Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study.

PublishedJournal ArticleThis is the final version of the article. Available from Cancer Research UK via the DOI in this record.BACKGROUND: The objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis. METHODS: Prospective cohort study of participants referred for suspicion of CRC in two English regions. Data were collected using a patient questionnaire, primary care and hospital records. Descriptive and regression analyses examined associations between symptoms and patient factors with total diagnostic interval (TDI), patient interval (PI), health system interval (HSI) and stage. RESULTS: A total of 2677 (22%) participants responded; after exclusions, 2507 remained. Participants were diagnosed with CRC (6.1%, 56% late stage), other cancers (2.0%) or no cancer (91.9%). Half the cohort had a solitary first symptom (1332, 53.1%); multiple first symptoms were common. In this referred population, rectal bleeding was the only initial symptom more frequent among cancer than non-cancer cases (34.2% vs 23.9%, P=0.004). There was no evidence of differences in TDI, PI or HSI for those with cancer vs non-cancer diagnoses (median TDI CRC 124 vs non-cancer 138 days, P=0.142). First symptoms associated with shorter TDIs were rectal bleeding, change in bowel habit, 'feeling different' and fatigue/tiredness. Anxiety, depression and gastro-intestinal co-morbidities were associated with longer HSIs and TDIs. Symptom duration-dependent effects were found for rectal bleeding and change in bowel habit. CONCLUSIONS: Doctors and patients respond less promptly to some symptoms of CRC than others. Healthcare professionals should be vigilant to the possibility of CRC in patients with relevant symptoms and mental health or gastro-intestinal comorbidities.We thank all the patients who contributed to this study and the public representatives in the study team for their valuable contributions to the project: Sue Ballard, Victor Boulter and Margaret Johnson. We thank the clinical teams, research nurses and clinic administrators at the participating hospitals: Cambridge University Hospitals NHS Foundation Trust – Mr Miller, Dr Cameron, Kathy Restarick and Debbie Hugh; North Tees & Hartlepool NHS Foundation Trust – Dr Rutter, Sue Kelsey and Debbie Whetter; County Durham and Darlington NHS Foundation Trust – Dr Cundell, Jill Deane and Gill Horner. Finally, we acknowledge the contribution to the research presented in this paper made by members of the Discovery Programme Steering Committee: Roger Jones (chair), Jon Banks, Alison Clutterbuck, Ardiana Gjini, Joanne Hartland, Maire Justice, Jenny Knowles, Richard Neal and Peter Rose. This study presents independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0608-10045). The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research or the Department of Health