Journal
BRITISH JOURNAL OF CANCER
Volume 126, Issue 4, Pages 652-663Publisher
SPRINGERNATURE
DOI: 10.1038/s41416-021-01603-7
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Funding
- Cancer Research UK [C8640/A23385, C18081/A31373]
- International Alliance for Cancer Early Detection
- Canary Center at Stanford University
- University of Cambridge
- OHSU Knight Cancer Institute, University College London
- University of Manchester
- Prevention and Population Research Committee Programme Award [C7923/A29018]
- Cancer Research UK Clinician Advanced Scientist Fellowship [C18081/A18180]
- Dutch Cancer Society [50-56300-98-587]
- Cancer Research UK -Early Detection and Diagnosis Committee [EDDCPJT\100018]
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Cancer patients with comorbidities, especially cardiovascular disease, are less likely to be promptly investigated for colorectal cancer and have a higher risk of emergency presentation. Comorbidity can be a risk factor for diagnostic delay and may help prioritize patients for prompt assessment.
Background Cancer patients often have pre-existing comorbidities, which can influence timeliness of cancer diagnosis. We examined symptoms, investigations and emergency presentation (EP) risk among colorectal cancer (CRC) patients by comorbidity status. Methods Using linked cancer registration, primary care and hospital records of 4836 CRC patients (2011-2015), and multivariate quantile and logistic regression, we examined variations in specialist investigations, diagnostic intervals and EP risk. Results Among colon cancer patients, 46% had at least one pre-existing hospital-recorded comorbidity, most frequently cardiovascular disease (CVD, 18%). Comorbid versus non-comorbid cancer patients more frequently had records of anaemia (43% vs 38%), less frequently rectal bleeding/change in bowel habit (20% vs 27%), and longer intervals from symptom-to-first relevant test (median 136 vs 74 days). Comorbid patients were less likely investigated with colonoscopy/sigmoidoscopy, independently of symptoms (adjusted OR = 0.7[0.6, 0.9] for Charlson comorbidity score 1-2 and OR = 0.5 [0.4-0.7] for score 3+ versus 0. EP risk increased with comorbidity score 0, 1, 2, 3+: 23%, 35%, 33%, 47%; adjusted OR = 1.8 [1.4, 2.2]; 1.7 [1.3, 2.3]; 3.0 [2.3, 4.0]) and for patients with CVD (adjusted OR = 2.0 [1.5, 2.5]). Conclusions Comorbid individuals with as-yet-undiagnosed CRC often present with general rather than localising symptoms and are less likely promptly investigated with colonoscopy/sigmoidoscopy. Comorbidity is a risk factor for diagnostic delay and has potential, additionally to symptoms, as risk-stratifier for prioritising patients needing prompt assessment to reduce EP.
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