Results of a study based at a hospital in Ankara, Turkey, demonstrated that patients with colorectal cancer (CRC) often delayed seeking medical care following symptom onset. The study findings were presented at a European Oncology Nursing Society (EONS) session at the European Society for Medical Oncology (ESMO) Congress, by Ümran Ege Tanrıkulu, MSN, RN, and Sultan Kav, PhD, RN, of Baskent University in Ankara, Turkey.

The researchers undertook this study to identify patterns of elapsed time between initial symptom onset and patients seeking medical care for CRC symptoms, as well as factors contributing to any delays.

The study involved 114 patients with colorectal cancer treated at an outpatient medical oncology clinic of a university hospital in Ankara. The research team used a 36-item questionnaire to collect data regarding demographic and clinical features, as well as patients’ knowledge, experience, and perception of their symptoms. Patients also completed a Brief Illness Perception Questionnaire.

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The researchers analyzed patterns in patients’ responses in conjunction with the time between initial onset of symptoms to their seeking medical care. The time period was categorized as “normal” if the patient sought care less than 1 month after experiencing initial symptoms. It was categorized as a “delay” if the elapsed time was between 1 and 3 months, a “long-term delay” if the elapsed time was more than 3 months, and a “very serious delay” if the elapsed time was more than 6 months.

In this study, approximately 60% of patients with symptoms showed, at a minimum, a delay in seeking medical help after symptom onset, and 31.6% had a very serious delay. More than half of the patients had stage III or higher disease at the time of diagnosis, and only 28.1% of patients had a family history of colorectal cancer. In her presentation, Ms Tanrıkulu reported almost all patients did not know the symptoms of colorectal cancer, and among patients in the study, only 16.7% reported they underwent screening.

The researchers considered 89.9% of patients in this study to have had signs and symptoms of colorectal cancer before diagnosis. Signs and symptoms reported by patients included changes in bowel habits (20.3%), rectal bleeding (14.1%), fatigue (12.1%), abdominal pain (10.3%), and weight loss (8.3%).

On the Brief Illness Perception Questionnaire, patients had a mean total score of 21.74. Patients also rated the most important factors they believed to be responsible for illness as being stress (50% of patients), nutrition (27%), genetic factors (12%), and sadness (11%). The researchers identified significant associations between diagnostic delay and patients’ level of education and changes in bowel habits.

The researchers found that medical care after manifestation of CRC symptoms was delayed considerably, and appeared to be a result of insufficient awareness of the symptoms of CRC.


Ege Tanrıkulu Ü, Kav S. Individual factors leading to delay in diagnosis in patients with colorectal cancer and their illness perceptions. Ann Oncol. 2022;33(suppl_7):S812-S814. doi:10.1016/annonc/annonc1042