Newswise — In a study published in the April issue of Diseases of the Colon & Rectum, researchers present results of a study designed to identify factors associated with disparities in colorectal cancer care. They studied a group of 30 primary minority, lower income patients who had been diagnosed with advanced colorectal cancer. Participants were interviewed regarding their perceptions and experiences of colorectal cancer and barriers they faced in seeking diagnosis and treatment.

According to lead author Isabel Leal, PhD, “Four themes describe factors on the structural, health care system, provider, and patient level, that interact to make engaging in prevention foreign this population, thus limiting early detection and treatment of colorectal cancer.”

These 4 themes included

  • Limited resources for accessing care
  • Misunderstanding of symptoms by patients; and misdiagnosis of symptoms by physicians
  • Beliefs about illness and health, such as relying on faith, or self-care when symptoms develop
  • Reactions to illness, including maintenance of masculinity, and confusing interactions with physicians, embarrassment, and fear

The authors conclude that improving screening rates in underserved populations will require addressing such barriers at multiple levels.

Citation:  Leal IM, Kao LS, Karanjawala B, Escamilla RJ, Ko TC, Millas SG. Understanding patients' experiences of diagnosis and treatment of advanced colorectal cancer in a safety-net hospital system: a qualitative study. Dis Colon Rectum 2018;61:504-513.

In an accompanying editorial, Dr. Timothy Geiger eloquently puts current screening recommendations and issues of access to care into perspective.

Dr. Geiger stated: "This article identifies multiple factors in the decision to be screened that we typically do not addressin a 20-minute office visit. We have direct control only of the provider factors, including knowledge of the risks and the expertise to make sound recommendations to improve quality and quantity of life. However, as Leal et al elegantly show, this addresses only part of the problem of screening noncompliance."

Citation: Geiger TM. Colorectal cancer screening and diagnosis: a patient-centered approach to understanding avoidance. Dis Colon Rectum 2018;61:417-418.

A prepublication copy is available upon request. Please email Margaret Abby, Managing Editor, Diseases of the Colon and Rectum, at 


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Dis Colon Rectum 2018;61:504-513