Effect of Chronic Comorbidities on Follow-up Colonoscopy After Positive Colorectal Cancer Screening Results: A Population-Based Cohort Study

Bhatia, Dominika; Sutradhar, Rinku; Paszat, Lawrence; Rabeneck, Linda; Singh, Simron; Tinmouth, Jill; Lipscombe, Lorraine L.

doi:10.14309/ajg.0000000000001742

Cited by 4 publications

(6 citation statements)

References 55 publications

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“…Consistent with earlier research, we found that high physical comorbidity burden was associated with prolonged diagnostic intervals, lower odds of fast-track referrals and endoscopy, and higher odds of emergency presentation . While patients with MHM have been found to have higher comorbidity, our study findings suggest that MHM and physical comorbidities are independently associated with timely cancer investigations.…”

Section: Discussionsupporting

confidence: 90%

“…IBS may provide an alternative explanation for cancer-delaying referrals in some patients, with longer symptom to diagnosis intervals and a higher emergency diagnosis risk, as observed in our study and previous studies. 8,27 Consistent with earlier research, we found that high physical comorbidity burden was associated with prolonged diagnostic intervals, 7,8 lower odds of fast-track referrals 29 and endoscopy, 3,19 and higher odds of emergency presentation. 19 While patients with MHM have been found to have higher comorbidity, 16 our study findings suggest that MHM and physical comorbidities are independently associated with timely cancer investigations.…”

Section: Interpretation In Contextsupporting

confidence: 89%

“…Previous research found that MHM was associated with premature cancer death . However, little was known about how MHM may be associated with the diagnostic process.…”

Section: Discussionmentioning

confidence: 98%

“…Previous research found that MHM was associated with premature cancer death. [1][2][3]6 However, little was known about how MHM may be associated with the diagnostic process. Findings from 1 UK study and 2 small Dutch studies 7,8,26,27 suggested longer diagnostic intervals for patients with MHM.…”

Section: Interpretation In Contextmentioning

confidence: 99%

“…Patients with preexisting mental health morbidity (MHM) are more likely to die prematurely from cancer. [1][2][3] Mental health conditions are among the most frequent morbidities in Western populations, with 1 in 4 adults self-reporting mental health problems 4 and 1 in 8 adults (13%) presenting symptoms of anxiety or depression to primary care. 5 MHM has been associated with advanced-stage cancer.…”

Section: Introductionmentioning

confidence: 99%

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Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England

et al. 2022

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ImportanceMental health morbidity (MHM) in patients presenting with possible cancer symptoms may be associated with prediagnostic care and time to cancer diagnosis.ObjectiveTo compare the length of intervals to cancer diagnosis by preexisting MHM status in patients who presented with symptoms of as-yet–undiagnosed colon cancer and evaluate their risk of emergency cancer diagnosis.Design, Setting, and ParticipantsThis cohort study was conducted using linked primary care data obtained from the population-based Clinical Practice Research Datalink, which includes primary care practices in England, linked to cancer registry and hospital data. Included participants were 3766 patients diagnosed with colon cancer between 2011 and 2015 presenting with cancer-relevant symptoms up to 24 months before their diagnosis. Data analysis was performed in January 2021 to April 2022.ExposuresMental health conditions recorded in primary care before cancer diagnosis, including anxiety, depression, schizophrenia, bipolar disorder, alcohol addiction, anorexia, and bulimia.Main Outcomes and MeasuresFast-track (also termed 2–week wait) specialist referral for investigations, time to colonoscopy and cancer diagnosis, and risk of emergency cancer diagnosis.ResultsAmong 3766 patients with colon cancer (median [IQR] age, 75 [65-82] years; 1911 [50.7%] women ), 623 patients [16.5%] had preexisting MHM recorded in primary care the year before cancer diagnosis, including 562 patients (14.9%) with preexisting anxiety or depression (accounting for 90.2% of patients with preexisting MHM) and 61 patients (1.6%) with other MHM; 3143 patients (83.5%) did not have MHM. Patients with MHM had records of red-flag symptoms or signs (ie, rectal bleeding, change in bowel habit, or anemia) in the 24 months before cancer diagnosis in a smaller proportion compared with patients without MHM (308 patients [49.4%] vs 1807 patients [57.5%]; P &lt; .001). Even when red-flag symptoms were recorded, patients with MHM had lower odds of fast-track specialist referral (adjusted odds ratio [OR] = 0.72; 95% CI, 0.55-0.94; P = .01). Among 2115 patients with red-flag symptoms or signs, 308 patients with MHM experienced a more than 2-fold longer median (IQR) time to cancer diagnosis (326 [75-552] days vs 133 [47-422] days) and higher odds of emergency diagnosis (90 patients [29.2%] vs 327 patients [18.1%]; adjusted OR = 1.63; 95% CI, 1.23-2.24; P &lt; .001) compared with 1807 patients without MHM.Conclusions and RelevanceThis study found that patients with MHM experienced large and prognostically consequential disparities in diagnostic care before a colon cancer diagnosis. These findings suggest that appropriate pathways and follow-up strategies after symptomatic presentation are needed for earlier cancer diagnoses and improved health outcomes in this large patient group.

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Section: Discussionsupporting

confidence: 90%

Section: Interpretation In Contextsupporting

confidence: 89%

“…Previous research found that MHM was associated with premature cancer death . However, little was known about how MHM may be associated with the diagnostic process.…”

Section: Discussionmentioning

confidence: 98%

Section: Interpretation In Contextmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England

et al. 2022

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The double burden of severe mental illness and cancer: a population-based study on colorectal cancer care pathways from screening to end-of-life care

Seppänen,

Daniel,

Houzard

et al. 2024

Epidemiol Psychiatr Sci

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Aims Cancer is one of the main causes of death in persons with severe mental illness (SMI). Although their cancer incidence is similar, or sometimes even potentially lower compared to the general population, their cancer mortality remains higher. The role of healthcare provision and care equity in this mortality is increasingly being addressed in research, but available studies are limited in their scope. In this context, our aim was to compare colorectal cancer (CRC) care pathways from screening to end-of-life care in patients with and without pre-existing SMI on a national scale. Methods This research leverages real-world data from the French national health claims database, covering the entire population, to assess cancer screening, diagnosis, treatment and post-treatment follow-up as well as quality of care (QOC) pathways among patients with incident CRC in 2015–2018, considering whether they had pre-existing SMI. We matched patients with SMI with three patients without – on age, sex, region of residence, year of cancer incidence and cancer type and location at presentation – as well as nationally established quality of CRC care indicators and regression models adjusting for relevant socio-economic, clinical and care provider-related covariates. Results Among patients with incident CRC, 1,532 individuals with pre-existing SMI were matched with individuals without SMI. After adjusting for covariates, both colon and rectal cancer patients with SMI were less likely to participate in the national CRC screening programme and to receive advanced diagnostic examinations (e.g., colonoscopies and several complementary diagnostic examinations). They also had lower odds of receiving combined treatments (e.g., neoadjuvant chemotherapy, radiotherapy and excision) and of having access to targeted therapy or capecitabine but higher odds for invasive care (e.g., stoma). Colon cancer patients with SMI were also more likely to have no treatment at all, and rectal cancer patients with SMI were less likely to receive post-treatment follow-up. Suboptimal QOC was observed for both groups of patients, but to a higher extent for patients with SMI, with statistically significant differences for indicators focusing on diagnosis and post-treatment follow-up. Conclusions Our findings reveal discrepancies across the care continuum of CRC between individuals with and without SMI and provide initial avenues on where to focus future efforts to address them, notably at the entry and exit stages of cancer care pathways, while calling for further research on the mechanisms preventing equity of physical healthcare for individuals with SMI.

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Effect of comorbidity assessed by the Charlson Comorbidity Index on the length of stay, costs, and mortality among colorectal cancer patients undergoing colorectal surgery

Zhang

Wang

et al. 2022

Current Medical Research and Opinion

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Effect of Chronic Comorbidities on Follow-up Colonoscopy After Positive Colorectal Cancer Screening Results: A Population-Based Cohort Study

Cited by 4 publications

References 55 publications

Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England

Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England

The double burden of severe mental illness and cancer: a population-based study on colorectal cancer care pathways from screening to end-of-life care

Effect of comorbidity assessed by the Charlson Comorbidity Index on the length of stay, costs, and mortality among colorectal cancer patients undergoing colorectal surgery

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