Delay in referral to specialty care for patients who have symptoms of colorectal cancer may lead to poor health outcomes. A retrospective cohort study in the Netherlands reviewed the time to specialty referral for a group of 309 patients with colorectal cancer who initially presented with symptoms to their primary care doctor. In univariable and multivariable analyses, those who initially presented with red flag symptoms, such as rectal bleeding or unintended weight loss, experienced shorter wait time than those who presented with non-alarming gastrointestinal symptoms. Univariable analysis showed that female patients and patients without a registered family history of the disease were also more likely to have a longer wait period. Of the 10% of patients with the longest wait times for referral to specialty care all patients had received an alternative initial diagnosis from their primary care physicians. These patients usually presented with conditions that obscured concern for colorectal cancer, such as hemorrhoids, fissures and inflammatory bowel disease. Initial diagnoses were not always reconsidered when complaints persisted and follow-up consultations were sometimes omitted.
The study points to a relationship between long time to referral of colorectal cancer in primary care and low cancer suspicion. There is potential for reducing longest times to referral of colorectal cancer patients in primary care by earlier reconsideration of the initial hypothesis and implementing strict follow-up consultations.
Potential for Reducing Time to Referral for Colorectal Cancer Patients in Primary Care
Nicole van Erp, MD, et al
University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
The Annals of Family Medicine