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The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose–response meta-analysis

British Journal of Cancer volume 129, pages 993–1006 (2023)Cite this article

Subjects

Abstract

Background

This systematic review and meta-analysis aimed to evaluate existing evidence on the relationship between diagnostic and treatment intervals and outcomes for colorectal cancer.

Methods

Four databases were searched for English language articles assessing the role of time before initial treatment in colorectal cancer on any outcome, including stage and survival. Two reviewers independently screened articles for inclusion and data were synthesised narratively. A dose–response meta-analysis was performed to examine the association between treatment interval and survival.

Results

One hundred and thirty papers were included in the systematic review, eight were included in the meta-analysis. Forty-five different intervals were considered in the time from first symptom to treatment. The most common finding was of no association between the length of intervals on any outcome. The dose–response meta-analysis showed a U-shaped association between the treatment interval and overall survival with the nadir at 45 days.

Conclusion

The review found inconsistent, but mostly a lack of, association between interval length and colorectal cancer outcomes, but study design and quality were heterogeneous. Meta-analysis suggests survival becomes increasingly poorer for those commencing treatment more than 45 days after diagnosis.

Registration

This review was registered, and the protocol is available, in PROSPERO, the international database of systematic reviews, with the registration ID CRD42021255864.

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Fig. 1: PRISMA diagram.
Fig. 2: Intervals assessed more than once.
Fig. 3: Dose-response meta-analysis results.

Data availability

Data used in this review is provided in Supplementary Appendices; any additional data are available upon request to the corresponding author.

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Funding

AD is supported by a NHMRC Postgraduate Scholarship. RJB is supported by a Victorian Cancer Agency, Early Career Research Fellowship (ECRF20015).

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Authors and Affiliations

  1. Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia

    Allison Drosdowsky, Rebecca J. Bergin, Kristi Milley, Lucy Boyd & Jon D. Emery

  2. Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia

    Karen E. Lamb, Amalia Karahalios & Maarten J. IJzerman

  3. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia

    Rebecca J. Bergin

  4. Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia

    Kristi Milley & Jon D. Emery

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Drosdowsky, A., Lamb, K.E., Karahalios, A. et al. The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose–response meta-analysis. Br J Cancer 129, 993–1006 (2023). https://doi.org/10.1038/s41416-023-02377-w

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