The nature and frequency of abdominal symptoms in cancer patients and their associations with time to help-seeking: evidence from a national audit of cancer diagnosis

Koo, Minjoung Monica; Wagner, Christian von; Abel, Gary; McPhail, Sean; Hamilton, William; Rubin, Greg; Lyratzopoulos, Georgios

doi:10.1093/pubmed/fdx188

Cited by 30 publications

(33 citation statements)

References 34 publications

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“…Previous work using the NCDA has shown significant variation in the patient interval (symptom onset to presentation) by different abdominal symptoms,24 and cohort studies have shown similar variation of different diagnostic intervals by symptoms for patients with colorectal,25 lung26 and pancreatic cancer 27. Other studies using linked primary care data have found longer diagnostic intervals (from symptom presentation to diagnosis) for those presenting with non-alarm symptoms5 28 29 when compared with alarm symptoms patients.…”

Section: Discussionmentioning

confidence: 95%

Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

et al. 2020

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IntroductionPatients presenting to primary care with site-specific alarm symptoms can be referred onto urgent suspected cancer pathways, whereas those with non-specific symptoms currently have no dedicated referral routes leading to delays in cancer diagnosis and poorer outcomes. Pilot Multidisciplinary Diagnostic Centres (MDCs) provide a referral route for such patients in England.ObjectivesThis work aimed to use linked primary care and cancer registration data to describe diagnostic pathways for patients similar to those being referred into MDCs and compare them to patients presenting with more specific symptoms.MethodsThis cross-sectional study linked primary care data from the National Cancer Diagnosis Audit (NCDA) to national cancer registration and Route to Diagnosis records. Patient symptoms recorded in the NCDA were used to allocate patients to one of two groups - those presenting with symptoms mirroring referral criteria of MDCs (non-specific but concerning symptoms (NSCS)) and those with at least one site-specific alarm symptom (non-NSCS). Descriptive analyses compared the two groups and regression analysis by group investigated associations with long primary care intervals (PCIs).ResultsPatients with NSCS were more likely to be diagnosed at later stage (32% stage 4, compared with 21% in non-NSCS) and via an emergency presentation (34% vs 16%). These patients also had more multiple pre-referral general practitioner consultations (59% vs 43%) and primary care-led diagnostics (blood tests: 57% vs 35%). Patients with NSCS had higher odds of having longer PCIs (adjusted OR: 1.24 (1.11 to 1.36)). Patients with lung and urological cancers also had higher odds of longer PCIs overall and in both groups.ConclusionsDifferences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.

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Section: Discussionmentioning

confidence: 95%

Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

et al. 2020

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“…We believe that past literature on self-care behaviors before diagnosis and the emerging evidence supports this research agenda. For instance, a recent study on the nature and the frequency of abdominal symptoms suggest that patients with persistent bloating and distention waited a minimum of two months before presenting to primary care [27]. The identification of self-care behaviors using commercial data could be an effective approach to probe earlier engagement in primary care.…”

Section: Discussionmentioning

confidence: 99%

Self-Care Behaviors of Ovarian Cancer Patients Before Their Diagnosis: Proof-of-Concept Study

Flanagan¹,

Skrobanski²,

Shi³

et al. 2019

JMIR Cancer

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BackgroundLonger patient intervals can lead to more late-stage cancer diagnoses and higher mortality rates. Individuals may delay presenting to primary care with red flag symptoms and instead turn to the internet to seek information, purchase over-the-counter medication, and change their diet or exercise habits. With advancements in machine learning, there is the potential to explore this complex relationship between a patient’s symptom appraisal and their first consultation at primary care through linkage of existing datasets (eg, health, commercial, and online).ObjectiveHere, we aimed to explore feasibility and acceptability of symptom appraisal using commercial- and health-data linkages for cancer symptom surveillance.MethodsA proof-of-concept study was developed to assess the general public’s acceptability of commercial- and health-data linkages for cancer symptom surveillance using a qualitative focus group study. We also investigated self-care behaviors of ovarian cancer patients using high-street retailer data, pre- and postdiagnosis.ResultsUsing a high-street retailer’s data, 1118 purchases—from April 2013 to July 2017—by 11 ovarian cancer patients and one healthy individual were analyzed. There was a unique presence of purchases for pain and indigestion medication prior to cancer diagnosis, which could signal disease in a larger sample. Qualitative findings suggest that the public are willing to consent to commercial- and health-data linkages as long as their data are safeguarded and users of this data are transparent about their purposes.ConclusionsCancer symptom surveillance using commercial data is feasible and was found to be acceptable. To test efficacy of cancer surveillance using commercial data, larger studies are needed with links to individual electronic health records.

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“… 76 , 88 , 89 Symptoms associated with the longest patient intervals (time from symptom onset to presentation) may also be particularly worthy of targeting. 90 …”

Section: Symptom Epidemiologymentioning

confidence: 99%

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

Koo

Unger‐Saldaña

Mwaka

et al. 2021

JCO Global Oncology

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Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site–specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems’ capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.

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The nature and frequency of abdominal symptoms in cancer patients and their associations with time to help-seeking: evidence from a national audit of cancer diagnosis

Cited by 30 publications

References 34 publications

Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

Self-Care Behaviors of Ovarian Cancer Patients Before Their Diagnosis: Proof-of-Concept Study

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

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