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Colorectal cancer diagnosis often delayed by pre-existing conditions
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A single pre-existing illness or mental health issue can delay a colorectal cancer diagnosis by an average of 10 days, and multiple comorbid conditions can delay diagnosis by over a month, according to new research published in the British Journal of Cancer.
“When you’re trying to diagnose cancer, other illnesses can be a distraction either because they also require attention or because they can mask what would otherwise be flagged as a possible sign of cancer,” Jose M. Valderas, PhD, MPH, of the University of Exeter Medical School, said in a press release. “It’s vital that doctors realize that existing illnesses make a diagnosis of cancer more difficult and stay alert to recognize signs and symptoms of cancer as such. It’s also important that patients flag symptoms with their doctor as early as possible, whether it’s unexplained weight loss or changes to your bowel habits.”
Valderas and colleagues reviewed the electronic primary care records of 4,512 patients aged 40 years and older diagnosed with colorectal cancer between 2007 and 2009. They assessed the time interval between the patients’ first symptomatic presentation of colorectal cancer and their diagnosis, and looked for associations between that interval and age, sex, consultation rate and number of comorbid conditions.
Overall, 72.9% of the patients had at least one “competing demand” and 31.3% had at least one “alternative explanation.”
Linear regression analysis revealed an independent association between the numbers of both types of comorbid conditions and a longer diagnostic interval. One competing demand delayed CRC diagnosis by an average of 10 days.
“A 10-day delay may not sound much but it may be the difference between a well-planned admission and an emergency admission with a complication,” Willie Hamilton, MD, also of the University of Exeter, said in the press release. “This really matters as the complications may kill.”
Further, the investigators found four or more competing demands delayed diagnosis by an average of 32 days, while a single alternative explanation delayed diagnosis by an average of 9 days. Among single comorbid conditions, data showed an association between inflammatory bowel disease and the longest delay of 26 days (95% CI, 14-39).
The researchers noted that the link between comorbid conditions and delayed CRC diagnosis was especially strong among patients aged older than 80 years, and concluded that clinical strategies need to be developed to reduce the diagnostic interval in CRC patients with pre-existing comorbid conditions.
It is important that these diagnostic delays are minimized because CRC symptoms can be related to later disease stage, according to Deborah Alsina, MBE, chief executive of Bowel Cancer UK.
“While the delays highlighted in this study are relatively small, if they add onto delays in patients presenting to their GP with symptoms, or in a diagnostic appointment, they become more serious,” she said in the press release. “Currently around 20% of people are diagnosed with bowel cancer as an emergency when outcomes are generally poorer and almost 50% in later stages of the disease when it is harder to treat. This interesting study highlights another aspect of the complexity of diagnosing bowel cancer as the majority of patients have multiple conditions. Therefore, finding quicker, more effective ways to identify and diagnose these patients is crucial to help GPs and other clinicians identify or rule out bowel cancer quickly to give people the very best opportunity for successful treatment. Bowel cancer is after all, treatable and curable especially if diagnosed early.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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