title: Are alarm symptoms predictive of cancer survival?: population-based cohort study.
abstract: BACKGROUND
  Alarm symptom presentations are predictive of cancer diagnosis but may also be associated with cancer survival.
  
  
  OBJECTIVE
  To evaluate diagnostic time intervals, and consultation patterns after presentation with alarm symptoms, and their association with cancer diagnosis and survival.
  
  
  METHODS
  Cohort study using the Clinical Practice Research Database, with linked Cancer Registry data, in 158 general practices.
  
  
  METHODS
  Participants included those with haematuria, haemoptysis, dysphagia, and rectal bleeding or urinary tract cancer, lung cancer, gastro-oesophageal cancer, and colorectal cancer.
  
  
  RESULTS
  The median (interquartile range) interval in days from first symptom presentation to the corresponding cancer diagnosis was: haematuria and urinary tract cancer, 59 (28-109); haemoptysis and lung cancer, 35 (18-89); dysphagia and gastro-oesophageal cancer, 25 (12-48); rectal bleeding and colorectal cancer, 49 (20-157). Three or more alarm symptom consultations were associated with increased odds of diagnosis of urinary tract cancer (odds ratio [OR] 1.84, 95% CI = 1.50 to 2.27), lung cancer (OR = 1.76, 95% CI = 1.07 to 2.90) and gastro-oesophageal cancer (OR = 2.17, 95% CI = 1.48 to 3.19). Longer diagnostic intervals were associated with increased mortality only for urinary tract cancer (hazard ratio 2.23, 95% CI = 1.35 to 3.69). Patients with no preceding alarm symptom had shorter survival from diagnosis of urinary tract, lung or colorectal cancer than those presenting with a relevant alarm symptom.
  
  
  CONCLUSIONS
  After alarm symptom presentation, repeat consultations are associated with cancer diagnoses. Longer diagnostic intervals appeared to be associated with a worse prognosis for urinary tract cancer only. Mortality is higher when cancer is diagnosed in the absence of alarm symptoms.
authors.affiliation: King's College London, Department of Primary Care and Public Health Sciences, London, and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London.
authors.forename: Alex
authors.initials: A
authors.lastname: Dregan
authors.affiliation: King's College London, Division of Cancer Studies, Thames Cancer Registry, London.
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
authors.affiliation: King's College London, Department of Primary Care and Public Health Sciences, London, and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London.
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.affiliation: King's College London, Department of Primary Care and Public Health Sciences, London, and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D058006:General Practice; D006417:Hematuria / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012002:Rectal Diseases / Q000209:etiology; D012017:Referral and Consultation; D012307:Risk Factors; D061665:Time-to-Treatment