Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study

Ewing, Marcela; Naredi, Peter; Zhang, Chenyang; Månsson, Jörgen

doi:10.3399/bjgp16x687985

Cited by 31 publications

(35 citation statements)

References 27 publications

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“…The rationale for standardized care pathways has been to improve identification of patients with a wellfounded suspicion of cancer. Our results confirm results from previous studies [13] that the most frequent symptom in patients subsequently diagnosed with rectal cancer was rectal bleeding. This symptom occurred in three-quarters of the patients.…”

Section: Discussionsupporting

confidence: 92%

Timely access to care in the treatment of rectal cancer and the effect on quality of life

et al. 2018

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Aim The aim of this study was to investigate if a delay in a patient's first contact with a healthcare professional, and any subsequent delay in diagnosis, affected selfassessed quality of life prior to start of treatment for rectal cancer.Method Questionnaires were administered when patients had been informed of the diagnosis and planned treatment. The primary end-point was self-assessed quality of life according to a seven-point Likert scale. The response variables were dichotomized and analysed by unadjusted and adjusted binary logistic regression.Results A reported duration of symptoms longer than 4 months was found to be associated with a lower quality of life than a reported duration of symptoms of less than 3 months. Furthermore, a reported period of longer than 2 months from first contact with a healthcare professional to a diagnosis was found to correlate with lower quality of life compared with a period shorter than 2 months. However, when adjusting for possible confounding variables the duration of symptoms and time to diagnosis were not found to affect self-assessed quality of life. Several variables were found to have significant influence in the statistical model, including sense of coherence, the presence of negative intrusive thoughts, comorbidity, depressed mood, male sex and comorbidity.Conclusion One conclusion of our study is that further efforts to shorten delay in rectal cancer care with the aim of improving quality of life may be futile. To improve the patient's quality of life at diagnosis other interventions should be considered, such as screening for depression and/or negative intrusive thoughts.Keywords Rectal cancer, quality of life, diagnostic delay, symptoms, health services accessibility What does this paper add to the literature? Improved survival rates in rectal cancer treatment have led to an increasing interest in quality of life. This study attempts to establish whether quality of life is affected by how long it takes from symptom onset to first contact with a healthcare professional and then before the diagnosis is confirmed.

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Section: Discussionsupporting

confidence: 92%

Timely access to care in the treatment of rectal cancer and the effect on quality of life

et al. 2018

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“…A previous study suggested that some symptoms, such as loss of appetite, weight loss, fatigue, and fever/flu presentations, were associated with a high‐lung cancer risk . Furthermore, some of the presented symptoms, such as jaundice, are likely to represent advanced colorectal cancer . A study based on the general population indicated that the incidences of these symptoms were not associated with disease stage .…”

Section: Discussionmentioning

confidence: 99%

“…17 Furthermore, some of the presented symptoms, such as jaundice, are likely to represent advanced colorectal cancer. 24 A study based on the general population indicated that the incidences of these symptoms were not associated with disease stage. 25 However, few studies have reported the relationship between the symptoms and physical signs of lung cancer and the stage of cancer, particularly for lung cancer.…”

Section: Discussionmentioning

confidence: 99%

What are the clinical symptoms and physical signs for non‐small cell lung cancer before diagnosis is made? A nation‐wide multicenter 10‐year retrospective study in China

et al. 2019

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Background Most lung cancer patients are diagnosed after the onset of symptoms. However, whether the symptoms of lung cancer were independently associated with the diagnosis of lung cancer is unknown, especially in the Chinese population. Methods We conducted a 10 years (2005‐2014) nationwide multicenter retrospective clinical epidemiology study of lung cancer patients diagnosed in China. As such, this study focused on nonsmall cell lung cancer (NSCLC). We calculated the odds ratios (ORs) for variables associated with the symptoms and physical signs using multivariate unconditional logistic regressions. Results A total of 7184 lung cancer patients were surveyed; finally, 6398 NSCLC patients with available information about their symptoms and physical signs were included in this analysis. The most common initial symptom and physical sign was chronic cough (4156, 65.0%), followed by sputum with blood (2110, 33.0%), chest pain (1146, 17.9%), shortness of breath (1090, 17.0%), neck and supraclavicular lymphadenectasis (629, 9.8%), weight loss (529, 8.3%), metastases pain (378, 5.9%), fatigue (307, 4.8%), fever (272, 4.3%), and dyspnea (270, 4.2%). Patients with squamous carcinoma and stage III disease were more likely to present with chronic cough ( P < 0.0001) and sputum with blood ( P < 0.0001) than patients with other pathological types and clinical stages, respectively. Metastases pain ( P < 0.0001) and neck and supraclavicular lymphadenectasis ( P = 0.0006) were more likely to occur in patients with nonsquamous carcinoma than in patients with other carcinomas. Additionally, patients with stage IV disease had a higher percentage of chest pain, shortness of breath, dyspnea, weight loss, and fatigue than patients with other stages of disease. In multivariable logistic analyses, compared with patients with adenocarcinoma, patients with squamous carcinoma were more likely to experience symptoms (OR = 2.885, 95% confidence interval [CI] 2.477‐3.359) but were less likely to present physical signs (OR = 0.844, 95% CI 0.721‐0.989). The odds of having both symptoms and physical signs were higher in patients with late‐stage disease than in those with early‐stage disease ( P < 0.0001). Conclusions The symptoms and physical signs of lung cancer were associated with the stage and pathological diagnosis of NSCLC. Patients with squamous carcinoma were more likely to develop symptoms, but not signs, than patients with adenocarcinoma. The more advanced the stage at diagnosis, the more likely that symptoms or physical signs are to develop. Further prospective cohort studies are needed to explore these results.

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“…15 Since then, English and Swedish case-control studies have reported that weight loss is associated with acute and chronic leukaemia and non-metastatic colorectal cancer. 35,36 For some cancer sites there have been no studies on the association with unexpected weight loss in primary care. Our analysis is the first to focus on the association between unexpected weight loss and cancer across all sites.…”

Section: Findings In Contextmentioning

confidence: 99%

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

et al. 2020

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Background We aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines. Methods This retrospective matched cohort study used cancer registry linked electronic health records from the UK’s Clinical Practice Research Datalink from between 2000 and 2014. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site and stage. Results In all, 63,973 patients had UWL recorded, of whom 1375 (2.2%) were diagnosed with cancer within 2 years (days-to-diagnosis: mean 181; median 80). Men with UWL (HR 3.28 (2.88–3.73)) and women (1.87 (1.68–2.08)) were more likely than comparators to be diagnosed with cancer within 3 months. The association was greatest in men aged ≥50 years and women ≥70 years. The commonest cancers were pancreas, cancer of unknown primary, gastro-oesophageal, lymphoma, hepatobiliary, lung, bowel and renal-tract. The majority were late-stage, but there was some evidence of association with stage II and stage III cancers. In the 3–24 months after presenting with UWL, cancer diagnosis was less likely than in comparators. Conclusion UWL recorded in primary care is associated with a broad range of cancer sites of early and late-stage.

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Identification of patients with non-metastatic colorectal cancer in primary care: a case-control study

Cited by 31 publications

References 27 publications

Timely access to care in the treatment of rectal cancer and the effect on quality of life

Timely access to care in the treatment of rectal cancer and the effect on quality of life

What are the clinical symptoms and physical signs for non‐small cell lung cancer before diagnosis is made? A nation‐wide multicenter 10‐year retrospective study in China

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

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