Background: Colorectal cancer patients have significantly poorer survival and higher mortality than breast cancer patients. Comparing patient experiences of pathways to treatment may identify areas for service improvement.
Method: Victorian breast and colorectal cancer patients were recruited within 6 months of diagnosis through an ongoing international cancer benchmarking project. Semi-structured telephone interviews were conducted (breast, n=22; colorectal, n=21). Framework analysis performed in NVivo investigated help-seeking, diagnostic and pre-treatment time-intervals (Model of Pathways to Treatment, Walter 2012).
Results: Breast patients experienced a rapid help-seeking interval via limited pathways (symptom or screening) to healthcare professionals (HCP). Colorectal patients reached HCPs through multiple pathways, including emergency, planned and opportunistic presentation. The social acceptability, awareness and normalisation of breast checks was apparent compared with bowel screening. Both groups had similar patient factors delaying or triggering help-seeking, but appraisal was longer for vague colorectal symptoms. Some regional patients noted long wait-times for GP appointments, but otherwise experiences were similar.
HCP factors contributed to longer diagnostic periods for symptomatic colorectal patients. Common/vague symptoms hampered cancer suspicion. Lack of urgency in HCP referral for investigations impacted patient behaviour – delayed organising appointment. System factors were also evident: urban, colorectal, public patients experienced lengthy wait-times for diagnostic testing, whereas mammograms were quickly arranged. The streamlined Breastscreen process was appreciated, particularly by rural patients, for convenience and timeliness but could be impersonal, “cattle-call”. All patients thought the pre-treatment interval quick, with HCP and system factors driving this. Some Breastscreen patients found returning to their GP for treatment referral time-wasting. Few colorectal patients returned to their GP.
Conclusion: Pathways to treatment differ for breast and colorectal patients, with delays particularly evident for symptomatic colorectal patients. Breast cancer experiences suggest increased symptom awareness, screening normalisation, and reduced HCP appraisal and investigation time as areas for improvement in colorectal patients’ pathways to treatment.