1
IRUS Total
Downloads

Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study

File Description SizeFormat 
Duration of symptom stage full transcript BJGP final accepted.docxAccepted version117.42 kBMicrosoft WordView/Open
Title: Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study
Authors: Arhi, CS
Burns, EM
Bottle, A
Bouras, G
Aylin, P
Ziprin, P
Darzi, A
Item Type: Journal Article
Abstract: Background Delays in referral for patients with colorectal cancer may occur if the presenting symptom is falsely attributed to a benign condition. Aim To investigate whether delays in referral from primary care are associated with a later stage of cancer at diagnosis and worse prognosis. Design and setting A national retrospective cohort study in England including adult patients with colorectal cancer identified from the cancer registry with linkage to Clinical Practice Research Datalink, who had been referred following presentation to their GP with a ‘red flag’ or ‘non-specific’ symptom. Method The hazard ratios (HR) of death were calculated for delays in referral of between 2 weeks and 3 months, and >3 months, compared with referrals within 2 weeks. Results A total of 4527 (63.5%) patients with colon cancer and 2603 (36.5%) patients with rectal cancer were included in the study. The percentage of patients presenting with red-flag symptoms who experienced a delay of >3 months before referral was 16.9% of those with colon cancer and 13.5% of those with rectal cancer, compared with 35.7% of patients with colon cancer and 42.9% of patients with rectal cancer who presented with non-specific symptoms. Patients referred after 3 months with red-flag symptoms demonstrated a significantly worse prognosis than patients who were referred within 2 weeks (colon cancer: HR 1.53; 95% confidence interval [CI] = 1.29 to 1.81; rectal cancer: HR 1.30; 95% CI = 1.06 to 1.60). This association was not seen for patients presenting with non-specific symptoms. Delays in referral were associated with a significantly higher proportion of late-stage cancers. Conclusion The first presentation to the GP provides a referral opportunity to identify the underlying cancer, which, if missed, is associated with a later stage in diagnosis and worse survival.
Issue Date: 1-Jul-2020
Date of Acceptance: 16-Jan-2020
URI: http://hdl.handle.net/10044/1/85761
DOI: 10.3399/bjgp20X710441
ISSN: 0960-1643
Publisher: Royal College of General Practitioners
Start Page: E463
End Page: E471
Journal / Book Title: British Journal of General Practice
Volume: 70
Issue: 696
Copyright Statement: © British Journal of General Practice 2020
Sponsor/Funder: Imperial College Healthcare NHS Trust
National Institute of Health Research
National Institute for Health Research
Funder's Grant Number: CPG2 Sandra Easton
n/a
Keywords: Science & Technology
Life Sciences & Biomedicine
Primary Health Care
Medicine, General & Internal
General & Internal Medicine
cancer
colorectal cancer
delays
primary care
referral
stage
survival
PRACTICE RESEARCH DATABASE
DIAGNOSTIC INTERVALS
THERAPEUTIC DELAY
RECTAL-CANCER
COLON-CANCER
SYMPTOMS
STAGE
TIME
IMPACT
UK
cancer
colorectal cancer
delays
primary care
referral
stage
survival
Science & Technology
Life Sciences & Biomedicine
Primary Health Care
Medicine, General & Internal
General & Internal Medicine
cancer
colorectal cancer
delays
primary care
referral
stage
survival
PRACTICE RESEARCH DATABASE
DIAGNOSTIC INTERVALS
THERAPEUTIC DELAY
RECTAL-CANCER
COLON-CANCER
SYMPTOMS
STAGE
TIME
IMPACT
UK
1117 Public Health and Health Services
Public Health
Publication Status: Published
Online Publication Date: 2020-06-25
Appears in Collections:Department of Surgery and Cancer
Department of Infectious Diseases
Institute of Global Health Innovation
School of Public Health