title: Variation at presentation among colon cancer patients with metastases: a population-based study.
abstract: OBJECTIVE
  The study aimed to describe and follow a 2 year cohort of colon cancer patients with Stage IV disease from presentation to long-term outcome.
  
  
  METHODS
  The records of 177 colon cancer patients diagnosed in southeast Sweden during 2009-2010 with disseminated disease at presentation were reviewed retrospectively.
  
  
  RESULTS
  The patients were heterogeneous with respect to age, performance status and survival. Despite metastatic disease, local symptoms from the primary tumour dominated the initial clinical picture. Forty-one per cent had anaemia. The time from suspicion of colon cancer to established diagnosis of disseminated disease varied from 0 to 231 days (emergency cases included, median 12 days). The majority (77%) were diagnosed in hospital. In 53% the primary tumour and the metastases were not diagnosed on the same occasion which may increase the risk for misinformation or delays in the care process. The possibility of simultaneous diagnosis was doubled when the patient was investigated as an inpatient. Patients were seen by one to 12 physicians (median three) in the investigation phase, and one to 47 (median 11) from diagnosis until the last record in the hospital notes. The 1-year survival was 46%.
  
  
  CONCLUSIONS
  Patients with metastatic colon cancer at presentation are heterogeneous and warrant an adapted multidisciplinary approach to achieve the goal of individualized treatment for each patient in accordance with the Swedish national cancer strategy.
authors.affiliation: Palliative Education and Research Center, Östergötland, Sweden; Regional Cancer Centre, Linköping, Sweden.
authors.forename: P A
authors.initials: PA
authors.lastname: Heedman
authors.forename: E
authors.initials: E
authors.lastname: Canslätt
authors.forename: G
authors.initials: G
authors.lastname: Henriks
authors.forename: H
authors.initials: H
authors.lastname: Starkhammar
authors.forename: V
authors.initials: V
authors.lastname: Fomichov
authors.forename: R
authors.initials: R
authors.lastname: Sjödahl
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000740:Anemia / Q000209:etiology; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D012737:Sex Factors; D013548:Sweden; D055815:Young Adult
keywords: Colon cancer; decision making; diagnostic approach; heterogeneity; integrated care; metastases