Abstract
Abstract
Background
Cancer patients often have pre-existing comorbidities, which can influence timeliness of cancer diagnosis. We examined symptoms, investigations and emergency presentation (EP) risk among colorectal cancer (CRC) patients by comorbidity status.
Methods
Using linked cancer registration, primary care and hospital records of 4836 CRC patients (2011–2015), and multivariate quantile and logistic regression, we examined variations in specialist investigations, diagnostic intervals and EP risk.
Results
Among colon cancer patients, 46% had at least one pre-existing hospital-recorded comorbidity, most frequently cardiovascular disease (CVD, 18%). Comorbid versus non-comorbid cancer patients more frequently had records of anaemia (43% vs 38%), less frequently rectal bleeding/change in bowel habit (20% vs 27%), and longer intervals from symptom-to-first relevant test (median 136 vs 74 days). Comorbid patients were less likely investigated with colonoscopy/sigmoidoscopy, independently of symptoms (adjusted OR = 0.7[0.6, 0.9] for Charlson comorbidity score 1–2 and OR = 0.5 [0.4–0.7] for score 3+ versus 0. EP risk increased with comorbidity score 0, 1, 2, 3+: 23%, 35%, 33%, 47%; adjusted OR = 1.8 [1.4, 2.2]; 1.7 [1.3, 2.3]; 3.0 [2.3, 4.0]) and for patients with CVD (adjusted OR = 2.0 [1.5, 2.5]).
Conclusions
Comorbid individuals with as-yet-undiagnosed CRC often present with general rather than localising symptoms and are less likely promptly investigated with colonoscopy/sigmoidoscopy. Comorbidity is a risk factor for diagnostic delay and has potential, additionally to symptoms, as risk-stratifier for prioritising patients needing prompt assessment to reduce EP.
Funder
Cancer Research UK
Dutch Cancer Society
KWF Kankerbestrijding
International Alliance for Cancer Early Detection
Publisher
Springer Science and Business Media LLC
Reference66 articles.
1. UK Government. Department of Health and Social Care. Government announces plans for earlier diagnosis for cancer patients. Available at https://www.gov.uk/government/news/government-announces-plans-for-earlier-diagnosis-for-cancer-patients (Last accessed March 2020).
2. Salika T, Abel GA, Mendonca SC, von Wagner C, Renzi C, Herbert A, et al. Associations between diagnostic pathways and care experience in colorectal cancer: evidence from patient-reported data. Frontline Gastroenterol. 2018;9:241–8.
3. NCIN. Routes to diagnosis 2006–2016 workbook. PHE. Available at http://www.ncin.org.uk/publications/routes_to_diagnosis (Last accessed June 2020).
4. Hamilton W, Walter FM, Rubin G, Neal RD. Improving early diagnosis of symptomatic cancer. Nat Rev Clin Oncol. 2016;13:740.
5. Mowat C, Digby J, Strachan JA, McCann R, Hall C, Heather D, et al. Impact of introducing a faecal immunochemical test (FIT) for haemoglobin into primary care on the outcome of patients with new bowel symptoms: a prospective cohort study. BMJ Open Gastroenterol. 2019;6:e000293.