Possible missed opportunities for diagnosing colorectal cancer in Dutch primary care: a multimethods approach

Brandenbarg, Daan; Groenhof, Feikje; Siewers, Ilse M; Voort, Anna van der; Walter, Fiona M; Berendsen, Annette J.

doi:10.3399/bjgp17x693905

Cited by 19 publications

(25 citation statements)

References 26 publications

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“…They can have variable effects 51,[66][67][68][69][70] , with some diseases being associated with shorter 71 and others with longer patient intervals [72][73][74][75][76] , while some studies [77][78][79] found no such effects ( Figure 1).…”

Section: Help-seeking For Possible Cancer Symptomsmentioning

confidence: 99%

“…On the other hand evidence on the effects of specific chronic diseases is provided by several studies 2,46,66,69,70,72,73,79,[82][83][84][85] . In particular, congestive heart failure or coronary artery disease can lead to missed opportunities to refer patients promptly for endoscopic examination 84 , despite symptoms of colorectal cancer.…”

Section: Diagnostic Process Referrals and Use Of Investigationsmentioning

confidence: 99%

“…. Some studies examined disease-specific effects on the diagnostic interval 23,46,66,67,69,70,72,79,83,86,87 ; others only examined the overall effect of any chronic disease 68,78,81,82,85,88-93 ( Figure 1). Overall, having any pre-existing disease is strongly associated with a longer diagnostic intervals, according to two large studies on leukemia and myeloma 91,92 and one on lymphoma 81 .…”

Section: Diagnostic Interval (From First Presentation To Diagnosis)mentioning

confidence: 99%

“…Alternative explanations can also be reinforced by doctor-patient interactions 72 67 (Supplementary 70 and significant event audits 46 highlighted missed diagnostic opportunities in patients with a history of diverticulitis or gynaecological conditions, with both GPs and specialists initially attributing colorectal or ovarian cancer symptoms to these conditions or related medications.…”

Section: Alternative Explanation Mechanismmentioning

confidence: 99%

“…Frequent help-seeking of patients can also influence the doctor's interpretation of symptoms in light of anxiety disorders. According to a study on colorectal cancer70 , patients with higher consultation rates for a variety of complaints were referred less for investigations, possibly because healthcare providers sometimes perceive frequent help-seekers as being over-vigilant about body changes.…”

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confidence: 99%

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Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

et al. 2019

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Section: Help-seeking For Possible Cancer Symptomsmentioning

confidence: 99%

Section: Diagnostic Process Referrals and Use Of Investigationsmentioning

confidence: 99%

Section: Diagnostic Interval (From First Presentation To Diagnosis)mentioning

confidence: 99%

Section: Alternative Explanation Mechanismmentioning

confidence: 99%

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confidence: 99%

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Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

et al. 2019

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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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Trends in primary care blood tests prior to lung and colorectal cancer diagnosis—A retrospective cohort study using linked Australian data

Rafiq,

Drosdowsky,

Solomon

et al. 2024

Cancer Medicine

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IntroductionAbnormal results in common blood tests may occur several months before lung cancer (LC) and colorectal cancer (CRC) diagnosis. Identifying early blood markers of cancer and distinct blood test signatures could support earlier diagnosis in general practice.MethodsUsing linked Australian primary care and hospital cancer registry data, we conducted a cohort study of 855 LC and 399 CRC patients diagnosed between 2001 and 2021. Requests and results from general practice blood tests (six acute phase reactants [APR] and six red blood cell indices [RBCI]) were examined in the 2 years before cancer diagnosis. Poisson regression models were used to estimate monthly incidence rates and examine pre‐diagnostic trends in blood test use and abnormal results prior to cancer diagnosis, comparing patterns in LC and CRC patients.ResultsGeneral practice blood test requests increase from 7 months before CRC and 6 months before LC diagnosis. Abnormalities in many APR and RBCI tests increase several months before cancer diagnosis, often occur prior to or in the absence of anaemia (in 51% of CRC and 81% of LC patients with abnormalities), and are different in LC and CRC patients.ConclusionsThis study demonstrates an increase in diagnostic activity in Australian general practice several months before LC and CRC diagnosis, indicating potential opportunities for earlier diagnosis. It identifies blood test abnormalities and distinct signatures that are early markers of LC and CRC. If combined with other pre‐diagnostic information, these blood tests have potential to support GPs in prioritising patients for cancer investigation of different sites to expedite diagnosis.

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Possible missed opportunities for diagnosing colorectal cancer in Dutch primary care: a multimethods approach

Cited by 19 publications

References 26 publications

Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms

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

Trends in primary care blood tests prior to lung and colorectal cancer diagnosis—A retrospective cohort study using linked Australian data

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