Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked-data study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Marie Moullet¹  Garth Funston²  Luke TA Mounce³  Gary A Abel³  Niek de Wit⁴  Fiona M Walter⁵  Yin Zhou¹ 

[1] Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge;Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Centre for Primary Care and Health Service Research, University of Manchester;University of Exeter Medical School, University of Exeter;Julius Center for Health Science and Primary Care, University Medical Centre Utrecht, Utrecht University;Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Wolfson Institute of Population Health, Queen Mary University of London

关键词: colon cancer;    early diagnosis;    primary health care;    rectal cancer;    retrospective studies;    general practice;   

DOI  :  10.3399/BJGP.2021.0563

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

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.

【 授权许可】

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