Comorbid Conditions Delay Colorectal Cancer Diagnosis

Preexisting conditions can delay the diagnosis of colorectal cancer, new findings suggest.

In a study published in the British Journal of Cancer, investigators sought to determine whether non-cancerous comorbid conditions delayed or complicated a colorectal cancer diagnosis.

The investigators used the Clinical Practice Research Datalink, UK, to identify 4512 patients with colorectal cancer who were 40 years and older.

Diagnostic interval was defined as time from first symptom to diagnosis, and comorbid conditions were classified as competing demands or alternative explanations. The investigators used linear regressions to examine the association between diagnostic interval and age, gender, consultation rate, and number of comorbid conditions.

Of the total participants, 72.9% had 1 or more competing demand and 31.3% had 1 or more alternative explanation.

The results of the study showed that patients with a single serious illness or mental health issue that was unrelated to cancer were diagnosed an average of 10 days later than usual—–a 13% increase from the typical time taken for a diagnosis.

For patients with 4 or more comorbidities, the time to diagnosis increased by 32 days.

Signs or symptoms of colorectal cancer that can be explained by a preexisting condition, such as stomach pains, delayed diagnosis by an average of 9 days—–a 12% increase from the typical time it takes for a diagnosis.

“A 10 day delay may not sound [like] much but it may be the difference between a well-planned admission and an emergency admission with a complication,” said co-lead investigator Willie Hamilton. “This really matters—–as the complications may kill.”

Most notably, patients with inflammatory bowel disease experienced the longest delay in diagnosis by 26 days.

“When you’re trying to diagnose cancer, other illnesses can be a distraction either because they also require attention or because they can mask what would otherwise be flagged as a possible sign of cancer,” said lead investigator Jose Valderas. “It’s vital that doctors realize that existing illnesses make a diagnosis of cancer more difficult and stay alert to recognize signs and symptoms of cancer as such. It’s also important that patients flag symptoms with their doctor as early as possible, whether it’s unexplained weight loss or changes to your bowel habits.”

Based on the study findings, the investigators concluded that effective clinical strategies are needed to shorten the diagnostic interval in patients with comorbidity.

“As symptoms of bowel cancer can relate to later stage of disease it is important that delays in diagnosis are minimized,” Deborah Alsina, MDE, chief executive of Bowel Cancer UK, commented. “While the delays highlighted in this study are relatively small, if they add onto delays in patients presenting to their GP with symptoms, or in a diagnostic appointment, they become more serious. Currently, around 20% of people are diagnosed with bowel cancer as an emergency when outcomes are generally poorer and almost 50% in later stages of the disease when it is harder to treat.

“This interesting study highlights another aspect of the complexity of diagnosing bowel cancer as the majority of patients have multiple conditions. Therefore finding quicker, more effective ways to identify and diagnose these patients is crucial to help GPs and other clinicians identify or rule out bowel cancer quickly to give people the very best opportunity for successful treatment. Bowel cancer is after all, treatable and curable especially if diagnosed early.”