Abstract C75: Diagnosing CRC in 3 vulnerable health centers in Santiago, Chile. Not an easy task
Authors: Rodríguez Viviana , Valdivieso María Jesús , Quezada Felipe , Herrera Maria Elisa , Martínez-Gutiérrez Javiera 
Published: February 2019

Abstract
Colorectal cancer (CRC) is a common cancer worldwide. In Chile it is the third leading cause of cancer mortality. Its incidence rate is about 14 per 100,000 inhabitants. It is known that there is an inverse relationship between GDP per capita and CRC mortality. In Chile it is estimated that for every 3 people with CRC two deaths occur, while in the United States this number is one death per 6 people diagnosed. The Chilean Health care system is a dual one; the public sector serves &gt;70% of the population with 50% of the resources. The private sector serves &lt;30% of the population and uses up the other 50%. Delays in diagnosis that may occur are multifactorial. An important factor is the low availability of colonoscopies. In Chile this resource is limited mainly in the public system, where most of low-income population is served. In Santiago, the South East Health Service (SSMSO) is a part of the public system and serves a population of about 1,500,000 inhabitants. Data from one of the three hospitals in the SSMSO show that 2/3 of referred patients arrive with advanced-stage CRC at the time of diagnosis. Our hypothesis is that there is a delay in the diagnostic process in the SSMSO inhabitants. To improve it, points of delay must be identified. This pilot study aims to describe CRC diagnosis in three primary care center (PCC) of the SSMSO from initial symptoms to endoscopic confirmation, estimating possible times of delay to the diagnosis. With this information we hope to propose interventions that will allow the articulation of primary, secondary and tertiary care for early CRC diagnosis.
Methods: Retrospective cohort study in 3 PCC. Collection of data was made through electronic medical records (EMR). We selected and reviewed all EMR with diagnosis of CRC from 2010 to march 2017. Demographic data, initial symptoms, secondary referrals, and place of diagnosis were extracted. With these data incidence, characterization of patients with CRC and estimation of waiting times were determined.
Results: We reviewed 60,783 EMR from eligible men and women. We found 22 people with confirmed CRC with an incidence of 4,4 per 100,000 inhabitants. The average age at diagnosis was 64.3 years; 45% (10) were men and 55% (12) women. 50% (11) of them had their diagnosis made in the private system. There were records of early symptoms in 63% (14) of patients. 43% (6) had weight loss, 36% (5) hematochezia, 21% (3) abdominal pain, 14% (2) anemia, 14% (2) diarrhea, 14% (2) change in bowel habit, 14% (2) palpable mass, and 13% (2) had been diagnosed due to an acute complication. Regarding waiting times, 4 people had a recorded time from symptoms to first consultation, which was 4.7 months on average. In one patient the time from symptoms to diagnosis was 9 months. 8 people had the time from referral to specialist evaluation on their EMR, which was 23.5 days on average. 7 of these patients were referred with a diagnosis already made.
Conclusion: There is a severe lack of information regarding CRC diagnosis. Data obtained through this pilot study were scarce and insufficient to estimate the waiting times between the symptoms and the diagnosis of CRC. One of the reasons for this lack of diagnosis might be that information systems in primary, secondary, and tertiary care are not connected, thus making it impossible to access patient information that might have been diagnosed in the hospitals and stayed there for the whole durations of their treatment. Through these results we might also infer that a large percentage of our patients were diagnosed outside the public network, probably because of the long waiting times for a colonoscopy in the public sector. This could explain the low incidence of CRC. It is necessary to carry out more studies that include secondary-level data as well as qualitative data to determine the diagnostic process of CRC more accurately.
Citation Format: Viviana Rodríguez, María Jesús Valdivieso, Felipe Quezada, Maria Elisa Herrera, Javiera Martínez-Gutiérrez. Diagnosing CRC in 3 vulnerable health centers in Santiago, Chile. Not an easy task [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C75.