Symptomatic Presentations In Primary Care Before Cancer Diagnosis: Opportunities And Challenges For Colon And Rectal Cancers Diagnosed As Emergencies

Cristina RENZI, University College London , United Kingdom
LYRATZOPOULOS G. 1 , CHU T. 3 , RACHET B. 2

1 Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
2 Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
3 Queen’s Medical Centre, University of Nottingham, Nottingham, UK

Purpose: To examine patterns of symptomatic presentation in primary care prior to colorectal cancer diagnosis comparing patients diagnosed following emergency presentation (EP) and non-EP.
Methods: Cohort study using cancer registry data individually linked to primary care records for colorectal cancers diagnosed in England in 2005-2006 (latest linked cohort with up to 10-year clinical records before cancer diagnosis).
Results: Among the 1029 colon and 577 rectal cancers, EP occurred in 35% and 15%, respectively. EP and non-EP had similar patterns of primary care consultations up to 2 years before cancer.
The year before diagnosis, over 95% of EP and non-EP patients had consulted their doctor for any reason, but significantly less frequently for a relevant symptom among EP (48% versus 71% among EP and non-EP colon cancers (p<0.001); 49% versus 61% among EP and non-EP rectal cancers (p=0.043)). EP also had less frequently ‘red flag’ symptoms (e.g. among rectal cancers, rectal bleeding was recorded in 9% versus 24% among EP and non-EP (p=0.002)). 18% of EP colon cancer and 23% of rectal cancer patients had 'red flag' symptoms recorded the year before diagnosis.
Multivariable analysis confirmed the above findings showing a lower likelihood of EP for patients with ‘red flag’ symptoms (change in bowel habits, rectal bleeding, anaemia) during the year before cancer diagnosis. Women, older and more deprived patients were more likely to present as emergencies.
Conclusions: Patients with EP and non-EP have a similar ‘background’ primary care consultation history until a few months before diagnosis. Emergency presenters with colon and rectal cancer have different symptom signatures and patient characteristics. A non-ignorable proportion of emergency presenters have previously consulted with 'red flag' symptoms. Patient and healthcare factors may be implicated with missed opportunities for earlier diagnosis in this subgroup.
Funding Source: Cancer Research UK - EDAG [C48748/A18667].