Factors contributing to appraisal and help-seeking delay among patients with colorectal cancer in Armenia: a research grant proposal

Abstract

Background: Colorectal cancer (CRC) is a major public health challenge worldwide. It is the third most common cancer among males, the second most common one among females, in the world. In high-income countries, the incidence of CRC tends to decrease and its survival tends to increase. In low and middle-income countries, such as Armenia is, the disease-specific rates have been increasing. Thus, in Armenia in 10 years from 2007 to 2017 the CRC disease-specific mortality has increased by 21.7%. Moreover, according to the predictions by 2040, the annual number of new cases of colon cancer will increase by 368. The time interval between the onset of the first symptom that is perceived by the patients as cancer alarming sign and the treatment initiation is considered as a total delay. The latter categories into appraisal, help-seeking and diagnostic delays. The proposed study will mainly investigate appraisal/help-seeking delay that results from the factors associated with patients and their decision-making process. Identification of factors that prolong the appraisal and help-seeking interval will allow shortening this time period and initiating early treatment of CRC, which will improve the prognosis of the disease and patients’ survival. Aim: The proposed quantitative study has an aim to investigate the proportion of delayed diagnosis and treatment among CRC patients, the proportion of the total delay among CRC patients due to the help-seeking/appraisal delay and the determinants of prolonged appraisal / help-seeking delay in Armenia. Methods: The proposed study will utilize a cross-sectional study design, with interviewer-administered face-to-face interviews. In total, 782 CRC patients receiving their treatment in certain oncological departments in Yerevan, Armenia will be approached using census sampling. Delay duration will be calculated through the C-SIM validated instrument and its protocol for calculating ‘pseudo-exact’ dates from estimated dates reported by the subjects. The methodology of the proposed study is developed according to the recommendations of the Aarhus Statement which provides guidance on designing and conducting research on cancer delay. Analysis: Statistical analysis will be performed through STATA 13 and will include descriptive statistics, independent t-test, and chi-square test. Further, multiple logistic regression analysis will be performed and the model will be adjusted for such confounders as age, gender, marital status, and educational level. The total budget required to conduct the project is 2,528,200 AMD. It will last from July 7, 2019, until February 7, 2020. The personal will consists of project coordinator, data collectors, data enterers.