting factors in stomach, colon and rectal cancer patients and also to determine the cancer screening tests knowledge, attitude and behavior of patients. This cross-sectional and descriptive study was conducted between September 2017 and January 2019 in gastric, colon and rectal cancer patients followed by medical oncology, surgical oncology and palliative care clinics of the Tokat province Gaziosmanpaşa University Faculty of Medicine Research and Application Hospital. The study was approved by Gaziosmanpaşa University Medical Faculty Ethical Committee (17-KAEK-069). Sample volume was calculated using the G * Power program. A literature based questionnaire form with questions about sociodemographic, medical history, family history and habit characteristics, presentation, diagnosis and treatment processes and cancer screening tests knowledge attitude and behavior was applied to patients with written consent by face-to-face interviews. The presentation time was period between noticing of first symptom or sign and first presentation to physician, the diagnosis time was period between first presentation to physician and diagnosis, the treatment time was period between diagnosis and first treatment. In statistical analysis mean, standard deviation, median, minimum, maximum, number, percentage, Maturity test of difference between two mean, One-way analysis of variance, chi-square test were used. The level of statistical significance was accepted as p <0.05. 69% of total 168 patients were male and mean age was 61.97±11.27, 35.7% were stomach, 36.9% were colon and 27.4% were rectal cancer. 45.2% of the patients had a family history of cancer. 7.7% of patients diagnosed with screening. Mean presentation time was 81,08±124,16 days, mean diagnosis time was 50,71±61,29 days and mean treatment time was 23,26±37,48 days. Diagnosis time is statistically significantly shorter in patients whose transport time to nearest health facility with a vehicle was 20 minutes or more and patients who were diagnosed in private hospital, treatment time is statisticially significantly shorter in patients who have hospitalization history (p<0,05). There was no statistically significant difference between other sociodemographic, medical history, family history and habit characteristics and presentation, diagnosis and treatment times (p>0,05). The rate of patients who know the cancer screening test was 19.6%, the rate of patients who have ever performed a cancer screening tests in patients who know the cancer screening tests was 45.5% and the rate of patients who perform cancer screening tests regularly in patients who have ever performed a cancer screening tests was 26.6%. Presentation time was shorter, diagnosis and treatment times were longer in patients who know cancer screening tests but it was not statistically significant (p>0,05). Presentation, diagnosis and treatment times were longer in patients who performed cancer screening tests but it was statistically significant for only diagnosis time (p<0,05). The rates of knowing and performing cancer screening tests were found to be significantly higher in women, nonsmokers and healthy-fed individuals (p<0,05). The rate of knowing and performing cancer screening tests was higher in patients with a family history of cancer but it was statistically significant for only knowing (p<0,05). There is a need for community-based interventions that include health workers in order to increase awareness and knowledge of individuals about the common signs and symptoms of cancers, diagnosis and treatment processes, possible adverse consequences of delay in diagnosis and treatment processes, and cancer screening tests.