Predictive value of common symptom combinations in diagnosing colorectal cancer

Thompson, Michael R.; Perera, Rafael; Senapati, Asha; Dodds, Simon

doi:10.1002/bjs.5826

Cited by 53 publications

(79 citation statements)

References 26 publications

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“…Single symptoms (frequent in early disease) are associated with long delay in diagnosis compared with multiple symptoms (indicating advanced disease) which are associated with shorter delay. 32,33 In fact, in this study change in bowel habit in 1.7% of patients (mean duration of six months), abdominal masses in 21.1% patients (mean duration five months), and abdominal pain in 1.4% patients (mean duration seven months) were symptoms obtained from the patients after repeated questioning and so were infrequently the index symptoms prompting hospital visit. For most of those who recognized these symptoms they were noticed in combination within six months of presentation.…”

Section: Discussionmentioning

confidence: 51%

Colorectal Carcinoma: An Update of Current Trends in Accra

Dakubo¹,

Naaeder²,

Tettey³

et al. 2011

West African Journal of Medicine

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Section: Discussionmentioning

confidence: 51%

Colorectal Carcinoma: An Update of Current Trends in Accra

Dakubo¹,

Naaeder²,

Tettey³

et al. 2011

West African Journal of Medicine

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“…A study assessing the combined value of rectal bleeding and additional symptoms has been undertaken in secondary care, showing that patients presenting with rectal bleeding and a change in bowel habit without perianal symptoms are at highest risk of colorectal cancer (PLR: 4.2). Patients with rectal bleeding and perianal symptoms, but without a change in bowel habit had lowest risk of colorectal cancer (negative likelihood ratio: 1.3) (Thompson et al, 2007). Similar studies, focussing on patients presenting in primary care are needed.…”

Section: Future Studiesmentioning

confidence: 97%

Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

et al. 2009

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BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009 and PsychINFO (1970 to May 2009 were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3 -15.4%, median: 8.1%). Age X60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00 -3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03 -3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54 -3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30 -10.35), specificity 0.95 (95% CI: 0.93 -0.96), but still only generates a posttest probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines.

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“…We examined acceptability of colonic follow-up investigations, satisfaction with result communication, and later psychologic outcomes of the diagnostic episode in terms of S ymptoms suggestive of colorectal cancer are nonspecific and common in the general population; only 5% of patients investigated have colorectal cancer (1). Diagnosis should be safe and acceptable because most of those tested have no abnormalities detected.…”

Section: Participantsmentioning

confidence: 99%

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

Wagner

Ghanouni²,

Halligan³

et al. 2012

Radiology

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For the SIGGAR Investigators Purpose:To use a randomized design to compare patients' short-and longer-term experiences after computed tomographic (CT) colonography or colonoscopy. Materials and Methods:After ethical approval, the trial was registered. Patients gave written informed consent. Five hundred forty-seven patients with symptoms suggestive of colorectal cancer who had been randomly assigned at a ratio of 2:1 to undergo either colonoscopy (n = 362) or CT colonography (n = 185) received a validated questionnaire to assess immediate test experience (including satisfaction, worry, discomfort, adverse effects) and a 3-month questionnaire to assess psychologic outcomes (including satisfaction with result dissemination and reassurance). Data were analyzed by using Mann-Whitney U, Kruskal-Wallis, and x 2 test statistics. Results:Patients undergoing colonoscopy were less satisfied than those undergoing CT colonography (median score of 61 and interquartile range [IQR] of 55-67 vs median score of 64 and IQR of 58-70, respectively; P = .008) and significantly more worried (median score of 16 [IQR,[12][13][14][15][16][17][18][19][20][21] vs 15 [IQR,[9][10][11][12][13][14][15][16][17][18][19], P = .007); they also experienced more physical discomfort (median score of 39 [IQR, vs 35 [IQR,) and more adverse events (82 of 246 vs 28 of 122 reported feeling faint or dizzy, P = .039). However, at 3 months, they were more satisfied with how results were received (median score of 4 [IQR,[3][4], P , .0005) and less likely to require follow-up colonic investigations (17 of 230 vs 37 of 107, P , .0005). No differences were observed between the tests regarding 3-month psychologic consequences of the diagnostic episode, except for a trend toward a difference (P = .050) in negative affect (unpleasant emotions such as distress), with patients undergoing CT colonography reporting less intense negative affect.

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Predictive value of common symptom combinations in diagnosing colorectal cancer

Abstract: Symptom combinations defined by age have greater diagnostic value than single symptoms alone.

Cited by 53 publications

References 26 publications

Colorectal Carcinoma: An Update of Current Trends in Accra

Colorectal Carcinoma: An Update of Current Trends in Accra

Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

Patient Acceptability and Psychologic Consequences of CT Colonography Compared with Those of Colonoscopy: Results from a Multicenter Randomized Controlled Trial of Symptomatic Patients

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