Young colorectal cancer patients experience referral delays in primary care leading to emergency diagnoses


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Chanpreet Arhi1,Paul Ziprin2,Alex Bottle3,Elaine Burns1,Paul Aylin1,Ara Darzi1
1Imperial College London,2Imperial college London,3Imperial College Londin

Abstract

Background

The incidence of colorectal cancer in young patients is increasing. In this population based case-control study, we hypothesise 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 (red-flag based on NICE guidance 2005 vs non-specific), the odds ratio (OR) of an emergency diagnosis and stage at diagnosis for those under the age of 50 compared with older patients, sourced from the cancer registry with linkage to the Clinical Practice Research Datalink database of primary care records. 

Results

7315 patients were included of which 561 (7.7%) were under 50, 1287 (17.6%) 50–59, 2458 (33.6%) 60–69 and 3534 (48.3%) 70–79 years old. Young patients were more likely to present with abdominal pain (21.1%), and were diagnosed with later stage (48.0%) and via an emergency (29.1%) compared with all age groups. They experienced a longer interval between referral to diagnosis by 12.5 days compared with those aged 60–69, reflecting the higher proportion of referrals via the non-urgent pathway (33.3% vs 26.5%). 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 non-specific compared with all age groups (OR 0.62 95% CI 0.49-0.80 for the 60-69 age group).

Conclusion

Young patients are more likely to present with symptoms that fall outside the referral guidelines. Referral criteria should be tailored according to the age group to reduce the risk of an emergency diagnosis due to missed opportunities in primary care.