The contribution of body mass index to appraisal delay in colorectal cancer diagnosis: a structural equation modelling study

BACKGROUND: Appraisal delay (AD) refers to the time interval between onset of symptoms and the date a patient first seeks healthcare. Because studies have shown that individuals who are overweight or obese may delay or avoid seeking healthcare due to stigma, this study aims to investigate the role that weight plays in AD among symptomatic individuals subsequently diagnosed with colorectal cancer (CRC). METHODS: Structural equation modelling tested the relationship between AD, body mass index (BMI), financial barriers, cognitive barriers, and reported symptoms among 179 newly diagnosed CRC patients in two U.S. healthcare systems. RESULTS: BMI was directly and significantly related to AD (β=0.10; P=0.044) and to cognitive barriers (β=0.24; P=0.005). Cognitive barriers were direct and significant predictors of increased AD (β=0.32; P=0.000). Symptom experience and financial barriers were mediated through cognitive barriers. CONCLUSIONS: Model results support the hypothesis that increased BMI is significantly and directly associated with increased AD and key cognitive barriers relevant to care-seeking behaviour.