Abstract
BackgroundTimely recognition of colorectal cancer related symptoms is essential to reduce time to diagnosis. This study aims to investigate the primary healthcare use preceding a colorectal cancer diagnosis.MethodsFrom a cohort of linked cancer and primary care data, patients diagnosed with primary colorectal cancer in the period 2007–2014 were selected and matched to cancer-free controls on gender, birth year, GP practice and follow-up period. Primary healthcare use among colorectal cancer cases before diagnosis was compared with matched cancer-free controls. Mean monthly number of GP consultations and newly prescribed medication was assessed in the year before index date (diagnosis date for cases). Results were stratified by colorectal cancer site: proximal colon cancer, distal colon cancer and rectal cancer.ResultsA total of 6,087 colorectal cancer cases could be matched to four cancer-free controls (N = 24,348). While mean monthly number of GP consultation were stable through the year among cancer-free controls, a statistical significant increase was seen among colorectal cancer cases in the last 4–8 months before diagnosis. Proximal colon cancer cases showed the longest time interval of increased mean monthly number of GP consultations. This increase was largely driven by a consultation for malignant neoplasm colon/rectum. The number patients receiving a newly prescribed medication was stable around 120 per 1,000 persons per month until 8 months before index date for proximal colon cancer cases, 4 months before index date for distal colon cancer cases and 3 months for rectal cancer cases. This increase was mainly driven by the prescription of laxatives drugs.ConclusionAn increase in the healthcare seeking behaviour of colorectal cancer patients prior to diagnosis was seen. The longest period of increased GP consultations and newly prescribed medication was seen among patients diagnosed with proximal colon cancer. This can be explained by the difficultly to diagnose proximal colon cancer given the more subtle signs compared to distal colon cancer and rectal cancer. Therefore, faster diagnosis for this specific tumour subtype may only be possible when clear clinical signs and symptoms are present.
Highlights
Recognition of colorectal cancer related symptoms is essential to reduce time to diagnosis
We aimed to investigate the number of general practitioner (GP) consultations among colorectal cancer patients and the medication they have been prescribed in the year before diagnosis
The mean monthly GP consultation in the month before colorectal cancer diagnosis was highest among patients diagnosed with proximal colon cancer (1.8) compared with distal colon cancer (1.7) and rectal cancer (1.6)
Summary
Recognition of colorectal cancer related symptoms is essential to reduce time to diagnosis. The incidence of colorectal cancer continues to increase in Europe, with approximately 500,000 patients newly diagnosed with colorectal cancer each year [1]. In the Netherlands, a national screening program was implemented in January 2014 with a participation rate of almost 75% in 2018 among people aged 55 to 75 years [3]. Previous studies showed that the median time between first consultation with cancer-related complaints to referral varies greatly for colorectal cancer patients with duration of months and even years for 10–25% of the colorectal cancer patients [5, 6]. In order to achieve an earlier diagnosis of colorectal cancer, it is important to know the current healthcare seeking behaviour of colorectal cancer patients prior to diagnosis which may provide new knowledge on specific groups to refer for a diagnostic work-up
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