Evidence map›Paper›PMID 27490803›Full record

ArticleBritish journal of cancer2016

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study.

Fiona M Walter, Jon D Emery, Silvia Mendonca, Nicola Hall, Helen C Morris, Katie Mills, Christina Dobson, Clare Bankhead, Margaret Johnson, Gary A Abel and 3 more

Abstract read
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In one paragraph

Article in British journal of cancer, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
59citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

59 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  5. Variations in the investigation of colorectal cancer-related symptoms in Australian primary care: a retrospective cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Fiona M WalterPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Jon D EmeryPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Silvia MendoncaPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Nicola HallSchool of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK.
Helen C MorrisPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Katie MillsPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Christina DobsonSchool of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK.
Clare BankheadNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
Margaret JohnsonLay Member.
Gary A AbelPrimary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Matthew D RutterSchool of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK.
William HamiltonCollege House, St Luke's Campus, University of Exeter, Exeter EX2 4TE, UK.
Greg P RubinSchool of Medicine, Pharmacy and Health, Durham University, Stockton on Tees TS17 6BH, UK.

Funding

Department of Health RP-PG-0608-10045
6 · The paper itself

Abstract

backgroundThe objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis.

methodsProspective 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.

resultsA 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.

conclusionsDoctors 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.

Indexed as

AdultAgedAged, 80 and overColorectal NeoplasmsFemaleHumansMaleMiddle AgedProspective Studies

Identifiers

PMID27490803
PMCPMC4997546

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.