Evidence map›Paper›PMID 32540874›Full record

ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2020

Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study.

Chanpreet S Arhi, Elaine M Burns, Alex Bottle, George Bouras, Paul Aylin, Paul Ziprin, Ara Darzi

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Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 3 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

20 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
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  14. Faecal immunochemical test: challenges and opportunities for cancer diagnosis in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2022
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  15. Influence of Diagnostic Delay on Survival Rates for Patients with Colorectal Cancer.International journal of environmental research and public health · 2022
    Observational
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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

7 authors.

Chanpreet S ArhiDepartment of Surgery and Cancer, Imperial College London, London.
Elaine M BurnsDepartment of Surgery and Cancer, Imperial College London, London.
Alex BottleSchool of Public Health, Imperial College London, London.
George BourasDepartment of Surgery and Cancer, Imperial College London, London.
Paul AylinSchool of Public Health, Imperial College London, London.
Paul ZiprinDepartment of Surgery and Cancer, Imperial College London, London.
Ara DarziDepartment of Surgery and Cancer, Imperial College London, London.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDelays in referral for patients with colorectal cancer may occur if the presenting symptom is falsely attributed to a benign condition.

aimTo investigate whether delays in referral from primary care are associated with a later stage of cancer at diagnosis and worse prognosis. DESIGN AND

settingA national retrospective cohort study in England including adult patients with colorectal cancer identified from the cancer registry with linkage to Clinical Practice Research Datalink, who had been referred following presentation to their GP with a 'red flag' or 'non-specific' symptom.

methodThe hazard ratios (HR) of death were calculated for delays in referral of between 2 weeks and 3 months, and >3 months, compared with referrals within 2 weeks.

resultsA total of 4527 (63.5%) patients with colon cancer and 2603 (36.5%) patients with rectal cancer were included in the study. The percentage of patients presenting with red-flag symptoms who experienced a delay of >3 months before referral was 16.9% of those with colon cancer and 13.5% of those with rectal cancer, compared with 35.7% of patients with colon cancer and 42.9% of patients with rectal cancer who presented with non-specific symptoms. Patients referred after 3 months with red-flag symptoms demonstrated a significantly worse prognosis than patients who were referred within 2 weeks (colon cancer: HR 1.53; 95% confidence interval [CI] = 1.29 to 1.81; rectal cancer: HR 1.30; 95% CI = 1.06 to 1.60). This association was not seen for patients presenting with non-specific symptoms. Delays in referral were associated with a significantly higher proportion of late-stage cancers.

conclusionThe first presentation to the GP provides a referral opportunity to identify the underlying cancer, which, if missed, is associated with a later stage in diagnosis and worse survival.

Indexed as

Colorectal NeoplasmsReferral and ConsultationAdultEnglandHumansPrimary Health CareRetrospective Studiescancercolorectal cancerdelaysprimary carereferralstagesurvival

Identifiers

PMID32540874
PMCPMC7299547

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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.