Why does New Zealand have such poor outcomes from colorectal cancer?: the importance of the pre-diagnostic period
Melissa Firth 1 , Tania Blackmore 1 , Lynne Chepulis 1 , Rawiri Keenan 1 , Tim Stokes 2 , Mark Elwood 3 , David Weller 4 , Jon Emery 5 , Ross Lawrenson 1 61 Medical Research Centre, University of Waikato, Hamilton, New Zealand
2 Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
3 School of Population Health, University of Auckland, Auckland, New Zealand
4 Centre for Population Health Sciences, The University of Edinburgh, Scotland, UK
5 Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
6 Corresponding author. Email: ross.lawrenson@waikato.ac.nz
Journal of Primary Health Care 13(1) 15-26 https://doi.org/10.1071/HC20049
Published: 31 March 2021
Journal Compilation © Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Over 3000 cases of colorectal cancer (CRC) are diagnosed annually in New Zealand. The proportion of late stage diagnoses is higher than in similar countries, and highest in Māori and Pacific patients. Survival outcomes are poorer than for people in Australia and poor for Māori and Pacific peoples. A regional screening programme is not yet available to the entire target population (60–74 years).
AIM: This study reviews research investigating the pre-diagnostic pathway for CRC in New Zealand and how this may contribute to poorer outcomes.
METHODS: This was a scoping review of original articles examining the pre-diagnostic period for CRC published on the PubMed database between 2009 and 2019. Findings were interpreted within the Model of Pathways to Treatment framework and in context of international evidence.
RESULTS: In total, 83 publications were assessed; eight studies were included. Studies were mainly older than 5 years, qualitative, and focused on screening. Facilitatory factors for the appraisal and help-seeking intervals increased CRC public awareness and the critical role of general practitioners. No specific facilitatory or inhibitory factors were identified for the diagnostic interval, but two studies found that time frames did not meet national and international targets. One study discovered longer pre-diagnostic intervals were associated with younger age at diagnosis.
DISCUSSION: Limited recent research has investigated the CRC pre-diagnostic pathways in NZ. Identification of facilitatory and inhibitory factors and implementation of appropriate strategies to improve them alongside the wider uptake of the screening programme may improve stage at diagnosis and outcomes for New Zealand CRC patients.
KEYwords: Bowel cancer; equity; primary health care
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