Colorectal cancer prognosed to advanced stage and its associated factors in oncologic unit of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia, 2023

Colorectal cancer prognosed to advanced stage and its associated factors in oncologic unit of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia, 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Colorectal cancer prognosed to advanced stage and its associated factors in oncologic unit of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia, 2023 Abebe Bekele Jibat, Yonas Fissha, Belachew Tegegne, Afework Edmealem This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4489569/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: The progression of colorectal cancer to an advanced stage makes its prognosis more difficult and further magnifies the health burden associated with the disease. In spite of this fact, the magnitude of colorectal cancer, which is prognosed at an advanced stage, and the associated factors are not well studied in Northeast Ethiopia. Methods: A hospital-based cross-sectional study was conducted among 354 selected patients from March 20, 2018 to March 20, 2023, using the lottery method. Data collectors collected data by reviewing a medical chart using a data abstraction chart. Descriptive statistics and binary logistic regression were applied. Variables with P < 0.25 in bivariable analysis were candidates for multivariable analysis. Variables whose P value is less than 0.05 in multivariable analysis were considered as statistically associated factors. Result: The magnitude of colorectal cancer case that were prognosed to at an advanced stage was 83.3%. Being aged (AOR = 6.1; 95% CI: 2.5–14.9), living at rural area (AOR = 6.6, 95% CI: (2–21)), not medically insured (AOR = 6.8; 95% CI: 2.3–19.9), delayed to visit a health facility (AOR = 5.5; 95% CI: (2.2–13.8)), delayed to seek treatment after being diagnosed (AOR = 3.1; 95% CI: (1.1–8.4).), and poor adherence to treatment (AOR = 6.9; 95% CI: (2.1-22.6) were factors associated with the prognosis of colorectal cancer to advanced stage presentation. Conclusion: In this study, magnitude of colorectal cancer prognosed to advanced stage was high. Being aged, rural residency, not medically insured, delay in health facility visit, delay in seeking treatment after diagnosed and poor adherence to treatment were significantly associated with prognosis of colorectal cancer to advanced stage presentation. Especial follow up of the rural community, expanding medical insurance, and improving treatment adherence are strategies that delay the prognosis of colorectal cancer to advanced stage. Prognosed to advanced stage Colorectal cancer Ethiopia Key messages What is known about colorectal cancer? Worldwide, colorectal cancer is the fourth disease that kills people. The incidence of colorectal cancer is increasing alarmingly. What this study adds? The magnitude of colorectal cancer which is prognosed to advanced stage is high. Seeking treatment lately, having poor treatment adherence, living in rural areas and old age are factors that hasten the prognosis of colorectal cancer to advanced stage. Our study motivates health care providers and stake holders to delay the prognosis of colorectal cancer to its advance stage. Introduction Globally, the prevalence of Colo-Rectal Cancer (CRC) has alarmingly increased from time to time. It is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related deaths in the world, and its burden is expected to increase by 60% to more than 2.2 million new cases and 1.1 million deaths by 2030[ 1 ]. Nowadays, non-communicable diseases like cancer are one of the most common causes of death in African countries, along with infectious diseases, traffic accidents, and other non-communicable disorders[ 2 ]. CRC is the most common malignancy among gastrointestinal disorders globally and its progression to an advanced stage make its prognosis more difficult and further magnifies the health burden associated with the disease. Colorectal cancer prognosed to advanced stage had a chance to have permanent stoma. A permanent stoma has a devastating impact on the patient's quality of life. According to a study, patients who have stoma had worse general health, more symptoms, less functionality, and a lower overall quality of life than non-stoma patients. Not only these, there were also notable impacts in terms of sexual health, social interaction, self-image, and psychiatric morbidity[ 3 ]. According to the study conducted in Iran, the cost and expenses of colorectal cancer patients were a main health expenditure[ 4 ]. Being unproductive due to disability, and premature death are the other burdens [ 5 ]. Colorectal cancer mortality and prognosis to advanced stage increased over time in different countries due to a variety of factors such as population growth and aging, as well as engaging in risky behaviors and lifestyles [ 6 – 8 ]. A 6 years of follow-up study in Ethiopia found that the overall mortality incidence of patients with colorectal patients was 80.05% [ 9 ]. Understanding the prognosis of colorectal cancer to an advanced stage and its associated factors are highly significant due to the high burden of the disease. Determining the prognostic factors of the disease will be helpful to understand which population are risky to advanced stage and develop efficient prevention and management strategies. Additionally, knowing factors can help oncologists and other health care professionals to make informed decisions concerning patient management, including treatment options and patient counseling. Although curative treatment for colorectal cancer with advanced stage is ineffective and scarce, there are a few studies that addressed magnitude of colorectal cancer prognosed to advanced stage and factors associated it. Particularly, factors such as chat chewing, which is highly prevalent in the study area, physical activity and treatment adherence level were not addressed in the previous studies. Hence, this study aimed to assess the magnitude of CRC prognosed to advanced stages of presentation and its associated factors among patients at Dessie Comprehensive Specialized Hospital in Northeast Ethiopia. Methods and Materials Study area and period The study was done in the oncologic unit of Dessie Comprehensive Specialized Hospital (DCSH) from March 20, 2018 to March 20, 2023. Currently, it has over 303 administrative and over 562 health workers. It also provides preventive, curative, and rehabilitative services, including oncology services, for over 8 million people. Dessie's comprehensive specialized hospital oncology unit provides treatment for about 1600 cancer patients, among whom 392 were diagnosed with CRC. Study design Hospital-based cross-sectional study was employed. Population The source population were all patients with colorectal cancer who were attending their treatment in the oncologic unit of Dessie Comprehensive Specialized Hospital. The study population were all patients with colorectal cancer who attended their treatment follow-up in the oncologic unit of Dessie Comprehensive Specialized Hospital from March 20, 2018 to March 20, 2023. Inclusion and exclusion criteria All patients with colorectal cancer who were attending their treatment follow-up from March 20,2018 to March 20, 2023, in the oncologic unit of Dessie Comprehensive specialized hospital were included in the study. The study excluded charts which were not recorded the status of outcome variable. Sample size determination The sample size for the first objective was determined using a single population proportion formula by considering the following assumptions: proportion of advanced stage presentation of CRC = 83.1%[10], 95% confidence level, and margin of error = 4%. N = 337= 337+5% (non-retrieval rate) =354 Sample size for the second objective was calculated by using Epi info STAT Calc, but the largest sample size was obtained from the first objective. There for, after adding 5% non-retrieval rate the final sample size was 354. Sampling technique The total number of CRC patients in the DCSH oncology unit was identified from the registration book, and then, using simple random sampling techniques, the required sample size was selected by lottery method. Data collection tool and procedure Data were extracted using a pre-tested and structured data abstraction sheet adapted from different literatures. The abstraction sheet was developed in English and contains socio-demographic data, including age, sex, marital status, place of residence, insurance status, educational status, and clinicopathological characteristics of the patients, such as treatment modality, recurrence history of the disease, level of Carcinoembryonic antigen (CEA) and hemoglobin, and other variables traced from the patient’s medical record charts. The data were accessed from April 21 st , 2023 till May 10, 2023. The authors accessed information that identified during the data collection period. Variables Dependent variable: Colorectal cancer prognosed to advanced stage (Yes, no) Independent variables Socio demographic and patient related factor : Age, Sex, Place of residence, Religion, Marital status, educational status, and ethnicity, and insurance status. personal and life style-related factors : Cigarette smoking, Chat chewing and Alcohol consumption., red meat consumption, physical exercise, weight and height Clinicopathological and Treatment related factors : Treatment modality, patient delay, diagnosis delay, delay to seek treatment, treatment adherence level, recurrence history after treatment, histological type, histological grading, metastasis history, primary site of the tumor, base line CEA level, anemic status and history of comorbidities. Operational definitions Colorectal cancer : is a disease in which cells in the colon or rectum grow out of control [11]. Advanced stage : patients with colorectal cancer diagnosed to the disease stage of III and IV [11]. Early-stage : patients with colorectal cancer diagnosed to the disease stage of I and II [12]. Comorbidity illness : any disease which is listed in the Charlson comorbidity index other than colorectal cancer at diagnosis[13]. Carcinoembryonic antigen : Tumor markers of gastrointestinal cancers especially colorectal cancer and classified as elevated (≥5ng/ml) and not elevated if <5 ng/ml[14]. Time to visit health facilities (symptom duration): the duration of time from perceiving of symptom for the first time up to health care visit and it is considered as delayed if a patient seeks health care visit more than or equal to 90 after the symptoms of CRC appeared [15, 16]. Time to diagnosis : the duration of time from initial health care visits up to the time when confirmed diagnosis is made, and considered as delayed if it is ≥30 days[15, 16]. Diagnosis to treatment interval (DTI ): The time interval between confirmed colorectal cancer diagnosis up to the date of first treatment started, and considered as delayed if it is more than 30 days[15, 16] . Poor-adherence : A patient were considered poor-adherence if they said ‘Yes’ for at most three questions [17]. Data quality assurance Prior to data collection, training was given to data collectors and supervisors on questionnaire content, methods of data collection, and ethical concerns. To improve the quality of data, pretest was done on five percent (5%) of questionnaires before two weeks of actual data collection. After reviewing the result of the pretest, modification of the questionnaire was performed for clarity and completeness of the questionnaire. Continuous supervision of data gathering and daily checking of the collected data were performed by supervisors and principal investigator. After data collection, data verification was conducted visually and possible corrections were made by cross-checking the questionnaire. Data processing and analysis The data were initially coded, checked, and entered in Epi-Data software version 4.6.1, and then exported to Statistical Product and Service Solutions (SPSS) software version 27.0 for cleaning and statistical analysis. Descriptive statistics such as frequency mean and standard deviation were carried out to see the distribution of the participants within the variables included in the study. After cross-tabulation of each explanatory variable with the outcome variable, a binary logistic regression analysis model was used. Model fitness was checked using the Hosmer and Lemeshow tests. Initially, bivariable logistic regression analysis was carried out to select variables for multivariable analysis. Variables with a P value less than 0.25 in the bivariable analysis were selected as candidates for the multivariable logistic regression analysis model. Multi-collinearity among the explanatory variables was checked using the variance inflation factor and tolerance rate. To identify significant factors, multivariable binary logistic regression was conducted using the backward LR method. The level of statistical significance was declared at a P-value less than 0.05. An adjusted odds ratio with its 95% CI was used to show the strength and direction of association between each explanatory variable and the outcome variable. Result Socio-demographic characteristics of study participants A total of 354 respondents were involved. The median age of the participants was 56 years, with an interquartile range of 13. Two hundred sixty (73.4%) respondents were in the age groups of 50 and older. One hundred eighty-seven (52.8%) were males, and 308 (87%) respondents were from rural areas. One hundred eighty-nine respondents were Muslims in their religion, which accounts for 53.4%. From the total of the study participants, 289 (81.6%), 207 (76.3%), and 296 (83.6%) were married, unable to read and write, and did not have health insurance respectively (Table 1). Life style and personal-related characteristics of the study participants From the total of 354 respondents, more than half (54.8%) had no history of alcohol consumption. From the total number of study participants, 23.7% and 39.8% had histories of cigarette smoking and chat chewing respectively. Regarding the diet, 28.5% had a history of red meat consumption. One hundred eighty-two (51.4%) had a history of performing physical exercise daily during their treatment period, and of those respondents who performed physical exercise, the majority of them, 93.9% (n = 246), performed walking types of physical exercise (Table 2). Clinico - pathological characteristics From the total respondents, 218 (61.6%) had an elevated level of carcinoembryonic antigen (CEA), and 18.9% had additional illnesses. One hundred fifty (42.4%) respondents had history of anemia during their treatment period. From all respondents, 330 (93.2%) of the patients presented with an adenocarcinoma histologic type. Regarding the delay, 76%, 72.3%, and 52.8% of the participants were delayed for visiting a health care facility, being diagnosed, and seeking treatment, respectively. Two hundred ninety-five (83.3%) metastasized to other sites than the primary site. Two hundred forty-two (68.4%) were treated with chemotherapy only (Table 3). Primary site of tumor and treatment adherence From the total number of respondents, 39.8% of the them had colon cancer, followed by rectal cancer (33.3%). The rest are colorectal, anorectal ad recto-sigmoid which accounts 15.82%, 9.32% and 1.69% respectively. Regarding adherence level, the majority of the respondents (73.2%) were found to have poor adherence status during their treatment period. Magnitude of colorectal cancer prognosed to advanced stage Two hundred ninety-five 295 (83.3%; 95% CI: 79.4% - 87.3%) patients had advanced disease (stage III or IV). Factors associated with colorectal cancer prognosed to advanced stage In bivariable analysis, age, place of residence, insurance status, delayed visit to a health care facility, time from visit to diagnosis, diagnosis to treatment delay, comorbidity illness, recurrence of the disease, consuming red meat, smoking habit, alcohol habit, histological type, and adherence level were fitted at a P-value < 0.25. Age, place of residency, insurance status, delay to visit, diagnosis to treatment delay, and adherence level were significantly associated with the outcome variable at a p-value of < 0.05. CRC patients who were 50 years of old and older were 6 times more likely to be prognosed to an advanced stage of the disease than patients who were under 50 years old (AOR = 6.1; 95% CI: 2.5–14.9). CRC patients whose residency were rural were 6.6 times more likely develop an advanced stage than those in urban areas (AOR = 6.6, 95% CI: 2–21). CRC patients without insurance coverage were 6.8 times more likely to be prognosed to an advanced stage than non-insurance users (AOR = 6.8; 95% CI: 2.3–19.9). Similarly, those CRC patients who were delayed to visit health care facilities were 5.5 times more likely to be prognosed to an advanced stage than patients than who were not delayed (AOR = 5.5; 95% CI: 2.2–13.8). Moreover, CRC patients who were delayed to get treatment were 3.1 times more likely to be prognosed to an advanced stage of the disease than those who were not delayed (AOR = 3.1; 95% CI: 1.1–8.4). Most interestingly, CRC patients with poor treatment adherence were five times (AOR = 5; 95% CI: 2–12) more likely to be prognosed to an advanced stage than those with good treatment adherence. (Table 5.) Discussion Colorectal cancer is one of the most common causes of cancer morbidity and mortality worldwide. This study was aimed at assessing the magnitude of colorectal cancer prognosed to advanced stage and its associated factors among CRC patients in oncologic units of Dessie Comprehensive Specialized Hospital in Northeast Ethiopia. The study revealed that 83.3% (95% CI: 79.4% - 87.3%) of CRC patients were presented at an advanced stage of the disease. This finding is in line with the study conducted in Amhara Region at Felege Hiwot Comprehensive Specialized Hospital and the University of Gondar Hospital, which is 83.1% [10], and with the study conducted in Sokoto, Nigeria, which was 86.8% [18]. However, it is higher than studies conducted in Addis Ababa's Tikur Anbessa specialized hospital, which is 62.7%[19]. Similarly, this study is higher than the study conducted in New York which (60.7%) [20], Nottingham at 67% [15], Korea at 23.1% [21], and Stanford at 72% [22]. This could be due to differences in socioeconomic status, accessibility of nearby health facilities, health policies of the respected countries, and patient-health care provider ratios in the study areas. In this study, aged respondents were more likely to be prognosed to advanced stages than those who were not aged. This finding is supported by the study conducted in Amhara region hospitals and in the United States [10, 23, 24]. This could be due to the fact that as age increases, changes occur in the colon, such as mucosal changes, decreased motility, and reduced blood flow. Older adults are less likely to participate in regular screening programs for colorectal cancer, and older adults may have other health conditions and comorbidities that make it harder to detect symptoms of colorectal cancer in its early stages [25]. Colorectal cancer prognosed to advanced stage among rural residents compared to urban residents. The finding is similar to the study conducted in different countries like Tanzania and Nigeria [18, 26, 27]. This could be due to probably low awareness of the warning signs of the disease, as most rural communities in Ethiopia are illiterate, inaccessible to health facilities, and have problems with transportation[28] Patients who didn't have medical insurance were presented with advanced stage than those who were insured. This finding is supported by the studies conducted in different countries [10, 24, 29]. The possible justification could be that health insurance coverage might solve the economic constraints of the patients and encourage them to visit health care facilities as early as possible if the signs and symptoms of the disease appear[30, 31]. Patients who delayed to visit a health care facility after the appearance of the first sign or symptom were presented with advanced stage than those who did not. This study is similar to studies conducted in Puerto Rico [32], Botswana [33], and Spain[34] . This could be since if patients don’t visit health care facilities and their physicians as early as possible after the sign or symptom, the disease could metastasize and disseminate to different organs [35]. Similarly, in this study, patients who were delayed to seek treatment after being diagnosed were more likely to be prognosed to advanced stage than those who started their treatment early; this is supported by the studies conducted in Taiwan and in five different countries in the British Journal of Cancer [16, 36]. The possible reasons for this could be fear and anxiety about cancer and the treatment process, which may cause patients to delay seeking treatment; misinformation about cancer and treatment options; financial barriers; and a lack of access to care. All these factors can cause patients to delay seeking treatment and finally present with an advanced stage of the disease. Another factor that contributed to this outcome was treatment adherence. CRC patients who had poor treatment adherence were more likely to be prognosed to advanced stage than patients with good treatment adherence. This might be because of the toxicity associated with chemotherapy agents, which results in unwanted side effects such as fatigue, vomiting, and diarrhea. These side effects can lead to poor patient compliance and an interruption of treatment. Another reason could be a lack of awareness about the importance of adherence to treatment follow-up, and financial constraints[37]. Limitation of the study Due to the fact that the current study's method of data collection was a chart review, one weakness is that it failed to take the economic situation of the respondents which may have had an impact on the study's findings. Conclusion The current study revealed that magnitude of colorectal cancer prognosed to advanced-stage presentation was high. Being aged, rural residency, not medically insured, delay to visit health facility, delay to seek treatment after diagnosed and poor treatment adherence were significantly associated with prognosis of colorectal cancer to advanced stage presentation. Clients shall visit health care facilities and seek treatment early. Health care providers provide multidisciplinary care, giving more attention to the rural residents and aged patients, and educate all patients about the importance of treatment adherence during their follow up. Medical insurance should be expanded. It is appreciated to conduct a study on the time to prognosis of colorectal cancer to advanced stage. Abbreviations AOR: Adjusted Odds Ratio BMI: Body Mass Index CEA: Carcinoembryonic antigen CI: Confidence Interval CRC: Colorectal Cancer DCSH: Dessie Comprehensive and Specialized Hospital SPSS: Statistical Product and Service Solutions TNM: Tumor Size, Nodal involvement, Metastasis Declarations Ethical consideration Ethical approval was written with reference number TOM/Res/1216/2015 on February 5, 2023, from the Tropical College of Medicine ERC (Ethical Review Committee). The Ethical Review Committee waived written consent since this research used secondary data from patient’s chart. The individual patients had not been subjected to any harm as far as confidentiality is concerned. Moreover, no personal identifier was used on the data collection form. The data were accessed by a third person except the principal investigator and kept confidential. Omitting the names of the respondents from the questionnaire helps to assure the confidentiality of the information. Consent for publication “Not applicable” Availability of data and materials All relevant data are within the manuscript and its Supporting Information files. Competing interests The authors declared that there is no conflict of interest. Funding There is no any fund. Author’s contribution AB conceived and designed the study, performed analysis and interpretation of data. AE advised and supervised the design conception, analysis, interpretation of data and made critical comments at each step of research. BT and YF drafted the manuscript. All authors read and approved the final Manuscript. Acknowledgement We, the authors, want to sincerely thank data collectors for their commitment. Additionally, we want to forward our deepest gratitude to Dessie Comprehensive Specialized Hospital Oncology Center employees for their strong support. References Arnold, M., et al., Global patterns and trends in colorectal cancer incidence and mortality. Gut, 2017. 66(4): p. 683-691. Siegel Rebecca, L. and D. Miller Kimberly, Jemal Ahmedin. Cancer statistics, 2019. CA: a cancer journal for clinicians, 2019. 69(1): p. 7-34. Vonk-Klaassen, S.M., et al., Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Quality of life research, 2016. 25: p. 125-133. Azizi, H. and E.D. 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Tables Table 1: Socio-demographic characteristics of colorectal cancer patients in Dessie comprehensive specialized hospitals in Dessie, Northeast Ethiopia, 2023 (N - 354) Variables Categories Frequency (N) Percentage (%) Age in years <50 94 26.6 ≥50 260 73.4 Sex Male 187 52.8 Female 167 47.2 Ethnicity Amhara 310 87.6 Oromo 24 6.8 Tigre 11 3.1 Others 9 2.5 Religion Orthodox 157 44.4 Muslim 189 53.4 Protestant 8 2.3 Place of residence Urban 46 13 Rural 308 87 Marital status Married 289 81.6 Single 13 3.7 Divorced 14 4.0 Widowed 38 10.7 Medical insurance Yes 58 16.4 No 296 83.6 Educational status Unable to read and write 270 76.3 Able to read and write 30 8.5 Grade 1-8 10 2.8 Grade 9-12 23 6.5 Diploma and above 21 5.9 Table 2: Life style and personal characteristics of colorectal cancer patients of Dessie comprehensive specialized hospital Northeast Ethiopia Dessie Ethiopia, 2023 (N - 354) Variable Categories Frequency Percentage (%) Alcohol consumptions (before diagnosed with advanced stage) Yes 160 45.2 No 194 54.8 Cigarette smoking (before diagnosed with advanced stage) Yes 84 23.7 No 270 76.3 Chat chewing (before diagnosed with advanced stage) Yes 141 39.8 No 213 60.2 Red meat and white meat consumptions Yes 101 28.5 No 253 71.5 Frequency of physical exercise during treatment period Daily 182 51.4 Weekly 64 18.1 Never 108 30.5 Types of physical exercise Walking 231 93.9 Aerobic activity 14 5.7 Stretching 1 0.4 Got counselling about physical exercise Yes 278 78.5 No 76 21.5 BMI Underweight 96 27.1 Normal weight 223 63.0 Over weight 30 8.5 Obesity 5 1.4 Table 3: Clinico-pathological characteristics of colorectal cancer patients in Dessie comprehensive specialized Hospitals Dessie Northeast Ethiopia (N = 354) Variable Category Frequency Percentage (%) CEA level(n=354) <5ng/ml 136 38.4 ≥5ng/ml 218 61.6 Comorbidity illness Yes 67 18.9 No 287 81.1 Types of comorbidities (N = 67) HIV 25 37.3 Hypertension 28 41.8 DM 13 19.4 Others 1 1.5 Anemic status Yes 150 42.4 No 204 57.6 Histological type Adenocarcinoma 330 93.2 Signet ring cell carcinoma 24 6.8 Histologic grading Differentiated 234 66.1 Moderately differentiated 97 27.4 Poorly Differentiated 23 6.5 CRC recurrence Yes 94 26.6 No 260 73.4 Duration of time between first symptom up to health care visit <3months 85 24 ≥3months 269 76 Diagnosis duration <1 month 98 27.7 ≥1month 256 72.3 Diagnosis to treatment <1month 167 47.2 ≥1month 187 52.8 Metastasis history Yes 295 83.3 No 59 16.7 Type of intervention given Chemotherapy only 242 68.4 Surgery and chemotherapy 104 29.4 Surgery, chemotherapy and Radiotherapy 8 2.3 Type of chemotherapy regimen taken Oxaliplatin +5fu (Folfox) 128 36.2 Oxaliplatin + Capecitabine 137 38.7 Irinotecan +5fu (Folfree) 62 17.5 Capecitabine po only 17 7.6 Table 5. Factors associated with colorectal cancer prognosed to advanced stage (N=354) Variables Category CRC prognosed to advanced stage COR (95%CI) AOR (95%CI) Yes (%) No (%) Age ≥50years 242(93.1) 18(6.9) 10.4(5.5-19.5) 6.1(2.5-14.9) <50 years 53(56.4) 41(43.6) 1 1 Place of residence Rural 266(86.4) 42 (13.6) 3.7(1.8-7.3) 6.6(2-21) Urban 29(63) 17(37) 1 1 Insurance status Paid 255(86.1) 41(13.9) 2.8(1.5-5.3) 6.8(2.3-19.9) Free 40(69) 18(31) 1 1 Delay to visit Delayed 238(88.5) 31(11.5) 3.7(2-6.7) 5.5(2.2-13.8) Not Delayed 57(67.1) 28(32.9) 1 1 Delay to get treatment Delayed 166(88.8) 21(11.2) 2.3(1.3-4.1) 3.1(1.1-8.4) Not delayed 129(77.2) 38(28.8) 1 1 Adherence Poor adherence 232(89.6) 27(10.4) 4.36(2.4-7.8) 5(2-12) Good adherence 63(66.3) 32(33.7) 1 1 Disease recurrence Yes 88(93.6) 6(6.4) 3.75(1.55-9.0) 3.3(0.9-12.1) No 207(79.6) 53(20.4) 1 1 Comorbidity illness Yes 235(81.9) 52(18.1) 1.89(0.8-4.3) No 60(89.5) 7(10.5) 1 Alcohol consumption Yes 141(88.1) 19(11.9) 1.92(1-3.48) 2.3(0.9-5.8) No 154(79.4) 40(20.6) 1 1 Smoking habit Yes 77(91.7) 7(8.3) 2.62(1.1-6.0) No 218(80.7) 52(19.3) 1 Time from health care visit to diagnosis ≥30 days 209(81.6 47(18.4) 0.62(0.3-1.2) <30 days 86(87.8) 12(12.2) 1 Histologic type adenocarcinoma 279(84.5) 51(15.5) 2.73(1.1-6.7) Signet ring cell carcinoma 16(66.7) 8(33.3) 1 Consuming red meat before presented with advanced stage Yes 75(74.3) 26(25.7) 0.43(0.24-0.77) No 220(87) 33(13) 1 P value for Hosmer and Lemeshow Test = 0.632 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4489569","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":310146780,"identity":"a39ceb21-6b15-4836-825e-89b55971e6d7","order_by":0,"name":"Abebe Bekele Jibat","email":"","orcid":"","institution":"Tropical College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Abebe","middleName":"Bekele","lastName":"Jibat","suffix":""},{"id":310146781,"identity":"bd468e04-f6f9-4f71-affc-f095b5e56fff","order_by":1,"name":"Yonas Fissha","email":"","orcid":"","institution":"Dessie College of Health Science","correspondingAuthor":false,"prefix":"","firstName":"Yonas","middleName":"","lastName":"Fissha","suffix":""},{"id":310146782,"identity":"a28d486d-4a79-4fe5-9a27-379258e56105","order_by":2,"name":"Belachew Tegegne","email":"","orcid":"","institution":"Injibara University","correspondingAuthor":false,"prefix":"","firstName":"Belachew","middleName":"","lastName":"Tegegne","suffix":""},{"id":310146783,"identity":"0baf4c37-bafc-4149-86b1-48521e0642ad","order_by":3,"name":"Afework Edmealem","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIie2PMUvDQBTHXwncFJv1siRf4UqhFRz8KncELkuKTqWDYKCQqTin36IuTg5XAjeVjkV4g4WCc0SQOijmuiglp7g53G+49x/+P+49AIfjP+Ip83IAM7cA0SEA+UEh/JvSjP6XYtOOFZH/pgSFp+nzvYy6m2pZ88lderNZMajHFQRx3qpQTWRYPmX9EGVC+QpHc8xYp1xXEBaWxR5nA/TVRCyaJhUFjkzwTooKmG43Yh28GuV6gRcve/GBKTPKe6OcWxSmfdIoGW+ahIoc+UHpmF8s5/c0Gb6VSvbmKAenXKMJl8vZOvWp5q1KpL0dq1USdzHZPdRXaMLtdj8+i4Kpstzfhun6f+g7HA6H44hPpEtrUoxIohYAAAAASUVORK5CYII=","orcid":"","institution":"Debre Markos University","correspondingAuthor":true,"prefix":"","firstName":"Afework","middleName":"","lastName":"Edmealem","suffix":""}],"badges":[],"createdAt":"2024-05-28 09:03:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4489569/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4489569/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57792403,"identity":"0f6ca584-eacc-46aa-b83f-fe3d79b6e355","added_by":"auto","created_at":"2024-06-05 18:00:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":949985,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4489569/v1/d919d967-1314-4954-af22-c81d7b63d8b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Colorectal cancer prognosed to advanced stage and its associated factors in oncologic unit of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia, 2023","fulltext":[{"header":"Key messages","content":"\u003cp\u003e\u003cstrong\u003eWhat is known about colorectal cancer?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWorldwide, colorectal cancer is the fourth disease that kills people. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe incidence of colorectal cancer is increasing alarmingly.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe magnitude of colorectal cancer which is prognosed to advanced stage is high.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSeeking treatment lately, having poor treatment adherence, living in rural areas and old age are factors that hasten the prognosis of colorectal cancer to advanced stage.\u003c/li\u003e\n \u003cli\u003eOur study motivates health care providers and stake holders to delay the prognosis of colorectal cancer to its advance stage. \u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eGlobally, the prevalence of Colo-Rectal Cancer (CRC) has alarmingly increased from time to time. It is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related deaths in the world, and its burden is expected to increase by 60% to more than 2.2\u0026nbsp;million new cases and 1.1\u0026nbsp;million deaths by 2030[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nowadays, non-communicable diseases like cancer are one of the most common causes of death in African countries, along with infectious diseases, traffic accidents, and other non-communicable disorders[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CRC is the most common malignancy among gastrointestinal disorders globally and its progression to an advanced stage make its prognosis more difficult and further magnifies the health burden associated with the disease.\u003c/p\u003e \u003cp\u003eColorectal cancer prognosed to advanced stage had a chance to have permanent stoma. A permanent stoma has a devastating impact on the patient's quality of life. According to a study, patients who have stoma had worse general health, more symptoms, less functionality, and a lower overall quality of life than non-stoma patients. Not only these, there were also notable impacts in terms of sexual health, social interaction, self-image, and psychiatric morbidity[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the study conducted in Iran, the cost and expenses of colorectal cancer patients were a main health expenditure[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Being unproductive due to disability, and premature death are the other burdens [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eColorectal cancer mortality and prognosis to advanced stage increased over time in different countries due to a variety of factors such as population growth and aging, as well as engaging in risky behaviors and lifestyles [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A 6 years of follow-up study in Ethiopia found that the overall mortality incidence of patients with colorectal patients was 80.05% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Understanding the prognosis of colorectal cancer to an advanced stage and its associated factors are highly significant due to the high burden of the disease. Determining the prognostic factors of the disease will be helpful to understand which population are risky to advanced stage and develop efficient prevention and management strategies. Additionally, knowing factors can help oncologists and other health care professionals to make informed decisions concerning patient management, including treatment options and patient counseling.\u003c/p\u003e \u003cp\u003eAlthough curative treatment for colorectal cancer with advanced stage is ineffective and scarce, there are a few studies that addressed magnitude of colorectal cancer prognosed to advanced stage and factors associated it. Particularly, factors such as chat chewing, which is highly prevalent in the study area, physical activity and treatment adherence level were not addressed in the previous studies. Hence, this study aimed to assess the magnitude of CRC prognosed to advanced stages of presentation and its associated factors among patients at Dessie Comprehensive Specialized Hospital in Northeast Ethiopia.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003e\u003cstrong\u003eStudy area and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was done in the oncologic unit of Dessie Comprehensive Specialized Hospital (DCSH) from March 20, 2018 to March 20, 2023. Currently, it has over 303 administrative and over 562 health workers. It also provides preventive, curative, and rehabilitative services, including oncology services, for over 8 million people. Dessie\u0026apos;s comprehensive specialized hospital oncology unit provides treatment for about 1600 cancer patients, among whom 392 were diagnosed with CRC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHospital-based cross-sectional study was employed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source population were all patients with colorectal cancer who were attending their treatment in the oncologic unit of Dessie Comprehensive Specialized Hospital.\u0026nbsp;The study population were all patients with colorectal cancer who attended their treatment follow-up in the oncologic unit of Dessie Comprehensive Specialized Hospital from March 20, 2018 to March 20, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients with colorectal cancer who were attending their treatment follow-up from March 20,2018 to March 20, 2023, in the oncologic unit of Dessie Comprehensive specialized hospital were included in the study. The study excluded\u0026nbsp;charts which were not recorded the status of outcome variable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size for the first objective was determined using a single population proportion formula by considering the following assumptions: proportion of advanced stage presentation of CRC = 83.1%[10], 95% confidence level, and margin of error = 4%.\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAb0AAACxCAYAAABQm2OLAAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAADsMAAA7DAcdvqGQAABXFSURBVHhe7d3daxTXA8bxk999Y6O9klZEvdOiaIwSVFDQ+IYoGGIVxAvRRkGoFK1Rr1SSaNuL4ksEBZHWFxpBivEVFBoJ9Q0itViokaLSq6i1/QPy2+fsnHSczM5uNrvZTc73A+vszM7Ozsyu59lz5pxNRV+KAQDAA/8LpgAAjHqEHgDAG4QeAMAbhB4AwBuEHgDAG4QeAMAbhB4AwBuEHgDAG4QeAMAbhB4AwBuEHgDAG4QeAMAbhB4AwBuEHgDAG4QeAMAbhB4AwBuEXhm5evWqmT17tqmoqDBjx441hw8fDh4BABSCV6F39+5ds23bNvP8+fNgSWHt3bvX3rLROnGB9uTJE7NkyRKjP2bf3NxsWlpagkfy9/r1a/taJ0+eDJYUnzvPjx8/DpYAQJlIFbBeOH/+fF9DQ0Nfb2+vndehx92qqqrs4/nQc3t6euz97u7uvsbGRrtM262rq+t/TLQ/ejyT1tZWu47T2dkZu6/ahjumKC2vrq62z43StidPnhzMDU4u+6KpjlnnAQDKhRehpwJYBXw4HFRQt7W1BXN9fR0dHXaZpvnQ8xQwjgp8t30V/C4UwhTC4WBztF7c8qamJruPjsJH29V24ig4dQvTc7Rv2tfwtgYrl33RcecbrABQDF6Engr+aOCo4A/XSuLCQ0GmQluFu6upaTtxIZMpwBw9P2774aAUredqR9F91nFEg0rrx4WXO6Zw7VK0bT3mamv5ynVfdHz5fpEAgELz4pre7du3zcqVK4O5tOvXr5tx48bZ+9u3b7fTY8eO2anout+KFSvMli1bVIqbNWvW2OtUFy5cMHv27AnWStN1s5s3b5rFixcHS96nx+/fv282btwYLElbvny5efjwYf81Rl17u3HjhpkxY4btzHLixAm7PJtUMAf3/vP06VO7fNKkScGStOnTp/cfdzFE96W+vt5cuXIlmAOA0vIi9BQklZWVwdz7FGIXL14033///Xth0N7eblI1JbNr1y47v3XrVruddevW2eAI07panilM9u/fbx9XyMX566+/7FSvpYAN35Kot6fCVMEc1dXVlVe4KWwz3ZYuXRqsNVDSvhSr4xAADJbXQxZUGKv21tTUFBtINTU1wb001WIWLFgQzP3nyJEjZv369cHc+7R9OX78uJ0WgguhHTt2mK+++qo/mAshGrrhm2rHUcXcFwAoNK9DT4Gk8XA7d+4MlqQLcefZs2fBvXRA9vT0mBcvXgRL0ly3/Hnz5tlpWDECT1wIaf9KHTLltC8AkI0XoVdXV2devXoVzKVp3JqaK8+cOdPfDBgeyzZt2jQbchpzpmtyrkao64Oad012ek5ck56aTR88eNAfeHqOmjjjjB8/PriX7N27d3aaS3NhbW3te6Edde3aNTvNdyzdYPYlel0RAEom9S191IvrvamejTr8uJvjuuWrB6d6PaonpJ6nHomuh2VcD0mJ2756N4a53qG5iI6NyyZT703X6zJ6G4zB7IvOVVKvVgAYThX6J1VwjWqqjeiXTu7du1fQnouqzV2+fNlO86GOIZs2bcpYAxwq/fLLmDFjStbsqFqyji+pxgkAw8mL5k01rx08eNBs2LDBNjMWippGV69eHcwNjoJS+1WswBNdq/zxxx9tz8rhpvOsc37p0qVgCQCUXsFDT9eI1DlEHUI07kwF7pQpU+y8pqX6PUaFy759++zwgVyuQ2WjbaiLfj6hpRqYOsQUuoNLlGq16nGp3/Qc7t/e1HlubW0dMLwDAEqpKM2bCgR176+urjabN2+2Y9xUEM6fP980NDTk3RwIAMBQFKV50/XW05/JUeCJuvSrF6V+uSQbXety47+y3ZIGTAMAEFbUa3oTJ04M7v3n7du3wb3M1CSnCmgut7gB02FxQcmtNDcAKLVR35ElLii5leYGAKVWlqFH8yYAoBjKMvQK2bwJAIBTlNBzQwL+/PNPO3XcGLlCjpUDACBXRQk9DVUQ/T04Nz5Mv12pvx0nc+bMsVMAAIZTUULvzZs3/c2PbsiCBmK7ZfwsVZrGLurLQNxgeQ3sD1+z1NhGrRutJWvwv4aGaF39KICeBwCIV5bX9HygEDt69Kg5cOBA7F8h0O9luhqz6Jdf9AUi+lNq+rUV/a6ovkw0NzeblpaW4BEAQJQXPzhdbhRaauLN9gPYrpYX7qyj5mL9lFvcT5ipljdhwoSi/p4nAIxk1PRK4PTp07Z2Fg08NXeGmyr1255Ra9eutddKo82cavok8AAgGaFXAvpDtCtXrgzm0nRdb9WqVaa+vt42VarTj4IvSkGpn3O7detWsCRdI1TTpwJP4QcAiEfolYD+YntlZWUwl9be3m6n7m/f6Tqf/ipFJvorDaImTW1vxowZtoaoWiAAIB6hV0ZqamqCe7lTSKpmGL4BAOIRemWEoRwAUFyEXgnomtyrV6+CubTa2lrT09PT/7cG1alFIagOK3Hj+NRpBQAwOIReCSxatMj8/PPPwVya/t5gU1OT7YiiDixdXV1my5YtNgjV29NRCOoaXj5NoQDgO8bplYBqbhqykG2cXhx1XNFvmsaN0wMAJKOmVwLqmXnw4MEBv66SjQala7iDfsUFADB41PRKSNftzp07Z7788svYnyIL07U+NYkq8AZbOwQApBF6AABv0LwJAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPAGoQcA8AahBwDwBqEHAPDGqA29x48fm5MnTwZzpXf37t2i78/Vq1fN2LFjg7nR4fXr1/a8PX/+PFjiBx2zPjMACmtUht6FCxfMjRs3zNatW4MlaSo49+7da9atWxcsyc3hw4fNlClTTEVFhZ0qXJLo9ZcuXWrX11TmzZtnPvnkE7Nt2zY7n0QFvXu+Xk8BnsQ9/vLlSzsVHau2E6XjVzBq27oft06U1tF+6zlJ50CF9OzZs+06eg2dt0zcOUoq2HVc27dvt+/jpEmTgqVpuTw/E23X7aeOJddt6Jjd50A3nZPo+dN8+BxrHzO9f0mfRx3ztWvX7HECKKC+Uaazs7Ovrq4umPtPT09PX0dHR9/kyZNjH8+kqampr7q62j7fzeu0nT9/3s6H9fb22nX1GnrcPSestbXVbiOJnqvjkIaGhsT91Wtof/S63d3ddn09X8saGxuDtdL0mDsWt6+5nAutp23pOaJ90/Z1Ph29ttbRMt203UznSY/rPOhxd5xRei2dR/eaYbk8PxPtp57X1tZm5925yrYdvWZVVVX/etovdz7D9N5q21pP+6jn6Diicv086jGtB6AwRl3oqRBJKiRUiORS0IsLlOj2VNCpMAsXyLqvZeFwiOPWy7Ww1murcE2ibamwdYWwpip4w/vhCvfwsbgAiAsmx60T3V+dQxXqTnQbem09L7xOmLYXt11H5zHpy0G252eiz0c0qHS+4oIpTOtEPzduHxx9XqL7474kZZLt86jtRT9rAPJX8OZN12Tjri2piUv3dSt2U422nyp4zPLly4MlQ3Pr1i07raystFOnvr7evH371jx9+jRYYsyGDRtMTU2NOX78uBk3blywdCA9tmTJEnP06NFgSbIrV66YPXv2BHP5u3z5sp2Gz8306dNNqkA1Z86cCZYM9PHHH9vpuXPn7NR59uyZmTZtWjBnBjTRvXv3zk5TBbqdDoY+QydOnDDLli0LlhSGmhn1+dD7F7Zw4UK7PKmZMxWK5v79++81Vb569cqkAjSYM7YJVs3YYfqcpAIzmBs8t7329nY7BTA0BQ+9f//91xYg+s+u8JswYYL56aefbOglXc9SgeOulSTd3DWyON98801ehWwmruCOqq2ttdOuri47VdjqGuKsWbNyuqY1c+ZMc/HiRVu4J9F2FyxYYMMpE11Dmj9/vrl586YNRxXOq1evNp9//rn59ttvg7WMfb1wAe0oqLXvmSikU7U1G0IKNu2z3seDBw/GfrnQ/mi/VdCnan+J+57J6dOn7TQaIEPljjMc1jJ16lQ7de9nnJ07d9qpAlLX9vR51ZeF69ev2+VRCkedJ52vY8eOBUvzo/foyJEjwRyAoSh46KmQU6EuKihUUKrw2rJliw3CTLROquaZ9ZapkJGHDx+aDz/8MJgbOgW2RAtDfcOXMWPG2KmrRX366ad2/3p7e+1x7969O7bHptvu77//bqdxVLCqhqntqADNFJAKpe7ubvPgwQPzyy+/2PDTc/TFwxXUTlINNMmuXbtMW1ubDU6FqoJYrxFHNd7PPvvMvhcKhWzBHufRo0e2Blos0Zp7LnTudEw6/hUrVpgvvvjC/PDDD7HnVIE4Y8YM+0VBtcOh1tJUg9T7Ge00A2Dwitp7M1OBUAxuuy5wC2Hx4sW2kGtpaenfvgLINQfOnTvXThU0KqQVBDpm3Q4cOGCXxX1Dd02GT548sdMo1RBVsOqmWqNqF9Hei2GuNqUQds3KWj/u/OfrxYsXtsan86FQyzT8QqGvArqxsdHWrPJp2tPzVLspN2rF0PE3NTXZAFSrQ1youy9wqunq/VCtO1uP3yQTJ06003BzOoD8lM2QBYVKuBkz0y2pebPQFBqXLl2yBbCaENVdXQWyrmep8HNhoxpstJDWc7VMATBYqlmFa7dv3rwJHkmm0NW+FZqa6VQ71X7du3fPBpkK8kzBp8DVtU0Fn8IhfB1sOBTjM6Nj2Lx5s22qPHTokOno6LDvra7PZqqB6f3QFyI5e/asnQIorbIJvUI0bxaDgk2vqddWoOh6ngq77777LljD2Gtlma6LFbOZbjAUVHH7qGVJ10FV2KuZbu3atXZeYe6u2Z06dcouy2T9+vV2+sEHH9jpcFGNNHzbtGmTXe6OM9pc7ebdtdo4zc3NNuBc7VnXM+/cuWM/C/oikIm+AOh1XQ0cQGmVTegNlev0cPv2bTstBgXAqlWrbPNWuBOH6w0YbcJSDSDu2tc///xjp+7a3nBQ5xYJNy+7+y4U4qhJT6KdetSMnHSNVnScqhEnNc3GUUhk+hKRC9VIwzf3HugLjPYn+hnRvJa7z1Ccv//+e8Dxupq+ez8z0edA10Hz5c79+PHj7RTAEKRqMAWXqgUMGEPlxisljaEbqlRhOWAMVpjGOunxVO0rdtxTqlYQO/ZL8xo3psfcoOaw8HY1rk20XrbXSdUSgiXDw50f7ZNeW/e1LEzz4f3WNBUIdl23vzofmtdxOHrPdY7c8WsdPc/NR7lxg+FtOO78xJ07J+n5SbRfep4bV6j3SfPh99ytE962W8+9/9o3PR4+V/ps6/xp21qmm86JbnH0uPvcuG3E0TZ1LgEMXcFDT/9BVTi4mwqGuGXF4ArCOK4gS9oPF1SuAHTPUYGjgisppFwB57atEMi0vh7TORlu4X3UceqLSLSw1b7peMPLdRzui4w7H67wd9yXGvd40vmKfh50C9PztCwcRGHZnp+Nwkn7qOcpdKKvo3mdn+gxat49T7foe6yADz+u/XThGuU+W+Fbpv8X2pdi/Z8BfFOhf1L/4UYNdTbR9bZCDVAvBl3f0djFpOY036nzTKqwt51GfKYmdfXe/eOPPwraGxfw1agLPdfLTuPWypF6PKr7v++FeTa6DqZelxobONhrgqOJrkdu3LixrL/EASPJqAk9dU0HRrtR9h0VGHajrqbnqManwbxxvSdLodz2Z6RQjU+/aKIhEz4177lf5KEJHCisURt6AABEjZpxegAAZEPoAQC8QegBALxB6AEAvEHoAQC8QegBALxB6AEAvEHoAQC8QegBALxB6AEAvEHoAQC8QegBALxB6AEAvEHoAQC8QegBALxB6BWJ/vjpyZMnzfPnz4MlpaX9OHz4sN0vAPAVoVcE+ivp27dvN1u3bjWTJk0KlqaXz54921RUVJgpU6aYu3fvBo8kU1DpL67reWPHjrVhmo0CTus72g/99fENGzbkFHwXLlywr6Vt7N27N1gKACOc/nI6Cqe3t7dv8uTJdhrW3d2tv1Df19bWZufPnz9v5zs7O+18Jm57jY2N9r62U1VV1dfa2hqsMZB7rbi3V69XXV0dzGXW1NTU/3q57CcAjASEXoEpnBQYUQquaNg0NDTY5Um0PYVOOEQVnFrW09MTLPmP1tN29VpxoSd1dXWJoRmlbSn8AGCko3mzgHTd7MSJE2bZsmXBkjQ1a6YCytTX1wdL0hYuXGiXJzVzqpkxFVJm3LhxwRJj5s6da6ft7e12GrZ//36zZ8+e99aPWrNmjWlpaQnmkumYUsFspk+fHiwBgJGL0Cug06dP2+m8efPs1Llx44adTps2zU6dqVOn2mlXV5edRikM3759a2bNmhUsSXMBdPv2bTt1rl69ah/LFlB6XW1XgZpE1/6+/vprc+zYsWAJAIxshF4BPXr0yFRVVQVzA1VWVgb3BmfMmDHBvcxUIzt79qztPJPN+PHj7fTXX3+10zgKPIX4gQMHbK1RgQoAIx2hV0Cq0dXU1ARzw2vbtm0518hcj1KFdBwF6Jw5c8zu3bvNRx99ZHtwvnz5MngUAEYuQm8U0PCEHTt2JF7HGwyF4rNnz9QLpv+WSw0SAModoTcM1BFFotfu3Hxtba2dRunaoJpLo9fuXMeXRYsW2alqZCtWrLA1Mndz1xF1X6EIACD0Ckrh5sImTB1L1AMyGl6a1/Jox5cwDUq/f//+ewPKXVhqsLl0dnYOuFVXV/c/5tZz3LbCA+cBwAsat4DC0Ng3ndLwmDonFT72MQ1KFzfWTssdt054DJ22pcHoGq8nWifb4HTRWLxMb290XwDAF9T0CsjVqJ4+fWqnYarNdXR0mH379tkmx1OnTtlaWLSWp+bMcG9NXae7c+eO7Vyi523atMk0NzebXbt2BWsM3m+//WZfZ/HixcESAPBDhZIvuI8CUC9KBcqhQ4eCJeVHTaYzZ84cUnACwEhE6BWYrpctXbrUXLx4sSyvmenXYTZv3mwePHgQLAEAf9C8WWBqjlTTpWp84c4n5UD7o7/QcP369WAJAPiFml6RKGD025i6zleo8XNDoWuC6gWq63jlsD8AUAqEHgDAGzRvAgC8QegBALxB6AEAvEHoAQC8QegBALxB6AEAPGHM/wGT2bwlIyyZ5AAAAABJRU5ErkJggg==\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eN =\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e337= 337+5% (non-retrieval rate) =354\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size for the second objective was calculated by using Epi info STAT Calc, but the largest sample size was obtained from the first objective. There for, after adding 5% non-retrieval rate the final sample size was 354.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total number of CRC patients in the DCSH oncology unit was identified from the registration book, and then, using simple random sampling techniques, the required sample size was selected by lottery method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tool\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were extracted using a pre-tested and structured data abstraction sheet adapted from different literatures. The abstraction sheet was developed in English and contains socio-demographic data, including age, sex, marital status, place of residence, insurance status, educational status, and clinicopathological characteristics of the patients, such as treatment modality, recurrence history of the disease, level of\u0026nbsp;Carcinoembryonic antigen\u0026nbsp;(CEA) and hemoglobin, and other variables traced from the patient\u0026rsquo;s medical record charts.\u0026nbsp;The data were accessed from April 21\u003csup\u003est\u003c/sup\u003e, 2023 till May 10, 2023. The authors accessed information that identified during the data collection period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable:\u0026nbsp;\u003c/strong\u003eColorectal cancer prognosed to advanced stage (Yes, no)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eSocio demographic and patient related factor\u003c/strong\u003e: \u0026nbsp;Age, Sex, Place of residence, Religion, Marital status, educational status, and ethnicity, and insurance status.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003epersonal and life style-related factors\u003c/strong\u003e: Cigarette smoking, Chat chewing and Alcohol consumption., red meat consumption, physical exercise, weight and height\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eClinicopathological and Treatment related factors\u003c/strong\u003e: \u0026nbsp;Treatment modality, patient delay, diagnosis delay, delay to seek treatment, treatment adherence level, recurrence history after treatment, histological type, histological grading, metastasis history, primary site of the tumor, base line CEA level, anemic status and history of comorbidities.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eColorectal cancer\u003c/strong\u003e: \u0026nbsp;is a disease in which cells in the colon or rectum grow out of control\u0026nbsp;[11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdvanced stage\u003c/strong\u003e: patients with colorectal cancer diagnosed to the disease stage of III and IV\u0026nbsp;[11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly-stage\u003c/strong\u003e: patients with colorectal cancer diagnosed to the disease stage of I and II \u0026nbsp;[12].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidity illness\u003c/strong\u003e: any disease which is listed in the Charlson comorbidity index other than colorectal cancer at diagnosis[13].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCarcinoembryonic antigen\u003c/strong\u003e: Tumor markers of gastrointestinal cancers especially colorectal cancer and classified as elevated (\u0026ge;5ng/ml) and not elevated if \u0026lt;5 ng/ml[14].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTime to visit health facilities\u003c/strong\u003e (symptom duration): the duration of time from perceiving of symptom for the first time up to health care visit and it is considered as delayed if a patient seeks health care visit more than or equal to 90 after the symptoms of CRC appeared\u0026nbsp;[15, 16].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTime to diagnosis\u003c/strong\u003e: the duration of time from initial health care visits up to the time when confirmed diagnosis is made, and considered as delayed if it is \u0026ge;30 days[15, 16].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis to treatment interval (DTI\u003c/strong\u003e): The time interval between confirmed colorectal cancer diagnosis up to the date of first treatment started, and considered as delayed if it is more than 30 days[15, 16]\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePoor-adherence\u003c/strong\u003e: A patient were considered poor-adherence if they said \u0026lsquo;Yes\u0026rsquo; for at most three questions\u0026nbsp;[17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to data collection, training was given to data collectors and supervisors on questionnaire content, methods of data collection, and ethical concerns. To improve the quality of data, pretest was done on five percent (5%) of questionnaires before two weeks of actual data collection.\u0026nbsp;After reviewing the result of the pretest, modification of the questionnaire was performed for clarity and completeness of the questionnaire. Continuous supervision of data gathering and daily checking of the collected data were performed by\u0026nbsp;supervisors and principal investigator.\u0026nbsp;After data collection, data verification was conducted visually and possible corrections were made by cross-checking the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were initially coded, checked, and entered in Epi-Data software version 4.6.1, and then exported to Statistical Product and Service Solutions (SPSS) software version 27.0 for cleaning and statistical analysis. Descriptive statistics such as frequency mean and standard deviation were carried out to see the distribution of the participants within the variables included in the study. After cross-tabulation of each explanatory variable with the outcome variable, a binary logistic regression analysis model was used. Model fitness was checked using the Hosmer and Lemeshow tests. Initially, bivariable logistic regression analysis was carried out to select variables for multivariable analysis. Variables with a P value less than 0.25 in the bivariable analysis were selected as candidates for the multivariable logistic regression analysis model. Multi-collinearity among the explanatory variables was checked using the variance inflation factor and tolerance rate. To identify significant factors, multivariable binary logistic regression was conducted using the backward LR method. The level of statistical significance was declared at a P-value less than 0.05. An adjusted odds ratio with its 95% CI was used to show the strength and direction of association between each explanatory variable and the outcome variable.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 354 respondents were involved. The median age of the participants was 56 years, with an interquartile range of 13. Two hundred sixty (73.4%) respondents were in the age groups of 50 and older. One hundred eighty-seven (52.8%) were males, and 308 (87%) respondents were from rural areas. One hundred eighty-nine respondents were Muslims in their religion, which accounts for 53.4%. From the total of the study participants, 289 (81.6%), 207 (76.3%), and 296 (83.6%) were married, unable to read and write, and did not have health insurance respectively (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLife style and personal-related characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the total of 354 respondents, more than half (54.8%) had no history of alcohol consumption. From the total number of study participants, 23.7% and 39.8% had histories of cigarette smoking and chat chewing respectively. Regarding the diet, 28.5% had a history of red meat consumption. One hundred eighty-two (51.4%) had a history of performing physical exercise daily during their treatment period, and of those respondents who performed physical exercise, the majority of them, 93.9% (n = 246), performed walking types of physical exercise (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinico - pathological characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the total respondents, 218 (61.6%) had an elevated level of carcinoembryonic antigen (CEA), and 18.9% had additional illnesses. One hundred fifty (42.4%) respondents had history of anemia during their treatment period. From all respondents, 330 (93.2%) of the patients presented with an adenocarcinoma histologic type. Regarding the delay, 76%, 72.3%, and 52.8% of the participants were delayed for visiting a health care facility, being diagnosed, and seeking treatment, respectively. Two hundred ninety-five (83.3%) metastasized to other sites than the primary site. Two hundred forty-two (68.4%) were treated with chemotherapy only (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary site of tumor and treatment adherence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the total number of respondents, 39.8% of the them had colon cancer, followed by rectal cancer (33.3%). The rest are colorectal, anorectal ad recto-sigmoid which accounts 15.82%, 9.32% and 1.69% respectively. Regarding adherence level, the majority of the respondents (73.2%) were found to have poor adherence status during their treatment period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMagnitude of colorectal cancer prognosed to advanced stage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo hundred ninety-five 295 (83.3%;\u0026nbsp;95% CI: 79.4% - 87.3%) patients had advanced disease (stage III or IV).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with colorectal cancer prognosed to advanced stage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn bivariable analysis, age, place of residence, insurance status, delayed visit to a health care facility, time from visit to diagnosis, diagnosis to treatment delay, comorbidity illness, recurrence of the disease, consuming red meat, smoking habit, alcohol habit, histological type, and adherence level were fitted at a P-value \u0026lt; 0.25. Age, place of residency, insurance status, delay to visit, diagnosis to treatment delay, and adherence level were significantly associated with the outcome variable at a p-value of \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRC patients who were 50 years of old and older were 6 times more likely to be prognosed to an advanced stage of the disease than patients who were under 50 years old (AOR = 6.1; 95% CI: 2.5\u0026ndash;14.9). CRC patients whose residency were rural were 6.6 times more likely develop an advanced stage than those in urban areas (AOR = 6.6, 95% CI: 2\u0026ndash;21). CRC patients without insurance coverage were 6.8 times more likely to be prognosed to an advanced stage than non-insurance users (AOR = 6.8; 95% CI: 2.3\u0026ndash;19.9). Similarly, those CRC patients who were delayed to visit health care facilities were 5.5 times more likely to be prognosed to an advanced stage than patients than who were not delayed (AOR = 5.5; 95% CI: 2.2\u0026ndash;13.8). Moreover, CRC patients who were delayed to get treatment were 3.1 times more likely to be prognosed to an advanced stage of the disease than those who were not delayed (AOR = 3.1; 95% CI: 1.1\u0026ndash;8.4). Most interestingly, CRC patients with poor treatment adherence were five times (AOR = 5; 95% CI: 2\u0026ndash;12) more likely to be prognosed to an advanced stage than those with good treatment adherence. (Table 5.)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eColorectal cancer is one of the most common causes of cancer morbidity and mortality worldwide. This study was aimed at assessing the magnitude of colorectal cancer prognosed to advanced stage and its associated factors among CRC patients in oncologic units of Dessie Comprehensive Specialized Hospital in Northeast Ethiopia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study revealed that 83.3% (95% CI: 79.4% - 87.3%) of CRC patients were presented at an advanced stage of the disease. This finding is in line with the study conducted in Amhara Region at Felege Hiwot Comprehensive Specialized Hospital and the University of Gondar Hospital, which is 83.1%\u0026nbsp;[10], and with the study conducted in Sokoto, Nigeria, which was 86.8%\u0026nbsp;[18]. However, it is higher than studies conducted in Addis Ababa's Tikur Anbessa specialized hospital, which is 62.7%[19]. Similarly, this study is higher than the study conducted in New York which (60.7%)\u0026nbsp;[20], Nottingham at 67%\u0026nbsp;[15], Korea at 23.1%\u0026nbsp;[21], and Stanford at 72%\u0026nbsp;[22]. This could be due to differences in socioeconomic status, accessibility of nearby health facilities, health policies of the respected countries, and patient-health care provider ratios in the study areas.\u003c/p\u003e\n\u003cp\u003eIn this study, aged respondents were more likely to be prognosed to advanced stages than those who were not aged. This finding is supported by the study conducted in Amhara region hospitals and in the United States\u0026nbsp;[10, 23, 24]. This could be due to the fact that as age increases, changes occur in the colon, such as mucosal changes, decreased motility, and reduced blood flow. Older adults are less likely to participate in regular screening programs for colorectal cancer, and older adults may have other health conditions and comorbidities that make it harder to detect symptoms of colorectal cancer in its early stages\u0026nbsp;[25].\u003c/p\u003e\n\u003cp\u003eColorectal cancer prognosed to advanced stage among rural residents compared to urban residents. The finding is similar to the study conducted in different countries like Tanzania and Nigeria\u0026nbsp;[18, 26, 27]. This could be due to probably low awareness of the warning signs of the disease, as most rural communities in Ethiopia are illiterate, inaccessible to health facilities, and have problems with transportation[28]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients who didn't have medical insurance were presented with advanced stage than those who were insured. This finding is supported by the studies conducted in different countries\u0026nbsp;[10, 24, 29]. The possible justification could be that health insurance coverage might solve the economic constraints of the patients and encourage them to visit health care facilities as early as possible if the signs and symptoms of the disease appear[30, 31].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients who delayed to visit a health care facility after the appearance of the first sign or symptom were presented with advanced stage than those who did not. This study is similar to studies conducted in Puerto Rico\u0026nbsp;[32], Botswana\u0026nbsp;[33], and Spain[34]\u0026nbsp;. This could be since if patients don’t visit health care facilities and their physicians as early as possible after the sign or symptom, the disease could metastasize and disseminate to different organs\u0026nbsp;[35].\u003c/p\u003e\n\u003cp\u003eSimilarly, in this study, patients who were delayed to seek treatment after being diagnosed were more likely to be prognosed to advanced stage than those who started their treatment early; this is supported by the studies conducted in Taiwan and in five different countries in the British Journal of Cancer\u0026nbsp;[16, 36]. The possible reasons for this could be fear and anxiety about cancer and the treatment process, which may cause patients to delay seeking treatment; misinformation about cancer and treatment options; financial barriers; and a lack of access to care. All these factors can cause patients to delay seeking treatment and finally present with an advanced stage of the disease.\u003c/p\u003e\n\u003cp\u003eAnother factor that contributed to this outcome was treatment adherence. CRC patients who had poor treatment adherence were more likely to be prognosed to advanced stage than patients with good treatment adherence. \u0026nbsp;This might be because of the toxicity associated with chemotherapy agents, which results in unwanted side effects such as fatigue, vomiting, and diarrhea. These side effects can lead to poor patient compliance and an interruption of treatment. Another reason could be a lack of awareness about the importance of adherence to treatment follow-up, and financial constraints[37].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the fact that the current study's method of data collection was a chart review, one weakness is that it failed to take the economic situation of the respondents which may have had an impact on the study's findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe current study revealed that magnitude of colorectal cancer prognosed to advanced-stage presentation was high. Being aged, rural residency, not medically insured, delay to visit health facility, delay to seek treatment after diagnosed and poor treatment adherence were significantly associated with prognosis of colorectal cancer to advanced stage presentation. Clients shall visit health care facilities and seek treatment early. Health care providers provide multidisciplinary care, giving more attention to the rural residents and aged patients, and educate all patients about the importance of treatment adherence during their follow up. Medical insurance should be expanded. It is appreciated to conduct a study on the time to prognosis of colorectal cancer to advanced stage.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR:\u0026nbsp;Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003eCEA:\u0026nbsp;Carcinoembryonic antigen\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCRC:\u0026nbsp;Colorectal Cancer\u003c/p\u003e\n\u003cp\u003eDCSH: Dessie Comprehensive and Specialized Hospital\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Product and Service Solutions\u003c/p\u003e\n\u003cp\u003eTNM: Tumor Size, Nodal involvement, Metastasis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was written with reference number TOM/Res/1216/2015 on February 5, 2023, from the Tropical College of Medicine ERC (Ethical Review Committee). The Ethical Review Committee waived written consent since this research used secondary data from patient’s chart. The individual patients had not been subjected to any harm as far as confidentiality is concerned. Moreover, no personal identifier was used on the data collection form. The data were accessed by a third person except the principal investigator and kept confidential. Omitting the names of the respondents from the questionnaire helps to assure the confidentiality of the information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e“Not applicable”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are within the manuscript and its Supporting Information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no any fund.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAB\u0026nbsp;\u003c/strong\u003econceived and designed the study, performed analysis and interpretation of data. \u003cstrong\u003eAE\u003c/strong\u003e advised and supervised the design conception, analysis, interpretation of data and made critical comments at each step of research.\u0026nbsp;\u003cstrong\u003eBT\u003c/strong\u003e and\u0026nbsp;\u003cstrong\u003eYF\u003c/strong\u003e drafted the manuscript. All authors read and approved the final Manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe, the authors, want to sincerely thank data collectors for their commitment. Additionally, we want to forward our deepest gratitude to Dessie Comprehensive Specialized Hospital Oncology Center employees for their strong support. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eArnold, M., et al., Global patterns and trends in colorectal cancer incidence and mortality. 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CA Cancer J Clin, 2017. 67(3): p. 177-193.\u003c/li\u003e\n \u003cli\u003eGong, G., et al., Determinants of delayed detection of cancers in Texas Counties in the United States of America. International Journal for Equity in Health, 2012. 11: p. 1-9.\u003c/li\u003e\n \u003cli\u003eWolf, A.M., et al., Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA: a cancer journal for clinicians, 2018. 68(4): p. 250-281.\u003c/li\u003e\n \u003cli\u003eAmin, M.B., et al., The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more \u0026quot;personalized\u0026quot; approach to cancer staging. CA Cancer J Clin, 2017. 67(2): p. 93-99.\u003c/li\u003e\n \u003cli\u003eOlsen, M., Cancer in Sub-Saharan Africa: The need for new paradigms in global health. 2015: Boston University Frederick S. Pardee Center for the Study of the Longer \u0026hellip;.\u003c/li\u003e\n \u003cli\u003eRogers, C.R., et al., Rural\u0026ndash;urban disparities in colorectal cancer survival and risk among men in Utah: A statewide population-based study. Cancer Causes \u0026amp; Control, 2020. 31: p. 241-253.\u003c/li\u003e\n \u003cli\u003eAskari, A., et al., The relationship between ethnicity, social deprivation and late presentation of colorectal cancer. Cancer epidemiology, 2017. 47: p. 88-93.\u003c/li\u003e\n \u003cli\u003eLoehrer, A.P., et al., Impact of health insurance expansion on the treatment of colorectal cancer. Journal of Clinical Oncology, 2016. 34(34): p. 4110.\u003c/li\u003e\n \u003cli\u003eZhang, Y., et al., Effects of health insurance on tumor stage, treatment, and survival in large cohorts of patients with breast and colorectal cancer. Journal of Health Care for the Poor and Underserved, 2015. 26(4): p. 1336-1358.\u003c/li\u003e\n \u003cli\u003eOrtiz-Ortiz, K.J., et al., Factors associated with late stage at diagnosis among Puerto Rico\u0026rsquo;s government health plan colorectal cancer patients: a cross-sectional study. BMC Health Services Research, 2016. 16(1): p. 344.\u003c/li\u003e\n \u003cli\u003eBhatia, R.K., et al., Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol, 2018. 4: p. 1-13.\u003c/li\u003e\n \u003cli\u003eZarcos-Pedrinaci, I., et al., Factors Associated with Prolonged Patient-Attributable Delay in the Diagnosis of Colorectal Cancer. Cancer Res Treat, 2018. 50(4): p. 1270-1280.\u003c/li\u003e\n \u003cli\u003eLeake, I., Understanding the routes of metastasis in colorectal cancer. Nature Reviews Gastroenterology \u0026amp; Hepatology, 2014. 11(5): p. 270-270.\u003c/li\u003e\n \u003cli\u003eT\u0026oslash;rring, M.L., et al., Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries. British journal of cancer, 2017. 117(6): p. 888-897.\u003c/li\u003e\n \u003cli\u003eStephens, K. and B.N. Fahy, Adherence to surveillance colonoscopy guidelines in patients following curative-intent colorectal cancer resection. Cancer Treatment and Research Communications, 2021. 29: p. 100479.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Socio-demographic characteristics of colorectal cancer patients in Dessie comprehensive specialized hospitals in Dessie, Northeast Ethiopia, 2023 (N - 354)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eAmhara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e87.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eOromo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eTigre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e53.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePlace of residence\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMedical insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e16.4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.246119733924616%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.485587583148558%\" valign=\"top\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.93791574279379%\" valign=\"top\"\u003e\n \u003cp\u003e83.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"1.3303769401330376%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" valign=\"top\"\u003e\n \u003cp\u003eEducational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eUnable to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.754716981132077%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eAble to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.754716981132077%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eGrade 1-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.754716981132077%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eGrade 9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.754716981132077%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.08805031446541%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.830188679245282%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.32704402515723%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81132075471698%\" valign=\"top\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.9433962264150944%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2:\u0026nbsp;Life style and personal characteristics of colorectal cancer patients of Dessie comprehensive specialized hospital Northeast Ethiopia Dessie Ethiopia, 2023 (N - 354)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol consumptions (before diagnosed with advanced stage)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e54.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCigarette smoking (before diagnosed with advanced stage)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eChat chewing (before diagnosed with advanced stage)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e60.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRed meat and white meat consumptions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e71.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eFrequency of physical exercise during treatment period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e51.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eWeekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTypes of physical exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eWalking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e93.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eAerobic activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eStretching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGot counselling about physical exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e78.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23076923076923%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\" valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.192307692307693%\" valign=\"top\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eNormal weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e63.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eOver weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.586206896551722%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.206896551724135%\" valign=\"top\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3: \u0026nbsp;Clinico-pathological characteristics of colorectal cancer patients in Dessie comprehensive specialized Hospitals Dessie Northeast Ethiopia (N = 354)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCEA level(n=354)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;5ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;5ng/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eComorbidity illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;81.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eTypes of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; comorbidities (N = 67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;37.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e41.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAnemic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHistological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 93.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eSignet ring cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHistologic grading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eDifferentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eModerately differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003ePoorly Differentiated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCRC recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDuration of time between first symptom up to health care visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;3months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;3months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDiagnosis duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;1month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDiagnosis to treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;1month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;1month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMetastasis history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Type of intervention given\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eChemotherapy only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 68.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eSurgery and chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eSurgery, chemotherapy and Radiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.42105263157895%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eType of chemotherapy regimen taken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003eOxaliplatin +5fu (Folfox)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eOxaliplatin + Capecitabine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eIrinotecan +5fu (Folfree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003eCapecitabine po only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5. Factors associated with colorectal cancer prognosed to advanced stage (N=354)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"666\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.972972972972972%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRC prognosed to advanced stage\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.94117647058823%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.05882352941177%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;50years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e242(93.1) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e18(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e10.4(5.5-19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e6.1(2.5-14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e53(56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e41(43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePlace of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e266(86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e42 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e3.7(1.8-7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e6.6(2-21)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e29(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e17(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eInsurance status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003ePaid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e255(86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e41(13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e2.8(1.5-5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e6.8(2.3-19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eFree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e40(69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e18(31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDelay to visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eDelayed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e238(88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e31(11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e3.7(2-6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e5.5(2.2-13.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNot Delayed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e57(67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e28(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDelay to get treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eDelayed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e166(88.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e21(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e2.3(1.3-4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e3.1(1.1-8.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNot delayed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e129(77.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e38(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAdherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003ePoor adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e232(89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e27(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e4.36(2.4-7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e5(2-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eGood adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e63(66.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e32(33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDisease recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e88(93.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e6(6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e3.75(1.55-9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e3.3(0.9-12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e207(79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e53(20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eComorbidity illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e235(81.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e52(18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e1.89(0.8-4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e60(89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e7(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e141(88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e19(11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e1.92(1-3.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e2.3(0.9-5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e154(79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e40(20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSmoking habit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e77(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e7(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e2.62(1.1-6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e218(80.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e52(19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Time from health care visit to diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e209(81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e47(18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.62(0.3-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e86(87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e12(12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Histologic type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eadenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e279(84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e51(15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e2.73(1.1-6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eSignet ring cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e16(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e8(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.825825825825827%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eConsuming red meat before presented with advanced stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.162162162162161%\" valign=\"top\"\u003e\n \u003cp\u003e75(74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.81081081081081%\" valign=\"top\"\u003e\n \u003cp\u003e26(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.26726726726727%\" valign=\"top\"\u003e\n \u003cp\u003e0.43(0.24-0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.966966966966968%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.39676113360324%\" valign=\"top\"\u003e\n \u003cp\u003e220(87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.574898785425102%\" valign=\"top\"\u003e\n \u003cp\u003e33(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.279352226720647%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.874493927125506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eP value for Hosmer and Lemeshow Test = 0.632\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prognosed to advanced stage, Colorectal cancer, Ethiopia ","lastPublishedDoi":"10.21203/rs.3.rs-4489569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4489569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eThe progression of colorectal cancer to an advanced stage makes its prognosis more difficult and further magnifies the health burden associated with the disease. In spite of this fact, the magnitude of colorectal cancer, which is prognosed at an advanced stage, and the associated factors are not well studied in Northeast Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A hospital-based cross-sectional study was conducted among 354 selected patients from March 20, 2018 to March 20, 2023, using the lottery method. Data collectors collected data by reviewing a medical chart using a data abstraction chart. Descriptive statistics and binary logistic regression were applied. Variables with P \u0026lt; 0.25 in bivariable analysis were candidates for multivariable analysis. Variables whose P value is less than 0.05 in multivariable analysis were considered as statistically associated factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e The magnitude of colorectal cancer case that were prognosed to at an advanced stage was 83.3%. Being aged (AOR = 6.1; 95% CI: 2.5–14.9), living at rural area (AOR = 6.6, 95% CI: (2–21)), not medically insured (AOR = 6.8; 95% CI: 2.3–19.9), delayed to visit a health facility (AOR = 5.5; 95% CI: (2.2–13.8)), delayed to seek treatment after being diagnosed (AOR = 3.1; 95% CI: (1.1–8.4).), and poor adherence to treatment (AOR = 6.9; 95% CI: (2.1-22.6) were factors associated with the prognosis of colorectal cancer to advanced stage presentation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn this study, magnitude of colorectal cancer prognosed to advanced stage was high. Being aged, rural residency, not medically insured, delay in health facility visit, delay in seeking treatment after diagnosed and poor adherence to treatment were significantly associated with prognosis of colorectal cancer to advanced stage presentation. Especial follow up of the rural community, expanding medical insurance, and improving treatment adherence are strategies that delay the prognosis of colorectal cancer to advanced stage.\u003c/p\u003e","manuscriptTitle":"Colorectal cancer prognosed to advanced stage and its associated factors in oncologic unit of Dessie Comprehensive Specialized Hospital, Northeast Ethiopia, 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-05 17:52:41","doi":"10.21203/rs.3.rs-4489569/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7f632fe-eeb1-4327-91ce-69dd2392f884","owner":[],"postedDate":"June 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-28T01:52:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-05 17:52:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4489569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4489569","identity":"rs-4489569","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}