Concern over bowel cancer patients with symptoms year before diagnosis

A fifth of bowel cancer patients who received an emergency diagnosis in one year in England had characteristic symptoms the year before, suggesting their disease could have been caught earlier, researchers say.

With the majority of patients having seen a doctor in the 12 months before their diagnosis, whether emergency or non-emergency, the authors of the new study say multiple factors could be behind the finding.

“The sample [of patients] we have analysed come from more than 200 GP practices, so this suggests that it is not a problem of specific doctors, it suggests that it is a system-wide problem,” said Cristina Renzi, lead researcher of the study from University College London and the London School of Hygiene and Tropical Medicine.

“Emergency presentations are associated with worse patient-reported outcomes and disruptions to hospital services,” she added. “Cancer survival after an emergency colorectal cancer diagnosis is also substantially lower.”

With the study also showing that more than half of bowel cancer patients who receive an emergency diagnosis had no record of relevant symptoms up to a month beforehand, Renzi believes more needs to be done to support GPs, while patients should be encouraged to discuss all symptoms of concern with their doctor.

Writing in the British Journal of Cancer, the researchers, from four British universities, described how they analysed GP records and cancer registration data from more than 1,600 patients over the age of 25 who had been diagnosed with either colon or rectal cancer between 2005 and 2006.

While Renzi admits that the situation might have changed since the data was collected, the proportion of emergency diagnoses made for rectal cancers, she said, has remained fairly constant over the last decade, while those for colon cancers has dropped slightly.

Of the 1,029 colon cancer patients, 35% were diagnosed in an emergency situation, such as A&E or an emergency GP referral, compared to 15% of the 577 with rectal cancer. Emergency diagnoses were more common among women, those aged 80 or over and, for rectal cancer, those with a low socio-economic status.

When researchers examined up to five years of medical history for the colorectal cancer patients, whether diagnosed in an emergency situation or not, they discovered that more than 95% had seen a doctor in the previous 12 months. “In both cases it seems that they have been to their doctor multiple times and increasingly so the year before diagnosis,” said Renzi.

Those diagnosed in non-emergency situations were more likely to have symptoms typical of bowel cancer, including “red flag” symptoms such as rectal bleeding, anaemia or a change in bowel habits. But, the authors report, 18% of colon cancer patients and 23% of rectal cancer patients diagnosed in emergency situations also showed at least one red flag symptom in the 12 months before their diagnosis.

That, the authors said, suggests that around 20% of colorectal cancer patients could have been diagnosed earlier. That they were not, says Renzi, could be down to a number of factors.

“It might be that the doctor has referred them to have a diagnostic test and maybe the cancer progressed more rapidly; it might be that the patient had to come back and they didn’t,” said Renzi. “For now, we haven’t been able to really understand what went wrong after they were seen with the typical red flag symptoms.”

With many of those given an emergency diagnosis showing no red flag symptoms or other relevant signs, such as weight loss, Renzi said it was important that patients talk to their GP about all symptoms they are experiencing, while doctors need access to specialists and diagnostic facilities.

“The GPs need more support to deal with patients who present with non-specific symptoms in order to be able to diagnose cancer earlier, even in those cases,” she said.

Concern over bowel cancer patients with symptoms year before diagnosis