Diagnosing colorectal (bowel) cancer for people with pre-existing chronic conditions

A new study, entitled Do presenting symptoms, use of pre-diagnostic endoscopy and risk of emergency cancer diagnosis vary by comorbidity burden and type in patients with colorectal cancer? has just been published (online and in print) in relation to the COMORBID CanTest project.

What the study found

Most people diagnosed with cancer have pre-existing chronic conditions (also known as comorbidities), which might delay the diagnosis of cancer. To better understand which patient groups are at higher risk of delays and where along the diagnostic journey delays might occur, a collaborative research team, including three core CanTest members (Georgios Lyratzopoulos, Niek J. de Wit and Cristina Renzi) as well as Sara Benitez Majano and Bernard Rachet of the Inequalities in Cancer Outcomes Network (ICON) Group at the London School of Hygiene and Tropical Medicine, examined anonymised GP and hospital records of 4,836 patients with bowel (colorectal) cancer in England.

Patients with pre-existing comorbidities presented to their GP with somewhat different symptoms, compared to those without comorbidities: they more often had anaemia, rather than rectal bleeding or change in bowel habit. Comorbid patients were less likely to be promptly investigated with a bowel endoscopy, and the time to diagnosis was twice as long, compared to non-comorbid patients. Patients with pre-existing heart conditions had a particularly high risk of being diagnosed with cancer as an emergency.

Illustrations showing the difference in time intervals from presenting symptoms in primary care to diagnosis can be viewed here.

How the study findings can help improve clinical practice and future research

Closer interaction between GPs and specialists and use of multi-disciplinary rapid diagnostic centres might be particularly important for patients with chronic conditions, particularly those presenting with anaemia. Comorbidities, in addition to symptoms, are important for prioritizing which patients need immediate endoscopy to reduce emergency presentations. Non-invasive tests (FIT- Faecal Immunochemical Test or other tests) might be especially useful for patients with chronic conditions. The findings relate to a period when FIT was not as widely available, while nowadays doctors have greater opportunity to use this non-invasive test. Further research is necessary using more recent data, as emergency presentations and poorer cancer survival continue to present a problem for patients with chronic conditions. Targeted patient education campaigns might be useful for people with chronic conditions, as they might not always report all symptoms, especially if vague. The results can inform guidelines on referrals and diagnostic investigations to help diagnose cancer earlier.

The full article, published in the British Journal of Cancer, can be viewed here.

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