London School of Hygiene & Tropical Medicine

The need to support GPs to diagnose and refer bowel cancer patients quickly, and enhance people's knowledge of cancer symptoms, has been highlighted in two new studies published in the British Journal of Cancer. Both were co-authored by the London School of Hygiene & Tropical Medicine.

The first study, funded by Cancer Research UK, found that around one in five bowel cancer patients diagnosed after an emergency presentation have displayed at least one cancer 'red flag' symptom in the year leading up to their diagnosis.

It showed that 'red flag' symptoms, such as anaemia, rectal bleeding, change in bowel habits, were much more common in patients who were diagnosed via non-emergency routes, and that patients diagnosed as an emergency often did not display these symptoms.

The lack of these 'red flag' symptoms in many patients diagnosed as an emergency makes it much more difficult for GPs to diagnose the cancer early. However, 17.5% of colon cancer patients and 23% of rectal cancer patients diagnosed as an emergency had 'red flag' symptoms, indicating there could have been opportunities to pick up the disease earlier.

The study, conducted in collaboration with University College London, looked at the National Cancer Registry data that was linked to GP data for 1,606 patients across more than 200 GP practices. The research focused on patient data for the five years leading up to the cancer diagnosis.

Co-author Dr Bernard Rachet, from the School's Cancer Survival Group, said: "We found that patients diagnosed with a colorectal cancer after an emergency admission have similar consultation rates in primary care as other patients. This means that patient factors are unlikely to be the main driver for the high proportion of cancers diagnosed in emergency in England."

Cristina Renzi, lead researcher from University College London, said: "We know that patients diagnosed with cancer after emergency presentations don't do as well as patients who are diagnosed by their doctor through non-emergency routes. This study shows that most patients - who are picked up through the emergency route - can be harder to diagnose as they often don't show typical bowel cancer symptoms. However, in most cases they visit their doctor for various reasons multiple times during the months leading up to their diagnosis. This increase in the number of non-specific visits could represent opportunities to diagnose the cancer earlier.

"It's important to find ways to ensure these patients can be diagnosed at an early stage. And this study highlights the need to support GPs and give them the tools to diagnose and refer patients promptly when they feel it's necessary."

The second study, part of The Policy Research Unit in Cancer Awareness, Survival and Early Diagnosis, funded by the Department of Health Policy Research Programme, found that awareness of early symptoms of cancer varies greatly across England, and in areas where cancer symptom awareness is lower, people with cancer do not live as long after diagnosis. This may be because people with limited knowledge of cancer symptoms go to their doctor later and have more advanced disease that those with more knowledge.

Using the Cancer Research UK Cancer Awareness Measure and survival data from the National Cancer Registry, the study is the first in England to look at whether regional variation in cancer survival might be linked to regional variation in cancer symptom awareness and barriers to seeing the GP.  

On average, each additional cancer symptom recognised was associated with about a 1.6% increase in 1-year overall cancer survival. The length of survival after diagnosis was associated with perceived barriers to seeing the doctor - such as embarrassment and difficulties getting transport to the doctor's surgery - for breast cancer, but not other cancers.

East London, including areas such as Tower Hamlets and Newham, had the lowest awareness of cancer symptoms and highest average number of barriers to seeking medical help among their residents. The highest cancer awareness was found in areas such as Peterborough, Bedfordshire and Cambridgeshire.

The study was led by Dr Maja Niksic from the London School of Hygiene & Tropical Medicine's Cancer Survival Group, who conducted the research while at King's College London.

Dr Niksic said: "Cancer survival is lower in the UK than in other developed countries, which is why the Government has prioritised early diagnosis. It's important to understand the reasons behind poor cancer survival in some areas and find ways to improve it. This study doesn't answer all those questions, but it does find an interesting association."

"It's vital to encourage people to see their doctor if they notice any unusual changes that could be a sign of cancer. When cancer is caught at an early stage, treatment is more likely to be successful.

"Health campaigns should focus on helping people to recognise these cancer symptoms early and seek medical advice about these as soon as possible- especially in socio-economically deprived areas, where cancer survival is generally lower."

Co-author Dr Bernard Rachet added: "Efforts should be made to reduce the barriers to seeking help in primary care felt by the patients."

Publications

• Renzi C, Lyratzopoulos G, Card T, Chu T, Macleod U, Rachet B. Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England. British Journal of Cancer. DOI:10.1038/bjc.2016.250.
• Niksic M, Rachet B, Duffy SW, Quaresma M, Møller H, Forbes LJ. Is cancer survival associated with cancer symptom awareness and barriers to seeking medical help in England? An ecological study. British Journal of Cancer. DOI:10.1038/bjc.2016.246.