Background: Endometriosis is a common condition in women of reproductive age, causing pelvic pain and subfertility, but little is known about its impact on health-related quality of life (HRQoL) and work productivity worldwide. Methods: In 10 countries across five continents, this study recruited 1,418 women, aged 18-45, without a previous surgical diagnosis of endometriosis, scheduled to undergo a laparoscopy to investigate symptoms suggestive of endometriosis or to be sterilised. Pre-operatively, women completed a standardised questionnaire assessing symptoms, diagnostic delay, HRQoL and work productivity using validated instruments. Surgeons completed a standardised questionnaire incorporating findings at laparoscopy including endometriosis stage according to revised American Fertility Society criteria. Results: There was a mean delay of 9.2 years (SD 8.8), principally in primary care, between the onset of symptoms and diagnostic laparoscopy. This diagnostic delay was longer in centres where healthcare was predominantly state-funded (12.8 vs. 7.6 years; p<0.001). In multivariate analyses, the delay was positively associated with the number of pelvic symptoms (chronic pelvic pain, dysmenorrhoea, dyspareunia and heavy periods; p<0.001) and a higher body mass index (p<0.001). Physical HRQoL was significantly reduced in affected women compared to those with similar symptoms and no endometriosis (p=0.012). Not being in paid employment, severe pelvic pain and moderate-severe disease were associated with reduced physical HRQoL (all p<0.001). Each affected woman lost on average 10.0 hours (SD 10.6) of work weekly, due mainly to reduced effectiveness while working. The annual indirect cost of endometriosis associated with work productivity loss ranged from US$399 per woman in Ibadan (Nigeria) to US$18,586 per woman in Boston (USA). Conclusions: Endometriosis significantly impairs HRQoL and work productivity across countries and ethnicities, yet women continue to experience diagnostic delays in primary care. A higher index of suspicion is needed to expedite specialist assessment of symptomatic women. Future research should seek to clarify pain mechanisms in relation to endometriosis severity.

Oral cancer is the 6th most common cancer in the world, with a poor prognosis and frequent late-stage diagnosis, which significantly impacts survival and quality of life. The key to better control of this disease is early detection, preferably at a precancerous stage. In order to facilitate this early detection and diagnosis, it is critical to identify the factors potentially impacting on the time lag from initial detection to diagnostic biopsy. The overall goal is to develop effective strategies for early identification of oral cancers in order to achieve better control over this disease. There are 2 components in this thesis: the objectives of part I (personal interview) were 1) to develop an interview-style questionnaire, 2) to collect data from patients with high-risk oral lesions (HRL’s) and 3) to characterize the experiences of these individuals that may have impacted the time interval leading up to diagnosis. The objectives of Part II (focus group discussion) were 1) to gather feedback regarding the questionnaire developed in Part I, 2) to obtain recommendations for future planning and delivery of province-wide questionnaire and 3) as a group, to share information on patients’ experiences to diagnosis and patients’ perspectives on their interactions with health professionals (HP’s) throughout this journey. An interview-style questionnaire was developed to collect both qualitative and quantitative data on patients’ experiences. Forty patients with HRL’s diagnosed within 12 months were recruited and interviewed in the Dysplasia Clinic of the BC Oral Cancer Prevention Program. Two focus groups were conducted and feedback from participants regarding the questionnaire and patients’ experiences was recorded. Among 40 patients interviewed, 21 (53%) initially self-identified their lesions (SIG) and 19 (47%) were identified by health professional screening (PSG; 84% by dental professionals). The SIG showed higher rates of invasive SCC at diagnosis as compared to those in the PSG (76% vs. 32%, P = 0.01) and SIG took twice as long to have the initial biopsy performed as the PSG (23 ± 52 vs. 11 ± 28 months). Notably, the main symptom of patients in SIG was pain or presence of non-healing ulcers (18/21; 86%). In contrast, all lesions in PSG were asymptomatic. The mean time from detection to diagnosis was 17.5 ± 42.3 months (range: 0-240 months). Fourteen patients (35%) experienced a time lag of greater than 6 months from first detection of an oral lesion until the first diagnostic biopsy was performed. Both patient and professional factors impact on the time lag. The main contributing factors for this time lag include both patient factors (a lack of concern, fear, and a lack of oral cancer awareness) and the professional factors (lack of knowledge in differentiating high-risk lesions, delay in initiating the referral or ‘watch and wait’, and delay in scheduling of referral appointments to the specialists). Focus group results supported the format and content of the questionnaire, provided input in designing of future province-wide survey and emphasized that patients require continued post-diagnostic and treatment care. A general lack of awareness of oral cancer in general population and in HP’s in addition to a lack of screening activities have been brought forward as critical factors that result in delay to diagnosis. In conclusion, these results suggest HP’s, especially dental professionals, can play a critical role in early identification of HRL’s at an asymptomatic, pre-invasive stage through regular screening. Strategies in raising awareness of oral cancer in both the general population and among HP’s are essential for early identification of oral cancers in order to achieve better control over this disease.

Oral cancer is the 6th most common cancer in the world, with a poor prognosis and frequent late-stage diagnosis, which significantly impacts survival and quality of life. The key to better control of this disease is early detection, preferably at a precancerous stage. In order to facilitate this early detection and diagnosis, it is critical to identify the factors potentially impacting on the time lag from initial detection to diagnostic biopsy. The overall goal is to develop effective strategies for early identification of oral cancers in order to achieve better control over this disease. There are 2 components in this thesis: the objectives of part I (personal interview) were 1) to develop an interview-style questionnaire, 2) to collect data from patients with high-risk oral lesions (HRL’s) and 3) to characterize the experiences of these individuals that may have impacted the time interval leading up to diagnosis. The objectives of Part II (focus group discussion) were 1) to gather feedback regarding the questionnaire developed in Part I, 2) to obtain recommendations for future planning and delivery of province-wide questionnaire and 3) as a group, to share information on patients’ experiences to diagnosis and patients’ perspectives on their interactions with health professionals (HP’s) throughout this journey. An interview-style questionnaire was developed to collect both qualitative and quantitative data on patients’ experiences. Forty patients with HRL’s diagnosed within 12 months were recruited and interviewed in the Dysplasia Clinic of the BC Oral Cancer Prevention Program. Two focus groups were conducted and feedback from participants regarding the questionnaire and patients’ experiences was recorded. Among 40 patients interviewed, 21 (53%) initially self-identified their lesions (SIG) and 19 (47%) were identified by health professional screening (PSG; 84% by dental professionals). The SIG showed higher rates of invasive SCC at diagnosis as compared to those in the PSG (76% vs. 32%, P = 0.01) and SIG took twice as long to have the initial biopsy performed as the PSG (23 ± 52 vs. 11 ± 28 months). Notably, the main symptom of patients in SIG was pain or presence of non-healing ulcers (18/21; 86%). In contrast, all lesions in PSG were asymptomatic. The mean time from detection to diagnosis was 17.5 ± 42.3 months (range: 0-240 months). Fourteen patients (35%) experienced a time lag of greater than 6 months from first detection of an oral lesion until the first diagnostic biopsy was performed. Both patient and professional factors impact on the time lag. The main contributing factors for this time lag include both patient factors (a lack of concern, fear, and a lack of oral cancer awareness) and the professional factors (lack of knowledge in differentiating high-risk lesions, delay in initiating the referral or ‘watch and wait’, and delay in scheduling of referral appointments to the specialists). Focus group results supported the format and content of the questionnaire, provided input in designing of future province-wide survey and emphasized that patients require continued post-diagnostic and treatment care. A general lack of awareness of oral cancer in general population and in HP’s in addition to a lack of screening activities have been brought forward as critical factors that result in delay to diagnosis. In conclusion, these results suggest HP’s, especially dental professionals, can play a critical role in early identification of HRL’s at an asymptomatic, pre-invasive stage through regular screening. Strategies in raising awareness of oral cancer in both the general population and among HP’s are essential for early identification of oral cancers in order to achieve better control over this disease.

Oral cancer is the 6th most common cancer in the world, with a poor prognosis and frequent late-stage diagnosis, which significantly impacts survival and quality of life. The key to better control of this disease is early detection, preferably at a precancerous stage. In order to facilitate this early detection and diagnosis, it is critical to identify the factors potentially impacting on the time lag from initial detection to diagnostic biopsy. The overall goal is to develop effective strategies for early identification of oral cancers in order to achieve better control over this disease. There are 2 components in this thesis: the objectives of part I (personal interview) were 1) to develop an interview-style questionnaire, 2) to collect data from patients with high-risk oral lesions (HRL’s) and 3) to characterize the experiences of these individuals that may have impacted the time interval leading up to diagnosis. The objectives of Part II (focus group discussion) were 1) to gather feedback regarding the questionnaire developed in Part I, 2) to obtain recommendations for future planning and delivery of province-wide questionnaire and 3) as a group, to share information on patients’ experiences to diagnosis and patients’ perspectives on their interactions with health professionals (HP’s) throughout this journey. An interview-style questionnaire was developed to collect both qualitative and quantitative data on patients’ experiences. Forty patients with HRL’s diagnosed within 12 months were recruited and interviewed in the Dysplasia Clinic of the BC Oral Cancer Prevention Program. Two focus groups were conducted and feedback from participants regarding the questionnaire and patients’ experiences was recorded. Among 40 patients interviewed, 21 (53%) initially self-identified their lesions (SIG) and 19 (47%) were identified by health professional screening (PSG; 84% by dental professionals). The SIG showed higher rates of invasive SCC at diagnosis as compared to those in the PSG (76% vs. 32%, P = 0.01) and SIG took twice as long to have the initial biopsy performed as the PSG (23 ± 52 vs. 11 ± 28 months). Notably, the main symptom of patients in SIG was pain or presence of non-healing ulcers (18/21; 86%). In contrast, all lesions in PSG were asymptomatic. The mean time from detection to diagnosis was 17.5 ± 42.3 months (range: 0-240 months). Fourteen patients (35%) experienced a time lag of greater than 6 months from first detection of an oral lesion until the first diagnostic biopsy was performed. Both patient and professional factors impact on the time lag. The main contributing factors for this time lag include both patient factors (a lack of concern, fear, and a lack of oral cancer awareness) and the professional factors (lack of knowledge in differentiating high-risk lesions, delay in initiating the referral or ‘watch and wait’, and delay in scheduling of referral appointments to the specialists). Focus group results supported the format and content of the questionnaire, provided input in designing of future province-wide survey and emphasized that patients require continued post-diagnostic and treatment care. A general lack of awareness of oral cancer in general population and in HP’s in addition to a lack of screening activities have been brought forward as critical factors that result in delay to diagnosis. In conclusion, these results suggest HP’s, especially dental professionals, can play a critical role in early identification of HRL’s at an asymptomatic, pre-invasive stage through regular screening. Strategies in raising awareness of oral cancer in both the general population and among HP’s are essential for early identification of oral cancers in order to achieve better control over this disease. / Dentistry, Faculty of / Graduate

Abstract Incidence trends of laryngeal cancer in Finland were analyzed, especially in relation to survival, in a patient series of 5766 patients diagnosed in 1956–1995 and identified from the Finnish Cancer Registry. The age-adjusted incidence rate decreased from 6.5 to 3.5 per 100 000 person-years in males and remained unchanged among females. Only minor improvement occurred in survival. In a hospital-based material from Northern Finland (353 patients with laryngeal squamocellular carcinoma, LSCC, diagnosed in 1976–1995), the incidence among males decreased only for supraglottic cancer, diminishing the supraglottic to glottic incidence ratio from 1.4:1 to 0.5:1. Evaluation of diagnostic delays and their impact on survival and risk of recurrence was undertaken in a sample of 66 LSCC patients. In only 38% of the patients was malignancy suspected at the initial visit to a physician; infection was the most common misdiagnosis (41%). Half of the first consultations resulted in referral, whereas 17% of the patients were neither referred nor controlled. The median patient delay was 2 months and median professional delay 3 months. The latter exceeded 12 months in 17% of the patients. The delays were not significantly related to any other clinical parameter, nor were they interrelated. Professional delay of 12 months or more resulted in increased relative hazard of death (HR = 4.74, p = 0.05), equalling the effect of advanced stage (stage IV). One-third of the patients developed a recurrence. In univariate analysis, professional delay of 12 months or more increased the risk of local (p = 0.019) and neck (p = 0.019) recurrence. In a multivariate model, professional delay of 12 months or more indicated an adjusted relative hazard ratio (HR) of 4.6 for local recurrence (p = 0.02) and 9.5 for neck recurrence (p = 0.015). Immunohistochemical factors p53, apoptosis, angiogenesis and proliferation were included in a multivariate model evaluating prognostic factors of LSCC in addition to clinical and sociodemographic factors. Advanced stage (stages III–IV) (relative hazard ratio of death (HR) 8.9, p = 0.01), supraglottic site (HR 5.6, p = 0.02) and high apoptotic index (≥ 0.3) (HR 11.1, p = 0.05) were the best indicators of impaired prognosis. Professional delay and enhanced apoptotic rate could be helpful in selecting LSCC patients for more aggressive primary treatment.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-08-21T12:48:09Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) DISSERTACAO MESTRADO MOYSES PRONTA (1) (1).pdf: 679547 bytes, checksum: cf4dd53c812b868e1a8d7ceb72f62419 (MD5) / Made available in DSpace on 2014-08-21T12:48:09Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) DISSERTACAO MESTRADO MOYSES PRONTA (1) (1).pdf: 679547 bytes, checksum: cf4dd53c812b868e1a8d7ceb72f62419 (MD5) Previous issue date: 2013-09-30 / There are several studies on the differential diagnosis of Bipolar Disorder (BD), however, further investigation with an emphasis on clinical phenotypes that inaugurate the disease is needed. The aims of this study are to identify the psychiatric disorders most frequently diagnosed before the definitive diagnosis of BD, the time until the correct diagnosis and compare BD I and II for the variables studied. We studied 259 patients with current diagnosis of BD according to the DSM- IV-TR, evaluated by the same psychiatrist. Early psychiatric signs and symptoms were identified through an interview with the patient and family members and were considered suggestive of an initial diagnosis that was coded according to the same diagnostic criteria. The authors analyzed data on patients' age at prodromes suggestive of initial psychiatric diagnosis and time delay to the actual diagnosis of BD. Comparisons were made between sex, schooling and type of BD. The mean age of patients was 41.6 years, with a predominance of adults (19-60 years), women (67.6%), as well as type II BD (68.3%). Patients were on average 24.6 years of age at initial diagnosis, 41.6 years in the diagnosis of BD and the mean time delay between these was 16.9 years. The most common initial diagnoses were depressive disorders (41.3%), anxiety (12.7%), ADHD (8.1%), disorders related to substance abuse (7.7%), somatoform disorders (6 9%), and psychosis (5.4%). BD can be considered a “great imitator” in modern psychiatry, since initial phenotypes can mimic other disorders. BD diagnosis is very delayed in Brazil. / Há diversos estudos sobre o diagnóstico diferencial do Transtorno Bipolar (TB), entretanto, investigações com ênfase nos fenótipos clínicos que inauguram a doença são escassos. Os objetivos deste estudo consistem em identificar as doenças psiquiátricas mais frequentemente diagnosticadas antes do diagnóstico definitivo de TB, assim como o intervalo de tempo até o mesmo; e comparar o pacientes com TB I e II quanto aos diagnósticos iniciais, escolaridade, sexo e faixa etária. Para tanto, estudamos 259 pacientes com diagnóstico atual de TB segundo os critérios do DSM-IV-TR, realizado por um mesmo psiquiatra. Através de entrevistas com o paciente e familiares, identificou-se retrospectivamente os sinais e sintomas precoces considerados sugestivos do primeiro diagnóstico psiquiátrico, segundo os mesmos critérios. Dados relativos à idade dos pacientes no diagnóstico inicial e tempo até o diagnóstico atual de TB foram analisados e comparações foram feitas entre sexo, escolaridade, faixa etária e tipo de TB. A média de idade encontrada foi de 41,6 anos, com predominância de adultos (19-60 anos), do gênero feminino (67,6%), com TB II(68,3%). Os pacientes tinham em média 24,6 anos de idade no diagnóstico inicial, 41,6 anos no diagnóstico de TB e o tempo médio de atraso diagnóstico foi de 16,9 anos. Os diagnósticos iniciais mais frequentemente encontrados foram: transtornos depressivos (41,3%), ansiosos (12,7%), TDAH (8,1%), transtornos relacionados ao abuso de substâncias psicoativas (7,7%), transtornos somatoformes (6,9%) e psicóticos (5,4%). O T pode ser considerado um “grande imitador” moderno da Psiquiatria, posto que fenótipos iniciais podem mimetizar outros transtornos. Há um atraso significativo no diagnóstico do TBno Brasil.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-05-04T14:27:54Z No. of bitstreams: 1 RODRIGO MASELLI THOM? GARCIA.pdf: 1139747 bytes, checksum: 918a44a313fb8cf1d56fef9b097af761 (MD5) / Made available in DSpace on 2018-05-04T14:27:54Z (GMT). No. of bitstreams: 1 RODRIGO MASELLI THOM? GARCIA.pdf: 1139747 bytes, checksum: 918a44a313fb8cf1d56fef9b097af761 (MD5) Previous issue date: 2018-02-28 / Introduction: Acute Scrotum Syndrome is a medical emergency. Some children and adolescents cannot be cared for by a specialist or accustomed to this pathological condition of the acute scrotum, especially torsion of the spermatic cord, also called testicular torsion. Delays in care, misinformation by patients, family members or healthcare professionals can cause irreversible damage to the patient. Objective: to correlate factors that delayed the diagnosis and treatment of acute scrotal syndrome with loss of testis. Method: The charts of 127 patients from March 2007 to May 2017 were analyzed in the Patient Record Services of Hospital e Maternidade Celso Pierro. Patients who underwent surgery are included in the study (n = 71). Patients with incomplete records, age greater than 18 years or who did not undergo surgical treatment were not included in the study (n = 56). Exploratory data analysis was performed through descriptive measures (mean, standard deviation, minimum, median, maximum, frequency and percentage). Orchiectomy and orchidopexy groups were compared using the Mann-Whitney test (age, distance from the house to the hospital, time of symptoms and time in the Hospital e Maternidade Celso Pierro) or Qui-Square (race, agreement, side affected and pr?-hospital care). Factors related to orchiectomy were assessed through Logistic Regression. In the multiple analysis, the variable selection criterion used was stepwise. The level of significance was 5%. Results: Among the 71 patients diagnosed with Acute Scrotum Syndrome undergoing surgery, 22 (31%) were between 0 and 12 years of age and 49 (69%) were older than 12 years. It was evidenced that there is significant difference between the groups for the variables that measure time. The time of symptoms and time of Hospital e Maternidade Celso Pierro is greater for the orchidectomy group. For the other variables, no significant differences were found between groups. The group of patients most submitted to orchiectomy are non-white patients, with no private medical insurance, right testicle affected and without pr?- hospital care. On the other hand, the group of patients most submitted to orchidopexy are the whites, also without private medical care or pre-hospital care and the affected left testicle. The 1 hour increase in symptom time increases the chance of orchiectomy by 4%. The 1 hour increase in Hospital e Maternidade Celso Pierro increases the chance of orchiectomy by 0.2%. Conclusion: Elapsed time of symptoms remains the main factor associated with loss of the testis in Acute Scrotum Syndrome and torsion of the spermatic cord. Even without data with statistical significance, we can also conclude that this study showed that patients with more than 12 years of age, not white, with right side affected, without private medical care and pr?-hospital care are the most submitted to orchiectomy. / Introdu??o: a S?ndrome do Escroto Agudo configura uma emerg?ncia m?dica. Algumas crian?as e adolescentes n?o conseguem ser atendidas por um profissional especializado ou habituado nessa condi??o patol?gica do escroto agudo em especial a Tor??o do Cord?o Esperm?tico, muito chamada tamb?m de tor??o testicular. A demora no atendimento e tratamento desses pacientes, desinforma??o dos pr?prios pacientes, familiares ou profissionais da ?rea da sa?de podem causar danos irrevers?veis ao test?culo. Objetivo: correlacionar fatores que atrasaram o diagn?stico e tratamento da s?ndrome do escroto agudo com a perda do test?culo. M?todo: os prontu?rios de 127 pacientes desde mar?o de 2007 a maio de 2017 foram analisados nos Servi?os de Prontu?rio de Pacientes do Hospital e Maternidade Celso Pierro. Os pacientes que foram submetidos ? cirurgia est?o inclusos no estudo (n=71). Pacientes com prontu?rios incompletos, idade maior que 18 anos ou que n?o foram submetidos ao tratamento cir?rgico n?o foram inclu?dos no estudo (n=56). Foi realizada an?lise explorat?ria de dados atrav?s de medidas descritivas (m?dia, desvio padr?o, m?nimo, mediana, m?ximo, frequ?ncia e porcentagem). Os grupos de orquiectomia e orquidopexia foram comparados atrav?s do teste de MannWhitney (idade, dist?ncia da casa at? o hospital, tempo de sintomas e tempo no Hospital e Maternidade Celso Pierro) ou Qui-Quadrado (etnia, conv?nio, lado acometido e atendimento pr?-hospitalar). Os fatores relacionados ? orquiectomia foram avaliados atrav?s de Regress?o Log?stica. Na an?lise m?ltipla o crit?rio de sele??o de vari?veis usado foi o stepwise. O n?vel de signific?ncia adotado foi de 5%. Resultados: Entre os 71 pacientes avaliados com o diagn?stico de S?ndrome do Escroto Agudo submetidos ? cirurgia, 22 deles (31%) tem idades entre 0 e 12 anos e 49 (69%) tem idades maior que 12 anos. Evidenciou-se que existe diferen?a significativa entre os grupos para as vari?veis que medem tempo. O tempo de sintomas e tempo de Hospital e Maternidade Celso Pierro ? maior para o grupo de orquiectomia. Para as demais vari?veis n?o foram encontradas diferen?as significativas entre os grupos. O grupo de pacientes mais submetidos ? orquiectomia s?o os n?o brancos, sem conv?nio m?dico particular, test?culo direito acometido e sem atendimento pr?-hospitalar. J? o grupo de pacientes mais submetidos ? orquidopexia s?o os brancos, tamb?m sem conv?nio m?dico particular ou atendimento pr?-hospitalar e test?culo esquerdo acometido. O aumento em uma hora no tempo de sintomas aumenta a chance de orquiectomia em 4%. O aumento em 1 hora no tempo de Hospital e Maternidade Celso Pierro aumenta a chance de orquiectomia em 0,2%. Conclus?o: o tempo decorrido de sintomas ainda permanece o principal fator associado ? perda do test?culo na S?ndrome do Escroto Agudo e Tor??o do Cord?o Esperm?tico. Mesmo sem dados com signific?ncia estat?stica, podemos concluir tamb?m que esse estudo mostrou que os pacientes com mais de 12 anos, n?o branco, com lado direito acometido, sem conv?nio m?dico particular e atendimento pr?-hospitalar s?o os mais submetidos ? orquiectomia.

Bipolar disorder (BD) is a severe psychiatric diagnosis that is difficult to identify. Diagnostic delays are 5-10 years and cause irreversible harm for the patient and burden health care systems. Health deterioration and societal costs may be avoided if BD were diagnosed and treated at an early stage in the disease progression. BD is supposed to be treated by specialised psychiatric health care, yet primary health care (PHC) is an important part of the process as it is often the first contact of care for patients. It would therefore be of interest to investigate the preconditions of PHC in relation to the process of early detection of BD. PHC is organised by regional administration and due to regional inequality in health care it would also be of interest to apply a geographic perspective, investigating potential geographic variation in preconditions. In this study, PHC professionals from two regions were interviewed using semi-structured interviews and data was thematically analysed. Results present mostly similarities but also some differing preconditions in the regional analysis. The study concludes that PHC has an important in the role of early detection of BD, but also for patients who already received a diagnosed.

Objectius: determinar si la demora diagnòstica o terapèutica influeix en la supervivència o en l'estadi del càncer colorectal (CCR), identificar els factors que fan que es consulti al metge davant la presència de símptomes de CCR. Doble abordatge metodològic: revisió sistemàtica amb metaanàlisi i investigació qualitativa. Resultats: S'han identificat 40 publicacions sobre supervivència i 50 sobre estadi. S'exclogueren 14 i 13 estudis respectivament perquè utilitzaven mostres molt restrictives. Dels 26 de supervivència restants, a 20 no hi havia associació. El metaanàlisi de supervivència es va fer amb 8, RR: 0,92 (IC 95%: 0,87-0,97). Dels 38 estudis d'estadi, a 26 no hi havia associació. El metaanàlisi d'estadi es va fer amb 16, OR: 0,98 (IC 95%: 0,76-1,25). Quan s'examinaren colon i recte per separat, s'observaren associacions no significatives en sentit contrari. Els factors que fan que una persona amb símptomes de CCR consulti al metge estan relacionats amb el gènere. / Objetivos: Determinar si la demora diagnóstica o terapéutica influye en la supervivencia o en el estadio del cáncer colorectal (CCR) (objetivos 1 y 2), conocer la interpretación que las personas hacen ante los primeros síntomas de CCR, identificar los factores que desencadenan la consulta al médico y describir el proceso diagnóstico del CCR desde el punto de vista de las personas que lo padecen (objetivos 3, 4 y 5). Doble abordaje metodológico: revisió sistemàtica con metaanálisis (objetivos 1 y 2) y investigación cualitativa (objetivos 3, 4 y 5). Resultados: Se han identificado 40 publicaciones sobre demora y supervivencia y 50 sobre demora y estadio. Se han excluido 14 y 13 estudios por utilizar muestras excesivamente restringidas. De los 26 estudios de supervivencia restantes, en 20 no se observó asociación, en 4 la demora fue un factor protector de la supervivencia y en 2 un factor de riesgo. El metaanálisis de supervivència se pudo realizar con 8 estudios y se obtuvo un RR de 0,92 (IC 95%: 0,87-0,97). De los 38 estudios de estadio restantens, en 26 no se observó asociación, en 4 la demora fue un factor protector y en 7 un factor de riesgo. El metaanálisis de estadio se pudo hacer con 16 estudios y se obtuvo una OR de 0,98 (IC 95%: 0,76-1,25). Cuando se examinaron colon y recto por separado, se observaron asociaciones no significativas en sentido contrario. En definitiva, no parece existir asociación entre demora y supervivencia o demora y estadio en el CCR, pero es necesario estudiar más el tema considerando colon y recto por separado. Los primeros síntomas del CCR se atribuyen a procesos banales. El hecho de que la persona se encuentre bien hace que de poca importancia a los síntomas. Los factores que hacen que una persona con síntomas de CCR consulte al médico están relacionados con el género. Mientras que las mujeres cercanas son un desencadenante directo de consulta en los hombres, las mujeres no suelen mencionar su problema de salud a la familia hasta que no han consultado al médico. El tiempo de espera para la realización de una colonoscopia es vivido como largo.