Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Aarhus C, Denmark.
PLoS One. 2013 Jul 22;8(7):e69700. doi: 10.1371/journal.pone.0069700. Print 2013.
Rectal bleeding is considered to be an alarm symptom of colorectal cancer. However, the symptom is seldom reported to the general practitioner and it is often assumed that patients assign the rectal bleeding to benign conditions. The aims of this questionnaire study were to examine whether rectal bleeding was associated with longer patient delays in colorectal cancer patients and whether rectal bleeding was associated with cancer worries. All incident colorectal cancer patients during a 1-year period in the County of Aarhus, Denmark, received a questionnaire. 136 colorectal cancer patients returned the questionnaire (response rate: 42%). Patient delay was assessed as the interval from first symptom to help-seeking and was reported by the patient. Patients with rectal bleeding (N = 81) reported longer patient intervals than patients without rectal bleeding when adjusting for confounders including other symptoms such as pain and changes in bowel habits (HR = 0.43; p = 0.004). Thoughts about cancer were not associated with the patient interval (HR = 1.05; p = 0.887), but more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding (chi(2) = 15.29; p<0.001). Conclusively, rectal bleeding was associated with long patient delays in colorectal cancer patients although more patients with rectal bleeding reported to have been wondering if their symptom(s) could be due to cancer than patients without rectal bleeding. This suggests that assignment of symptoms to benign conditions is not the only explanation of long patient delays in this patient group and that barriers for timely help-seeking should be examined.
直肠出血被认为是结直肠癌的警报症状。然而，这种症状很少向全科医生报告，而且通常认为患者将直肠出血归因于良性疾病。本问卷调查研究的目的是检验直肠出血是否与结直肠癌患者的更长的患者延误有关，以及是否与癌症担忧有关。丹麦奥胡斯郡在一年内所有新发结直肠癌患者都收到了一份问卷。136 名结直肠癌患者返回了问卷（应答率：42%）。患者延误被评估为从首次出现症状到寻求帮助的时间间隔，并由患者报告。在校正包括疼痛和肠道习惯改变等其他症状在内的混杂因素后，有直肠出血的患者（N=81）报告的患者间隔时间长于没有直肠出血的患者（HR=0.43；p=0.004）。关于癌症的想法与患者间隔时间无关（HR=1.05；p=0.887），但有更多的有直肠出血的患者报告说他们是否怀疑自己的症状可能是由癌症引起的，而没有直肠出血的患者则没有（卡方=15.29；p<0.001）。总之，直肠出血与结直肠癌患者的长患者延误有关，尽管有更多的有直肠出血的患者报告说他们是否怀疑自己的症状可能是由癌症引起的，而没有直肠出血的患者则没有。这表明将症状归因于良性疾病并不是该患者群体中长患者延误的唯一解释，应检查及时寻求帮助的障碍。
