eP238 - Influence of Patient Demographics and Symptoms on Timeliness of Colorectal Cancer Diagnosis

Purpose/Background: Rectal cancer is the 4th most common cancer in the US and contributed to 8.6% of all cancer deaths in 2023 with a 65% 5-year survival rate. Timeliness of rectal cancer diagnosis is paramount to the initiation of neoadjuvant and surgical therapy. The purpose of this study is to investigate factors, specifically factors in the early portions of the patient’s initial presentation that may be associated with the timeliness of presentation and diagnosis of rectal cancer.Methods/Interventions: This is a retrospective cohort study of patients with rectal cancer who underwent surgical resection at a single institution between 2015 and 2022. The institutional American College of Surgeons’ National Surgical Quality Improvement Program database was utilized to identify patients. The 2015-2019 Distressed Community Index (DCI) database was used to estimate economic well-being based on patient zip code. A zip code was considered “distressed” if it was within the bottom 20th percentile of its group (scores of 80+). Granular data was obtained by retrospective chart review. The primary outcome of interest was delayed presentation – defined as greater than one month from the time of patient-reported onset of symptoms to the first provider visit for that chief complaint. The secondary outcome of interest was diagnosis delay - defined as greater than 1 month from the time of initial chief complaint to the diagnosis date (date of biopsy confirming rectal cancer).Results/Outcomes: Among the 252 patients included, the majority were male (59%), Caucasian (82%), and English-speaking (91%), with an average age of 59 and an average DCI score of 53. Major chief complaints included abdominal pain (10%), rectal bleeding or blood in stool (42%), and change in bowel habits (18%). Most patients (58%) initially sought medical attention from their PCP or local clinic, while 18% of patients initially chose to visit the ED.Patients were stratified based on their duration of symptoms before initial chief complaint (less than one month vs. greater than month). Patients who reported a chief complaint related to changes in bowel habits typically had symptoms persistent for over one month before their first medical visit (p < 0.05). No significant differences in demographic factors, including DCI, or tumor characteristics were found between patients who presented within one month versus those who presented after.In a sub-analysis focusing on patients’ initial choice of seeking care at the ED vs. their PCP, it was observed that patients were more likely to consult to their PCP when their symptoms persisted for over 1 month (p < 0.05), particularly when their complaints were related to changes in bowel habits and bleeding (p < 0.05). Conversely, patients were more likely to present to the ED when their chief complaints were centered around abdominal pain (p < 0.05). Furthermore, those who presented to their PCP had a lower median DCI score than those who presented to the ED (55 vs. 63, p < 0.05).Conclusion/

Discussion: This study reveals how different clinical presentations can impact healthcare utilization patterns in rectal cancer diagnosis. The findings suggest that the acuity of patient’s presentation may affect their decision to seek care – complaints of bowel changes may be associated with a delayed diagnosis versus complaints of abdominal pain. This underscores the need for continued efforts to recognize the broad symptoms of rectal cancer presentation to promote early detection and timely diagnosis.Table 1Characteristics of patient presenting with less than or greater than one month of symptoms prior to initial presentation