Walter Fiona M, Emery Jon D, Mendonca Silvia, Hall Nicola, Morris Helen C, Mills Katie, Dobson Christina, Bankhead Clare, Johnson Margaret, Abel Gary A, Rutter Matthew D, Hamilton William, Rubin Greg P
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.
Br J Cancer. 2016 Aug 23;115(5):533-41. doi: 10.1038/bjc.2016.221. Epub 2016 Aug 4.
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.
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.
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.
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.
本研究旨在调查与结直肠癌（CRC）诊断及诊断时间相关的症状、临床因素和社会人口统计学因素。
对英国两个地区因疑似CRC而转诊的参与者进行前瞻性队列研究。通过患者问卷、初级保健和医院记录收集数据。描述性分析和回归分析检查了症状及患者因素与总诊断间隔（TDI）、患者间隔（PI）、卫生系统间隔（HSI）和分期之间的关联。
共有2677名（22%）参与者做出回应；排除后，剩余2507名。参与者被诊断为CRC（6.1%，56%为晚期）、其他癌症（2.0%）或无癌症（91.9%）。队列中有一半人有单一的首发症状（1332例，53.1%）；多个首发症状很常见。在这个转诊人群中，便血是唯一在癌症患者中比非癌症患者更常见的初始症状（34.2%对23.9%，P = 0.004）。对于癌症诊断与非癌症诊断的患者，在TDI、PI或HSI方面没有差异的证据（CRC患者的中位TDI为124天，非癌症患者为138天，P = 0.142）。与较短TDI相关的首发症状是便血、排便习惯改变、“感觉异常”和疲劳/疲倦。焦虑、抑郁和胃肠道合并症与较长的HSI和TDI相关。发现便血和排便习惯改变存在症状持续时间依赖性影响。
医生和患者对CRC的某些症状反应不如对其他症状迅速。医疗保健专业人员应对有相关症状以及有心理健康或胃肠道合并症的患者患CRC的可能性保持警惕。
