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Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study

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Title: Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study
Authors: Arhi, CS
Ziprin, P
Bottle, A
Burns, EM
Aylin, P
Darzi, A
Item Type: Journal Article
Abstract: AIM: The incidence of colorectal cancer in the under 50s is increasing. In this national population-based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. METHOD: We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary-care records. RESULTS: The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50-59, 2294 (31.4%) were aged 60-69 and 3345 (45.7%) were aged 70-79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60-69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red-flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. CONCLUSION: Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.
Issue Date: 1-Nov-2019
Date of Acceptance: 10-May-2019
URI: http://hdl.handle.net/10044/1/72704
DOI: 10.1111/codi.14734
ISSN: 1462-8910
Publisher: Wiley
Start Page: 1270
End Page: 1278
Journal / Book Title: Colorectal Disease
Volume: 21
Issue: 11
Copyright Statement: Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland. This is the peer reviewed version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1111/codi.14734. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Sponsor/Funder: National Institute of Health Research
Imperial College Healthcare NHS Trust
The Peter Sowerby Charitable Foundation
Imperial College Healthcare NHS Trust
Funder's Grant Number: NRLS2
N/A
72100-74250
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Surgery
Delayed referral
primary care
young patients
colorectal cancer
emergency diagnosis
NICE guidelines
CLINICAL-FEATURES
ADMISSIONS
SYMPTOMS
COHORT
ROUTES
Delayed referral
NICE guidelines
colorectal cancer
emergency diagnosis
primary care
young patients
Delayed referral
NICE guidelines
colorectal cancer
emergency diagnosis
primary care
young patients
Surgery
1103 Clinical Sciences
Publication Status: Published
Conference Place: England
Embargo Date: 2020-08-06
Online Publication Date: 2019-08-06
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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