Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England

Renzi, C.; Lyratzopoulos, G.; Card, T.; Chu, T.P.C.; Macleod, U.; Rachet, B.

Abstract

Background: More than 20% of colorectal cancers are diagnosed following an emergency presentation. We aimed to examine pre-diagnostic primary-care consultations and related symptoms comparing patients diagnosed as emergencies with those diagnosed through non-emergency routes. Methods: Cohort study of colorectal cancers diagnosed in England 2005 and 2006 using cancer registration data individually linked to primary-care data (CPRD/GPRD), allowing a detailed analysis of clinical information referring to the 5-year pre-diagnostic period. Results: Emergency diagnosis occurred in 35% and 15% of the 1029 colon and 577 rectal cancers. 'Background' primary-care consultations (2-5 years before diagnosis) were similar for either group. In the year before diagnosis, > 95% of emergency and non-emergency presenters had consulted their doctor, but emergency presenters had less frequently relevant symptoms (colon cancer: 48% vs 71% (P < 0.001); rectal cancer: 49% vs 61% (P=0.043)). 'Alarm' symptoms were recorded less frequently in emergency presenters (e.g., rectal bleeding: 9 vs 24% (P=0.002)). However, about 1/5 of emergency presenters (18 and 23% for colon and rectal cancers) had 'alarm' symptoms the year before diagnosis. Conclusions: Emergency presenters have similar 'background' consultation history as non-emergency presenters. Their tumours seem associated with less typical symptoms, however opportunities for earlier diagnosis might be present in a fifth of them.

Citation

Renzi, C., Lyratzopoulos, G., Card, T., Chu, T., Macleod, U., & Rachet, B. (2016). Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England. The British Journal of Cancer, 115(7), 866-875. https://doi.org/10.1038/bjc.2016.250

• Journal Article Type: Article
• Acceptance Date: Jul 18, 2016
• Online Publication Date: Aug 18, 2016
• Publication Date: Sep 27, 2016
• Deposit Date: Jul 27, 2016
• Publicly Available Date: Aug 18, 2016
• Journal: British journal of cancer
• Print ISSN: 0007-0920
• Electronic ISSN: 1532-1827
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 115
• Issue: 7
• Pages: 866-875
• DOI: https://doi.org/10.1038/bjc.2016.250
• Keywords: Symptomatic presentations, Primary care, Emergency diagnosis, Colorectal cancer, Data-linkage study
• Public URL: https://hull-repository.worktribe.com/output/441826
• Publisher URL: http://www.nature.com/bjc/journal/vaop/ncurrent/abs/bjc2016250a.html
• Additional Information: Copy of article first published in: British journal of cancer, 2016, v.115, issue 7.
• Contract Date: Jul 27, 2016