TY - JOUR
T1 - Pre-diagnostic clinical features and blood tests in patients with colorectal cancer
T2 - a retrospective linked-data study
AU - Moullet, Marie
AU - Funston, Garth
AU - Mounce, Luke Ta
AU - Abel, Gary A.
AU - de Wit, Niek
AU - Walter, Fiona M.
AU - Zhou, Yin
N1 - Funding Information:
Data acquisition was supported by The National Institute for Health Research School for Primary Care Research (Funding Round 13 grant reference: 346). This research is linked to the CanTest Collaborative, which is funded by Cancer Research UK (reference: C8640/A23385). Marie Moullet is a current employee of AstraZeneca. Luke TA Mounce is lead statistician on the Electronic Risk of Cancer (ERICA) Trial funded by The Dennis and Mireille Gillings Foundation. Yin Zhou is funded by a Wellcome Trust Primary Care Clinician PhD Fellowship (reference: 203921/Z/16/Z).
Funding Information:
Data acquisition was supported by the National Institute for Health Research School for Primary Care Research (Funding Round 13 grant reference: 346). This research is linked to the CanTest Collaborative, which is funded by Cancer Research UK (reference: C8640/A23385). Marie Moullet is a current employee of AstraZeneca. Luke TA Mounce is lead statistician on the Electronic Risk of Cancer (ERICA) Trial funded by the Dennis and Mireille Gillings Foundation. Yin Zhou is funded by a Wellcome Trust Primary Care Clinician PhD Fellowship (reference: 203921/Z/16/Z).
Publisher Copyright:
©The Authors.
PY - 2022/8
Y1 - 2022/8
N2 - BACKGROUND: The majority of colorectal cancer is diagnosed in patients following symptomatic presentation in the UK. AIM: To identify windows of opportunity for timely investigations or referrals in patients presenting with colon and rectal cancer-relevant symptoms or abnormal blood tests. DESIGN AND SETTING: A retrospective cohort study was undertaken using linked primary care and cancer registry data for patients with colorectal cancer diagnosed in England between 2012 and 2015. METHOD: Monthly consultation rates for relevant clinical features (change in bowel habit, rectal bleeding, abdominal pain, abdominal mass, constitutional symptoms, and other bowel symptoms) and abnormal blood test results (low haemoglobin, high platelets, and high inflammatory markers) up to 24 months pre-diagnosis were calculated. Poisson regression adjusted for age, sex, and relevant comorbidities was used to estimate the most likely month when consultation rates increased above baseline. RESULTS: In total, 5033 patients with colon cancer and 2516 with rectal cancer were included. Consultations for all examined clinical features and abnormal blood tests increased in the year pre-diagnosis. Rectal bleeding was the earliest clinical feature to increase from the baseline rate: at 10 months (95% confidence interval [CI] = 8.3 to 11.7) pre-diagnosis for colon cancer and at 8 months (95% CI = 6.1 to 9.9) pre-diagnosis for rectal cancer. Low haemoglobin, high platelets, and high inflammatory markers increased from as early as 9 months pre-diagnosis. CONCLUSION: This study found evidence for an early increase in rates of consultation for relevant clinical features and abnormal blood tests in patients with colorectal cancer, suggesting that earlier instigation of cancer-specific investigations or referrals may be warranted in some patients who were symptomatic.
AB - BACKGROUND: The majority of colorectal cancer is diagnosed in patients following symptomatic presentation in the UK. AIM: To identify windows of opportunity for timely investigations or referrals in patients presenting with colon and rectal cancer-relevant symptoms or abnormal blood tests. DESIGN AND SETTING: A retrospective cohort study was undertaken using linked primary care and cancer registry data for patients with colorectal cancer diagnosed in England between 2012 and 2015. METHOD: Monthly consultation rates for relevant clinical features (change in bowel habit, rectal bleeding, abdominal pain, abdominal mass, constitutional symptoms, and other bowel symptoms) and abnormal blood test results (low haemoglobin, high platelets, and high inflammatory markers) up to 24 months pre-diagnosis were calculated. Poisson regression adjusted for age, sex, and relevant comorbidities was used to estimate the most likely month when consultation rates increased above baseline. RESULTS: In total, 5033 patients with colon cancer and 2516 with rectal cancer were included. Consultations for all examined clinical features and abnormal blood tests increased in the year pre-diagnosis. Rectal bleeding was the earliest clinical feature to increase from the baseline rate: at 10 months (95% confidence interval [CI] = 8.3 to 11.7) pre-diagnosis for colon cancer and at 8 months (95% CI = 6.1 to 9.9) pre-diagnosis for rectal cancer. Low haemoglobin, high platelets, and high inflammatory markers increased from as early as 9 months pre-diagnosis. CONCLUSION: This study found evidence for an early increase in rates of consultation for relevant clinical features and abnormal blood tests in patients with colorectal cancer, suggesting that earlier instigation of cancer-specific investigations or referrals may be warranted in some patients who were symptomatic.
KW - colon cancer
KW - early diagnosis
KW - general practice
KW - primary health care
KW - rectal cancer
KW - retrospective studies
UR - http://www.scopus.com/inward/record.url?scp=85135381552&partnerID=8YFLogxK
U2 - 10.3399/BJGP.2021.0563
DO - 10.3399/BJGP.2021.0563
M3 - Article
C2 - 35667682
SN - 0960-1643
VL - 72
SP - e556-e563
JO - The British journal of general practice : the journal of the Royal College of General Practitioners
JF - The British journal of general practice : the journal of the Royal College of General Practitioners
IS - 721
ER -