Patient Delay in Colorectal Cancer Patients: Associations with Rectal Bleeding and Thoughts about Cancer

<div><p>Rectal bleeding is considered to be an alarm symptom of colorectal cancer. However, the symptom is seldom reported to the general practitioner and it is often assumed that patients assign the rectal bleeding to benign conditions. The aims of this questionnaire study were to examine whether rectal bleeding was associated with longer patient delays in colorectal cancer patients and whether rectal bleeding was associated with cancer worries. All incident colorectal cancer patients during a 1-year period in the County of Aarhus, Denmark, received a questionnaire. 136 colorectal cancer patients returned the questionnaire (response rate: 42%). Patient delay was assessed as the interval from first symptom to help-seeking and was reported by the patient. Patients with rectal bleeding (N = 81) reported longer patient intervals than patients without rectal bleeding when adjusting for confounders including other symptoms such as pain and changes in bowel habits (HR = 0.43; p = 0.004). Thoughts about cancer were not associated with the patient interval (HR = 1.05; p = 0.887), but more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding (chi² = 15.29; p<0.001). Conclusively, rectal bleeding was associated with long patient delays in colorectal cancer patients although more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding. This suggests that assignment of symptoms to benign conditions is not the only explanation of long patient delays in this patient group and that barriers for timely help-seeking should be examined.</p></div

Median patient interval (in days) for the five symptoms occurring in ≥20% of the sample (N = 136).

<p>Median patient interval in the 14 patients with rectal bleeding and none of the five common symptoms was 22 days (IQI = 3–42 days).</p><p>IQI = Interquartile interval.</p

Primary Care Use before Cancer Diagnosis in Adolescents and Young Adults – A Nationwide Register Study

<div><p>Introduction</p><p>Survival rates of cancer patients have generally improved in recent years. However, children and older adults seem to have experienced more significant clinical benefits than adolescents and young adults (AYAs). Previous studies suggest a prolonged diagnostic pathway in AYAs, but little is known about their pre-diagnostic healthcare use. This study investigates the use of primary care among AYAs during the two years preceding a cancer diagnosis.</p><p>Methods</p><p>The study is a retrospective population-based matched cohort study using Danish nationwide registry data. All persons diagnosed with cancer during 2002–2011 in the age group 15–39 years were included (N = 12,306); each participant was matched on gender, age and general practice with 10 randomly selected references (N = 123,060). The use of primary healthcare services (face-to-face contacts, blood tests and psychometric tests) was measured during the two years preceding the diagnosis (index date), and collected data were analysed in a negative binomial regression model.</p><p>Results</p><p>The cases generally increased their use of primary care already from 8 months before a cancer diagnosis, whereas a similar trend was not found for controls. The increase was observed for all cancer types, but it started at different times: 17 months before a diagnosis of CNS tumour, 12 months before a diagnosis of soft tissue sarcoma, 9 months before a diagnosis of lymphoma, 5–6 months before a diagnosis of leukaemia, bone tumour or GCT, and 3 months before a diagnosis of malignant melanoma.</p><p>Conclusion</p><p>The use of primary care among AYAs increase several months before a cancer diagnosis. The diagnostic intervals are generally short for malignant melanomas and long for brain tumours. A prolonged diagnostic pathway may indicate non-specific or vague symptomatology and low awareness of cancer among AYAs primary-care personnel. The findings suggest potential of faster cancer diagnosis in AYAs.</p></div

Upper part: Mean rates for consultations and blood tests in primary care for cases and references two years before the diagnosis (index date).

<p>Note the difference in the Y-axis range. Lower part: incidence rate ratios (IRR) for consultations with 95% confidence intervals.</p

Descriptive data on the childhood cancer patients.

<p>For each childhood cancer patient, ten control persons were included matched on age and gender.</p

Rates for consultations and diagnostic tests in daytime for children with cancer and control persons.

<p>Rates (mean number of consultations/diagnostic tests per 3 months interval) and incidence rate ratios (IRR) for children with cancer and control persons the year before diagnosis (for cases)/index day (for controls). The IRRs are presented with 95% confidence intervals (95%CIs).</p>*<p>p<0.05.</p>†<p>p<0.001.</p>††<p>p<0.0001.</p

Childhood cancer patients and controls in general practice during the 12 months before diagnosis.

<p>The curves show the proportion with the latest, the second latest and third latest consultation (y-axis) the year before cancer diagnosis (x-axis). For comparison, the same is shown for the matched control children until the index day. E.g. 64% of the children with cancer are seen once within a month before the diagnosis, whereas this figure is 21% for the control children.</p

Summary of hierarchical Cox regression analysis with length of the patient delay as dependent variable (N = 136).

<p>HR = Hazard ratio; CI = Confidence Intervals; HR^a : adjusted for the presence of other symptoms including changes in bowel habits, pain, weight loss, fatigue, and general indisposition.</p

Daytime consultations in general practice.

<p>Upper part: Consultation rates (mean consultations per month) in general practice for children with cancer and control children the year before diagnosis/index day. Lower part: The incidence rate ratios (IRR) for consultations with 95% confidence intervals (95%CIs).</p

The association between rectal bleeding and length of the patient delay in patients who had thoughts about cancer and in patients who did not have thoughts about cancer.

<p>The association between rectal bleeding and length of the patient delay in patients who had thoughts about cancer and in patients who did not have thoughts about cancer.</p