ArticleAnnals of family medicine2019
Potential for Reducing Time to Referral for Colorectal Cancer Patients in Primary Care.
Article in Annals of family medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review.Current oncology (Toronto, Ont.) · 2022Pooled it
- Pooled it
- Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022Pooled it
- Time to diagnosis and treatment in younger adults with colorectal cancer: A systematic review.PloS one · 2022Pooled it
- Exploring colorectal cancer patients' diagnostic pathways and general practitioners' assessment of the diagnostic processes: a Danish survey study.Scandinavian journal of primary health care · 2025Article
- Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study.BJGP open · 2023Article
- Early detection of colorectal cancer by leveraging Dutch primary care consultation notes with free text embeddings.Scientific reports · 2023Article
- Use of health services one year before primary colorectal cancer.BMC health services research · 2023Article
- Measurement of clinical delay intervals among younger adults with colorectal cancer using health administrative data: a population-based analysis.BMJ open gastroenterology · 2022Article
- Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England.JAMA network open · 2022Article
- Do presenting symptoms, use of pre-diagnostic endoscopy and risk of emergency cancer diagnosis vary by comorbidity burden and type in patients with colorectal cancer?British journal of cancer · 2022Article
- Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer.World journal of gastroenterology · 2021Article
- A steep increase in healthcare seeking behaviour in the last months before colorectal cancer diagnosis.BMC family practice · 2021Article
- Multilevel Approaches to Reducing Diagnostic and Treatment Delay in Colorectal Cancer.Annals of family medicine · 2019Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAn optimal diagnostic process in primary care is pivotal for reducing cancer-related disease burden. This study aims to explore reasons for long times to referral for Dutch colorectal cancer (CRC) patients in primary care.
methodsA retrospective cohort study of anonymized free-text primary care records from the Julius General Practitioners' Network database, linked to the Netherlands Cancer Registry. Patients with a confirmed CRC diagnosis from 2007 through 2011 that symptomatically presented in primary care were included. Median time and interquartile ranges from presentation in primary care to referral were calculated for multiple patient and presentation characteristics. Associations of these characteristics with long time to referral (75th percentile was ≥59 days) were examined with log-binomial regression analyses. Routes to referral of patients with the longest times to referral were explored using thematic free-text analyses (90th percentile at ≥219 days).
resultsAmong the 309 people with CRC, patients who were female, did not have a registered family history, had a history of malignancy, lacked alarm symptoms at presentation, or had hemorrhoids at physical examination were at risk for longer time to referral in univariable analyses (longer median durations and/or univariable association with the 75th percentile). Only presentation without alarm symptoms showed a statistically significant association with long duration (75th percentile) in multivariable analysis (relative risk = 1.7; 95% CI, 1.1-2.6). Thematic exploration of the diagnostic routes to referral of patients with the longest durations (90th percentile) showed 2 dominating themes: "alternative working diagnosis" and "suboptimal diagnostic strategies," and included the sub-themes "omitting to reconsider an initial diagnosis" and "lacking follow-up."
conclusionsLong time to referral for CRC in primary care is mainly related to low cancer suspicion. There is potential for reducing the longest times to referral for patients with CRC in primary care, with earlier reconsideration of the initial hypothesis and implementation of strict follow-up consultations.
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