1
|
Lauridsen GB, Jarbøl DE, Thye-Rønn P, Rasmussen S, Balasubramaniam K, Lykkegaard J. Exploring GPs' assessments of their patients' cancer diagnostic processes: a questionnaire study. Br J Gen Pract 2023; 73:e941-e948. [PMID: 37903641 PMCID: PMC10633666 DOI: 10.3399/bjgp.2022.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/16/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Most cancer diagnostic pathways start from primary care and several factors affect the diagnostic processes. AIM To analyse the associations between patient characteristics, symptom presentation, and cancer type and the GP's assessment of the diagnostic processes. DESIGN AND SETTING General practices in the North, Central, and Southern regions of Denmark were invited to participate in a questionnaire survey. METHOD Participating GPs received a list of patients with incident cases of cancer in the period between 1 March 2019 and 28 February 2021 based on administrative hospital data. A questionnaire was completed for each patient, addressing symptom presentation and the GP's assessment of the diagnostic process both overall and in four subcategories (the patient's role, the GP's role, the transition between primary and secondary care, and the secondary sector's role). RESULTS A total of 187 general practices informed on 8240 patients. For 5868 patients, diagnostic pathways started in general practice. Almost half (48.3%, 2837/5868) presented with specific cancer symptoms. GPs assessed 55.6% (3263) and 32.3% (1897) of the diagnostic processes as 'very good' and 'predominantly good', respectively; 11.9% (700) were 'predominantly poor' or 'very poor' for these 5868 patients. Long symptom duration of ≥2 months prior to GP contact and presenting with non-specific or a combination of non-specific and specific symptoms were associated with a poor overall assessment of the diagnostic process. Assessment in the four subcategories showed that the patient's role was assessed less positively than the other three categories. CONCLUSION A longer symptom duration and presenting without cancer-specific symptoms were associated with GPs assessing the diagnostic process as poor.
Collapse
Affiliation(s)
- Gitte Bruun Lauridsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Peter Thye-Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, and Diagnostic Center, Svendborg Hospital, Svendborg
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | | | - Jesper Lykkegaard
- Department of Public Health and Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense
| |
Collapse
|
2
|
Fjällström P, Hörnsten C, Lilja M, Hultstrand C, Coe AB, Hajdarevic S. Reduction in the diagnostic interval after the introduction of cancer patient pathways for colorectal cancer in northern Sweden. Scand J Prim Health Care 2023; 41:287-296. [PMID: 37450480 PMCID: PMC10478615 DOI: 10.1080/02813432.2023.2234003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden. DESIGN A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016. SETTING Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2). SUBJECTS Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden. MAIN OUTCOME MEASURES Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department. RESULTS The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18-99) to 29 days (IQI 9-74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department. CONCLUSION Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon. IMPLICATION In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.
Collapse
Affiliation(s)
- P. Fjällström
- Department of Nursing, Umeå University, Umeå, Sweden
| | - C. Hörnsten
- Department of Clinical Sciences, Psychiatry, Umeå university, Umeå, Sweden
| | - M. Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - C. Hultstrand
- Department of Nursing, Umeå University, Umeå, Sweden
| | - A. B. Coe
- Department of Sociology, Umeå University, Umeå, Sweden
| | - S. Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
3
|
Sheikh-Wu SF, Anglade D, Gattamorta K, Downs CA. Relationships Between Colorectal Cancer Survivors' Positive Psychology, Symptoms, and Quality of Life. Clin Nurs Res 2023; 32:171-184. [PMID: 35996878 DOI: 10.1177/10547738221113385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This cross-sectional study examined colorectal cancer (CRC) survivors' symptom and symptom cluster characteristics (occurrence, frequency, and severity), positive psychology (benefit-finding and post-traumatic growth), and quality of life (QoL), and determined whether positive psychology moderates symptoms and QoL relationship during acute cancer survivorship, time from diagnosis to treatment completion. A total of 117 CRC survivors completed demographics, symptoms, QoL, and positive psychology questionnaires. Descriptive statistics, multiple linear regression, and moderation analyses were performed. Participants reported high QoL (94%, M = 5.15) and moderate-high positive psychology (75%, M = 3.21). Nineteen symptoms and five symptom clusters were inversely related to QoL (p < .05). Positive psychology (M = ~≥3.24) moderated the relationship of QoL (p < .05) with symptoms occurrence (n = 10), symptom severity (n = 1), and with the generalized symptom cluster (weakness, fatigue, dizziness, drowsy, sleep disturbances, and pain). Positive psychology aids in symptom management and improves QoL. Nurses are poised to identify, prevent, promote, and advocate self-management skills to improve health-related outcomes.
Collapse
|
4
|
Rasmussen S, Balasubramaniam K, Due LG, Jarbøl DE, Haastrup PF. Involvement of personal and professional relations when experiencing colorectal cancer symptoms - a cross sectional study. Scand J Gastroenterol 2022; 57:1058-1065. [PMID: 35465809 DOI: 10.1080/00365521.2022.2059394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE As part of improving early diagnosis of colorectal cancer (CRC), knowledge about involvement of personal and professional relations, when experiencing CRC symptoms, is important. This study aimed to analyse involvement of personal and professional relations and whether age, sex, number of symptoms and available social network are associated with involving family, non-family and professional relations amongst individuals experiencing CRC symptoms. METHODS Some, 100 000 Danes over 20 years were randomly selected and invited to a cross sectional survey comprising questions about involvement of relations regarding four predefined CRC symptoms (abdominal pain, rectal bleeding and change in stool texture and frequency). RESULTS In total, 35 801 respondents over 40 years answered all relevant items and 9346 (26.1%) had experienced at least one CRC symptom in the preceding 4 weeks. Abdominal pain was more often than stool-related symptoms discussed with relations. Respondents with >1 symptom had higher odds of reporting general practitioner (GP) contact compared to respondents with single symptoms. Age ≥60 years was associated with higher odds of GP contact and involving family relations. Spouse/partner was the most frequently involved relation. Involving a personal relation increased the odds of GP contact. Having an available social network decreased GP contact for some symptoms. CONCLUSION Odds of involving professional relations, e.g. the GP, were higher amongst individuals experiencing multiple CRC symptoms and those involving personal relations. Having an available social network was associated with lower odds of GP contact, suggesting that individuals with no available social network are more prone to use their GP.
Collapse
Affiliation(s)
- Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Lisbet Gonge Due
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
5
|
Reproductive Health Experiences of Females Diagnosed with Young-Onset Colorectal Cancer: A Multi-Method Cross-Sectional Survey. Curr Oncol 2022; 29:465-478. [PMID: 35200542 PMCID: PMC8870126 DOI: 10.3390/curroncol29020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Given the increasing risk of young-onset colorectal cancer (yCRC) among adults under 50 years, it is important to understand impacts on reproductive health. Our objective was to assess experiences with reproductive health after yCRC diagnosis among females. Methods: We conducted a cross-sectional study among females, 18 years or older, who have been diagnosed yCRC and are able to communicate in English. Data were gathered using an online survey involving both quantitative (e.g., multiple choice) and qualitative (e.g., open-ended text) questions on pregnancy history, influence of yCRC on reproductive decisions, and experiences with reproductive healthcare. Results: Altogether, 101 females with yCRC participated, including 23 who had never been pregnant and 78 who had been pregnant. yCRC influenced family planning goals for one-third of participants. Furthermore, compared to participants who completed treatment, those currently undergoing treatment had higher odds of indicating their yCRC diagnosis influenced family planning goals (adjusted odds ratio 4.93; 95% confidence interval 1.29 to 18.78). Although 53 (52.5%) participants indicated having discussions regarding reproductive health with healthcare provider(s), 44 (43.6%) did not. Content analysis of open-ended survey questions identified themes on the emotional impacts, experiences with reproductive healthcare, reproductive and family planning considerations, and the related issue of sexual health impacts of yCRC. Conclusions: Gaps in care, related to limited reproductive health discussions, influence of yCRC on family planning, and experiencing lasting reproductive health impacts highlight the need for improving reproductive healthcare, particularly for females diagnosed with yCRC.
Collapse
|
6
|
Winandar T, Raharjo A, Wujoso H, Sidharta BRA, Bagus BI. Relationship between 25(OH)D and Colorectal Cancer Prevalence at Dr. Moewardi Hospital Surakarta-Indonesia: A Cross-Sectional Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Colorectal cancer is a malignancy of the colon and / or rectum. Vitamin D has a role as an inhibitor of tumor progression, namely through the process of influencing cellular differentiation and proliferation. (VDR) Vitamin D Receptor affects cell differentiation by upregulating brush boundary enzymes and improving morphological microvilli. This study seeks to determine the relationship between 25(OH)D levels and colorectal cancer in dr. Moewardi Hospital, Surakarta, Indonesia.
Methods: A cross-sectional design study with quantitative-analytical observation was conducted. All patients had symptoms of colorectal cancer, either undiagnosed or previously diagnosed. 25(OH)D samples were taken from a total of 50 patients at dr. Moewardi Surakarta and subsequent diagnostic measures from the results of histopathology were assessed. The parameters assessed were 25(OH)D level and a diagnosis of colorectal malignancy. Statistical analysis of 25(OH)D levels and colorectal diagnosis using the Chi Square test.
Results: The prevalence of colorectal cancer is higher in respondents with 25(OH)D deficiency and insufficiency compared to respondents with normal 25(OH)D concentrations who tend to have non-colorectal cancer. Based on the Chi-Square test result, the significance value was 0.004, marking a statistically significant association.
Conclusion: This study shows a significant relationship between deficiency and insufficiency of 25(OH)D concentrations with the occurrence of colorectal malignancy
Collapse
|
7
|
Larsen MB, Bachmann HH, Søborg B, Laurberg T, Emmertsen KJ, Laurberg S, Andersen B. Prevalence of self-reported abdominal symptoms among 50-74-years-old men and women eligible for colorectal cancer screening -a cross-sectional study. BMC Cancer 2021; 21:910. [PMID: 34376179 PMCID: PMC8356437 DOI: 10.1186/s12885-021-08657-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background Screening is defined as the identification of unrecognized disease in an apparently healthy population. Symptomatic individuals are recommended to contact a physician instead of participating in screening. However, in colorectal cancer (CRC) screening this approach may be problematic as abdominal symptoms are nonspecific. This study aimed at identifying the prevalence of self-reported abdominal symptoms among screening-eligible men and women aged 50–74 years. Methods This cross-sectional survey study included 11,537 individuals aged 50–74 years invited for CRC screening from 9 to 23 September 2019. Descriptive statistics of responders experiencing alarm symptoms of CRC, Low Anterior Resection Syndrome Score (LARS) and the Patient Assessment of Constipation-Symptoms (PAC-SYM) were derived. The association between abdominal symptoms and demographic and socioeconomic variables were estimated by prevalence ratio (PR) using a Poisson regression model with robust variance. Results A total of 5488 respondents were included. The respondents were more likely women, of older age, Danish, cohabiting and had higher education and income level compared to non-respondents. Abdominal pain more than once a week was experienced by 12.0% of the respondents. Of these, 70.8% had been experiencing this symptom for >1 month. Fresh blood in the stool was experienced by 0.7% and of these 82.1% for >1 month. About one third of those experiencing alarm symptoms more than once a week for >1 month had not consulted a doctor. A total of 64.1% of the respondents had no LARS, 21.7% had minor LARS and 14.2% had major LARS. The median PAC-SYM score was 0.33 (Interquartile range (IQR): 0.17;0.75), the median abdominal score was 0.50 (IQR: 0.00;1.00), median rectal score 0.00 (IQR:0.00;0.33) and median stool score 0.40 (IQR: 0.00;0.80). Men and those aged 65–74 reported less symptoms than women and those aged 50–64 years, respectively. Conclusions This study illustrated that abdominal symptoms were frequent among screening-eligible men and women. This should be taken into account when implementing and improving CRC screening strategies. A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08657-z.
Collapse
Affiliation(s)
- Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark.
| | - Heidi Heinsen Bachmann
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark
| | - Bo Søborg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark
| | - Tinne Laurberg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, DK-8200, Aarhus N, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200, Aarhus N, Denmark.,Department of Surgery, Randers Regional Hospital, Skovlyvej 1, NO, DK-8930, Randers, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| |
Collapse
|
8
|
Kawk HW, Nam GH, Kim MJ, Kim SY, Kim YM. Scaphium affine Ethanol Extract Induces Anoikis by Regulating the EGFR/Akt Pathway in HCT116 Colorectal Cancer Cells. Front Oncol 2021; 11:621346. [PMID: 34094906 PMCID: PMC8173041 DOI: 10.3389/fonc.2021.621346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/30/2021] [Indexed: 01/02/2023] Open
Abstract
Scaphium affine ethanol extracts (SAE) is a species that has been shown to contain various physiological effects; however, its anticancer effects have yet to be revealed. We qualitatively evaluated β-sitosterol in SAE through high-performance liquid chromatography (HPLC). The cytotoxicity in HCT116 and HT29 colorectal cancer cells and CCD841 normal colon cells was confirmed through WST-1 assays. Selective cytotoxicity was observed in colorectal cancer cells, with greater cytotoxicity demonstrated in the HCT116 cell line. As such, the HCT116 colorectal cell line was selected for subsequent experiments. After HCT116 cells were treated with SAE, it was confirmed that the apoptosis rate was increased in a SAE dose-dependent manner through Annexin V assay. SAE further showed dose-dependent suppression of invasion through invasion assays. Anoikis induction through the EGFR/Akt pathway in HCT116 colorectal cancer cells was confirmed by Western blotting. The tumor suppressive effects of SAE was assessed in vivo using a xenograft model of human HCT116 colorectal cancer cells. As a result, we confirmed that SAE decreased tumor size in a dose-dependent manner and that p-EGFR and cleaved-caspase 3 in tumors were also regulated in a dose-dependent manner. This study showed that SAE, by containing β-sitosterol with proven anticancer effects, induces anoikis through the EGFR/Akt pathway in HCT116 colorectal cancer cells both in vitro and in vivo.
Collapse
Affiliation(s)
- Hye Won Kawk
- Department of Biological Science and Biotechnology, College of Life Science and Nano Technology, Hannam University, Daejeon, South Korea
| | - Gun-He Nam
- Department of Biological Science and Biotechnology, College of Life Science and Nano Technology, Hannam University, Daejeon, South Korea
| | - Myeong Jin Kim
- Department of Biological Science and Biotechnology, College of Life Science and Nano Technology, Hannam University, Daejeon, South Korea
| | - Sang-Yong Kim
- Department of Food Science and Bio Technology, Shinansan University, Ansan, South Korea
| | - Young-Min Kim
- Department of Biological Science and Biotechnology, College of Life Science and Nano Technology, Hannam University, Daejeon, South Korea
| |
Collapse
|
9
|
Novelli IR, Araújo BAD, Grandisoli LF, Furtado ECG, Aguchiku EKN, Bertocco MCG, Sudbrak TP, Araújo ICD, Bosko ACF, Damasceno NRT. Nutritional Counseling Protocol for Colorectal Cancer Patients after Surgery Improves Outcome. Nutr Cancer 2020; 73:2278-2286. [DOI: 10.1080/01635581.2020.1819345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Isabelle R. Novelli
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil
| | - Bruno A. D. Araújo
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil
| | - Laura F. Grandisoli
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Elianete C. G. Furtado
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Evelyn K. N. Aguchiku
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Marina C. G. Bertocco
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Tassiane P. Sudbrak
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Isabel C. de Araújo
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Ana C. F. Bosko
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| | - Nágila R. T. Damasceno
- Department of Nutrition, School of Public Health, University of Sao Paulo, São Paulo, Brazil
- Division of Nutrition and Dietetic, Universitary Hospital, University of Sao Paulo, São Paulo, Brazil
| |
Collapse
|
10
|
Högberg C, Karling P, Rutegård J, Lilja M. Patient-reported and doctor-reported symptoms when faecal immunochemical tests are requested in primary care in the diagnosis of colorectal cancer and inflammatory bowel disease: a prospective study. BMC FAMILY PRACTICE 2020; 21:129. [PMID: 32611307 PMCID: PMC7331274 DOI: 10.1186/s12875-020-01194-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Rectal bleeding and a change in bowel habits are considered to be alarm symptoms for colorectal cancer and they are also common symptoms for inflammatory bowel disease. However, most patients with these symptoms do not have any of these diseases. Faecal immunochemical tests (FITs) for haemoglobin are used as triage tests in Sweden and other countries but little is known about the symptoms patients have when FITs are requested. OBJECTIVE Firstly, to determine patients' symptoms when FITs are used as triage tests in primary care and whether doctors record the symptoms that patients report, and secondly to evaluate the association between symptoms, FIT results and possible prediction of colorectal cancer or inflammatory bowel disease. METHODS AND MATERIALS This prospective study included 364 consecutive patients for whom primary care doctors requested a FIT. Questionnaires including gastrointestinal symptoms were completed by patients and doctors. RESULTS Concordance between symptoms reported from patients and doctors was low. Rectal bleeding was recorded by 43.5% of patients versus 25.6% of doctors, FITs were negative in 58.3 and 52.7% of these cases respectively. The positive predictive value (PPV) of rectal bleeding recorded by patients for colorectal cancer or inflammatory bowel disease was 9.9% (95% confidence interval [CI] 5.2-14.7); for rectal bleeding combined with a FIT the PPV was 22.6% (95% CI 12.2-33.0) and the negative predictive value (NPV) was 98.9% (95% CI 96.7-100). For patient-recorded change in bowel habits the PPV was 6.1% (95% CI 2.4-9.8); for change in bowel habits combined with a FIT the PPV was 18.2% (95% CI 9.1-30.9) and the NPV 100% (95% CI 90.3-100). CONCLUSIONS Doctors should be aware that, during consultations, they do not record all symptoms experienced by patients. FITs requested in primary care, when found positive, may potentially be of help in prioritising referrals, also when patients present with rectal bleeding or change in bowel habits.
Collapse
Affiliation(s)
- Cecilia Högberg
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development – Östersund, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Jörgen Rutegård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development – Östersund, Östersund Hospital, Umeå University, Umeå, Sweden
| |
Collapse
|
11
|
Han CJ, Gigic B, Schneider M, Kulu Y, Peoples AR, Ose J, Kölsch T, Jacobsen PB, Colditz GA, Figueiredo JC, Grady WM, Li CI, Shibata D, Siegel EM, Toriola AT, Ulrich AB, Syrjala KL, Ulrich CM. Risk factors for cancer-related distress in colorectal cancer survivors: one year post surgery. J Cancer Surviv 2020; 14:305-315. [PMID: 32166576 PMCID: PMC7261242 DOI: 10.1007/s11764-019-00845-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/01/2019] [Indexed: 01/12/2023]
Abstract
PURPOSES Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (CRC) survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery. METHODS We included 212 CRC patients with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support, and health-related quality of life (HrQOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress. RESULTS Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months. CONCLUSION Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies. IMPLICATIONS FOR CANCER SURVIVORS Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.
Collapse
Affiliation(s)
- Claire J Han
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anita R Peoples
- Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Torsten Kölsch
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, California, LA, USA
| | - William M Grady
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Erin M Siegel
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA
| | - Alexis B Ulrich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karen L Syrjala
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
| | - Cornelia M Ulrich
- Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
12
|
Alshammari SA, Alenazi HA, Alshammari HS. Knowledge, attitude and practice towards early screening of colorectal cancer in Riyadh. J Family Med Prim Care 2020; 9:2273-2280. [PMID: 32754487 PMCID: PMC7380819 DOI: 10.4103/jfmpc.jfmpc_290_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/14/2020] [Accepted: 04/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background and Aims: Colorectal cancer (CRC) is a common cause of mortality worldwide. It is preventable, treatable when detected early. The aim of this study is to assess knowledge, attitude and practice (KAP) of the participants toward CRC and its early screening, and identify the sources of information on the subjects. Methods: We conducted a cross-sectional study on the people 40y old and above at the primary care clinics at King Saud university medical city (KSUMC) in Riyadh. The estimated sample size was 245 subjects whom we requested to complete a self-administered Arabic questionnaire, which consisted of three parts. These were: 1. Demographic data, 2. KAP toward CRC, its early detection. 3 sources of information of the public about colorectal cancer. Results: A total of 231 subjects participated; (54.5%) were male (mean age = 50.7 ± 9.8). About 47% of the participants heard about cancer screening, and 45% knew that colonoscopy is used for such purposes. Another 24.2% were aware that occult blood in the stool test is a method of early detection of colon cancer. About 40% to 50% of the subjects were knowledgeable about hazardous factors and cautioning symptoms for CRC. Only 6.5% of the subjects did an early screening for CRC, but 82.9% would do it if their doctor advised them to do so. Conclusion: The participant's knowledge and early checkups of CRC are inadequate. They would undergo early screening if their doctors advised them to do so. It is time to develop a national policy for CRC screening involving primary care doctors and utilizing social media to improve people's information.
Collapse
Affiliation(s)
- Sulaiman A Alshammari
- Health Promotion and Health Education Research chair, Department of Family and Community Medicine, College of Medicine, King Saud University, Ad Diriyah, Saudi Arabia
| | | | | |
Collapse
|
13
|
Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study. NPJ Prim Care Respir Med 2020; 30:15. [PMID: 32265450 PMCID: PMC7138801 DOI: 10.1038/s41533-020-0173-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
We aimed to firstly determine the 1-year predictive values of lung cancer alarm symptoms in the general population and to analyse the proportion of alarm symptoms reported prior to diagnosis, and secondly analyse how smoking status and reported contact with general practitioners (GPs) regarding lung cancer alarm symptoms influence the predictive values. The study was a nationwide prospective cohort study of 69,060 individuals aged ≥40 years, randomly selected from the Danish population. Using information gathered in a survey regarding symptoms, lifestyle and healthcare-seeking together with registry information on lung cancer diagnoses in the subsequent year, we calculated the predictive values and likelihood ratios of symptoms that might be indicative of lung cancer. Furthermore, we analysed how smoking status and reported contact with GPs regarding the alarm symptoms affected the predictive values. We found that less than half of the patients had reported an alarm symptom six months prior to lung cancer diagnosis. The positive predictive values of the symptoms were generally very low, even for patients reporting GP contact regarding an alarm symptom. The highest predictive values were found for dyspnoea, hoarseness, loss of appetite and for current heavy smokers. The negative predictive values were high, all close to 100%. Given the low positive predictive values, our findings emphasise that diagnostic strategies should not focus on single, specific alarm symptoms, but should perhaps focus on different clusters of symptoms. For patients not experiencing alarm symptoms, the risk of overlooking lung cancer is very low.
Collapse
|
14
|
Armstrong D, Dregan A, Ashworth M, White P, McGee C, de Lusignan S. The association between colorectal cancer and prior antibiotic prescriptions: case control study. Br J Cancer 2020; 122:912-917. [PMID: 31929515 PMCID: PMC7078217 DOI: 10.1038/s41416-019-0701-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers. METHODS A case control study used the RCGP's Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a new diagnosis of colorectal cancer between 1 January 2008 and 31 December 2018 were identified in the database and were matched with 60,348 controls. Conditional logistic regression was used to examine the association between antibiotic prescriptions and colorectal cancer. RESULTS A dose-response association between colorectal cancers and prior antibiotic prescriptions was observed. The risk was related to the number and recency of prescriptions with a high number of antibiotic prescriptions over a long period carrying the highest risk. For example, patients prescribed antibiotics in up to 15 years preceding diagnosis were associated with a higher risk of colorectal cancer (odds ratio (OR) = 1.90, 95% confidence intervals (CI), 1.61-2.19, p < 0.001). CONCLUSIONS Antibiotic use over previous years is associated with subsequent colorectal cancer. While the study design cannot determine causality, the findings suggest another reason for caution in prescribing antibiotics, especially in high volumes and over many years.
Collapse
Affiliation(s)
- David Armstrong
- School of Population Health & Environmental Sciences, King's College London, London, UK.
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychological, and Neurosciences, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Patrick White
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Chris McGee
- Department of Clinical and Experimental Medicine, Surrey University, Guildford, UK.,Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, Surrey University, Guildford, UK.,Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
| |
Collapse
|
15
|
Li B, Wang F, Ma C, Hao T, Geng L, Jiang H. Predictive value of IL-18 and IL-10 in the prognosis of patients with colorectal cancer. Oncol Lett 2019; 18:713-719. [PMID: 31289546 PMCID: PMC6540337 DOI: 10.3892/ol.2019.10338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/15/2019] [Indexed: 12/30/2022] Open
Abstract
Predictive value of serum interleukin 10 (IL-10) and interleukin 18 (IL-18) expression in patients with colorectal cancer (CRC) was investigated. This study retrospectively analyzed the medical records of 146 patients with CRC admitted to the Binzhou Medical University Hospital as the study group, and collected the physical examination data of 82 volunteers as the control group. The expression levels of IL-10 and IL-18 in the serum were measured by enzyme-linked immunosorbent assay (ELISA). A 60-month follow-up on patients in the study group was performed to make records of their prognosis. The expressions of IL-10 and IL-18 were statistically different in patients with different Dukes stages, tumor sizes, histological grades, and different situations of distant metastasis of cancer cells (P<0.05); with a gradual downward trend following the operation. The expression levels of serum IL-10 and IL-18 in the study group 7 days after the operation were lower than the levels before the operation (P<0.05), and the expression levels of IL-10 and IL-18 of patients in the study group on the day of discharge were lower than the expression levels 7 days after the operation (P<0.05). The expressions of IL-10 and IL-18 of patients with reoccurred CRC after the operation were significantly higher than that of patients without recurrence of CRC in the study group (P<0.05). Thus, IL-10 and IL-18 are highly expressed in the serum of CRC patients, which makes IL-10 and IL-18 useful to serve as indicators to determine the prognosis of CRC patients. The lower the expression levels of IL-10 and IL-18, the lower the cancer recurrence rate, the better the prognosis and the longer the survival time.
Collapse
Affiliation(s)
- Baosong Li
- Department of Colorectal and Anal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Fengxia Wang
- Department of Laboratory, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Chong Ma
- Department of Colorectal and Anal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Tao Hao
- Department of Colorectal and Anal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Longlong Geng
- Department of Colorectal and Anal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| | - Hong Jiang
- Department of Colorectal and Anal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256603, P.R. China
| |
Collapse
|
16
|
Raś R, Barnaś E, Magierło JS, Drozdzowska A, Bartosiewicz E, Sobolewski M, Skręt A, Gutkowski K. Preoperative colonoscopy in patients with a supposed primary ovarian cancer. Medicine (Baltimore) 2019; 98:e14929. [PMID: 30896654 PMCID: PMC6709016 DOI: 10.1097/md.0000000000014929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The final diagnosis of ovarian cancer is based on surgery and pathological verification. Therefore patients who are presented to surgery may be described only as supposed ovarian cancer. According to the literature the diagnosis of ovarian cancer is confirmed only in 2/3 of them. The rest are that which mimic ovarian cancer. One of them is colorectal cancer. Colonoscopy is a gold standard in its diagnostics. On the other hand, ovarian cancer may disturb the bowel patency and makes the bowel resection or stoma necessary.The main aim was to find out the distribution of bowel patency disturbances in ovarian cancer patients during preoperative colonoscopy and to assess their predictive value with respect to the bowel resection or stoma and the additional aim to identify the pathologies which mimic the ovarian cancer.In a prospective study among 104 patients with supposed ovarian cancer, primary ovarian cancer was diagnosed in 68 patients. The rest of them suffered from colorectal cancer found at colonoscopy (N = 6), ovarian benign pathology (N = 8), ovarian borderline tumor (N = 5), and other nonandexal malignant diseases (N = 17). In ovarian cancer group dominated serous carcinoma and fedération international de gynécologie et d'obstétrique stage 3 (N = 33).During preoperative colonoscopy in ovarian cancer patients, the complete obstruction was found in 27.9%, and relative risk of bowel resection or stoma was in them 4.29 and 4.38, respectively. Another colonoscopic finding was limited patency caused by extrinsic compression (29%) which is connected with relative risk of bowel resection or stoma 3.16 and 3.21 accordingly. The last colonoscopy finding was described as moderate limited patency of unknown origin (20.6%) and the relative risk of bowel resection or stoma was 5.14 and 4.17, respectively.Colonoscopy enables the diagnoses of colorectal cancer one of the diseases which mimic ovarian cancer in patients supposed to have this diseases.Bowel patency disturbances found at colonoscopy are a potential risk factor to intestine resection or ostomy.Colonoscopy is not fully noninvasive procedure and its obligatory use in patients supposed to have ovarian cancer should be limited to the cases with specific symptoms, and tumor marker pattern. Preoperative computed tomography, dedicated to bowel examination, candidates as an alternative to colonoscopy, but not completely.
Collapse
Affiliation(s)
- Renata Raś
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
- Department of Physics, Rzeszow University of Technology
| | | | - Joanna Skręt- Magierło
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
- Medical Faculty, University of Rzeszow
| | - Anna Drozdzowska
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
| | - Ewelina Bartosiewicz
- Department of Gastroenterology and Hepatology with the Internal Diseases Unit, Clinical Hospital No.1
| | - Marek Sobolewski
- Department of Quantitative Methods, Rzeszow University of Technology, Rzeszow, Poland
| | - Andrzej Skręt
- Obstetrics and Gynecology Clinic, Clinical Hospital No1 Rzeszow, University of Rzeszow
| | - Krzysztof Gutkowski
- Medical Faculty, University of Rzeszow
- Department of Gastroenterology and Hepatology with the Internal Diseases Unit, Clinical Hospital No.1
| |
Collapse
|
17
|
Rasmussen S, Haastrup PF, Balasubramaniam K, Elnegaard S, Christensen RD, Storsveen MM, Søndergaard J, Jarbøl DE. Predictive values of colorectal cancer alarm symptoms in the general population: a nationwide cohort study. Br J Cancer 2019; 120:595-600. [PMID: 30792531 PMCID: PMC6461905 DOI: 10.1038/s41416-019-0385-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background Alarm symptoms are used in many cancer referral guidelines. The objectives were to determine the 1-year predictive values (PVs) of colorectal cancer (CRC) alarm symptoms in the general population and to describe the proportion of alarm symptoms reported prior to diagnosis. Methods A nationwide prospective cohort of 69,060 individuals ≥40 years randomly selected from the Danish population was invited to complete a survey regarding symptoms and healthcare-seeking in 2012. Information on CRC diagnoses in a 12-month follow-up came from the Danish Cancer Registry. PVs and positive and negative likelihood ratios were calculated. Results A total of 37,455 individuals participated (response rate 54.2%). Sixty-four individuals were diagnosed with CRC. The single symptom with the highest positive PVs (PPV) and LR+ was rectal bleeding. PPVs were generally higher among individuals aged ≥75 years and highest among those reporting at least one specific alarm symptom that led to a GP contact. Conclusion In general, the PPVs of CRC alarm symptoms are low and the NPVs high, especially in the youngest age groups. The LR + show a relative association with specific symptoms like rectal bleeding. Future campaigns on early diagnosis of CRC should focus on healthcare-seeking when experiencing rectal bleeding and target older people with the highest incidence.
Collapse
Affiliation(s)
- Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Sandra Elnegaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - René dePont Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Maria Munch Storsveen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| |
Collapse
|
18
|
Balasubramaniam K, Elnegaard S, Rasmussen S, Haastrup PF, Christensen RD, Søndergaard J, Jarbøl DE. Lifestyle, socioeconomic status and healthcare seeking among women with gynaecological cancer alarm symptoms: a combined questionnaire-based and register-based population study. BMJ Open 2018; 8:e021815. [PMID: 29980546 PMCID: PMC6042537 DOI: 10.1136/bmjopen-2018-021815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/04/2018] [Accepted: 05/14/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To determine the proportion of contacts to general practitioner (GP) with recent onset gynaecological cancer alarm symptoms (pelvic pain, postmenopausal bleeding, bleeding during intercourse or pain during intercourse) and to analyse the associations between lifestyle factors, socioeconomic status and GP contact for these symptoms. DESIGN Cross-sectional survey combined with data from national registers. SETTING The general Danish population. PARTICIPANTS A total of 25 866 non-pregnant women ≥20 years completed the survey. Women reporting at least one of four gynaecological alarm symptoms within the preceding 6 months form the study base (n=2957). RESULTS The proportion of women reporting GP contact ranged from 21.1% (pain during intercourse) to 32.6% (postmenopausal bleeding). Women aged 60+ years had higher odds of reporting GP contact for at least one of the four gynaecological cancer alarm symptoms compared with those aged 20-39 years (OR 2.56, 95% CI 1.69 to 3.89), and immigrants had higher odds of reporting GP contact for at least one of the symptoms (OR 1.56, 95% CI 1.13 to 2.15) compared with ethnic Danish individuals. Among those reporting postmenopausal bleeding and/or bleeding during intercourse, women in the age group 60+ years had higher odds of reporting GP contact compared with those aged 20-39 years (OR 2.79, 95% CI 1.33 to 5.87). A high educational level (>12 years) was positively associated with reporting GP contact for postmenopausal bleeding and/or bleeding during intercourse compared with a low educational level (<10 years) (OR 2.23, 95% CI 1.19 to 4.19). No associations were found with lifestyle factors. CONCLUSIONS Few women contacted their GP with recent onset gynaecological cancer alarm symptoms. Higher age, being immigrant and higher educational level increased the odds of GP contact. Future studies should explore the reasons for these findings as this may aid in prompting early diagnosis and thereby improve the prognosis of gynaecological cancer.
Collapse
Affiliation(s)
- Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sandra Elnegaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - René dePont Christensen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
19
|
Walter FM, Emery JD, Mendonca S, Hall N, Morris HC, Mills K, Dobson C, Bankhead C, Johnson M, Abel GA, Rutter MD, Hamilton W, Rubin GP. Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study. Br J Cancer 2016; 115:533-41. [PMID: 27490803 PMCID: PMC4997546 DOI: 10.1038/bjc.2016.221] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022] Open
Abstract
Background: The objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis. Methods: Prospective cohort study of participants referred for suspicion of CRC in two English regions. Data were collected using a patient questionnaire, primary care and hospital records. Descriptive and regression analyses examined associations between symptoms and patient factors with total diagnostic interval (TDI), patient interval (PI), health system interval (HSI) and stage. Results: A total of 2677 (22%) participants responded; after exclusions, 2507 remained. Participants were diagnosed with CRC (6.1%, 56% late stage), other cancers (2.0%) or no cancer (91.9%). Half the cohort had a solitary first symptom (1332, 53.1%); multiple first symptoms were common. In this referred population, rectal bleeding was the only initial symptom more frequent among cancer than non-cancer cases (34.2% vs 23.9%, P=0.004). There was no evidence of differences in TDI, PI or HSI for those with cancer vs non-cancer diagnoses (median TDI CRC 124 vs non-cancer 138 days, P=0.142). First symptoms associated with shorter TDIs were rectal bleeding, change in bowel habit, ‘feeling different' and fatigue/tiredness. Anxiety, depression and gastro-intestinal co-morbidities were associated with longer HSIs and TDIs. Symptom duration-dependent effects were found for rectal bleeding and change in bowel habit. Conclusions: Doctors and patients respond less promptly to some symptoms of CRC than others. Healthcare professionals should be vigilant to the possibility of CRC in patients with relevant symptoms and mental health or gastro-intestinal comorbidities.
Collapse
Affiliation(s)
- Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.,Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jon D Emery
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.,Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Silvia Mendonca
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Nicola Hall
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK
| | - Helen C Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Katie Mills
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Christina Dobson
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | | | - Gary A Abel
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Matthew D Rutter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK.,University Hospital of North Tees, Stockton on Tees TS19 8PE, UK
| | - William Hamilton
- College House, St Luke's Campus, University of Exeter, Exeter EX2 4TE, UK
| | - Greg P Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK
| |
Collapse
|