title: 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.
abstract: More than 20% of colorectal cancers are diagnosed following an emergency presentation. We aimed to examine pre-diagnostic primary-care consultations and related symptoms comparing patients diagnosed as emergencies with those diagnosed through non-emergency routes.
  
  
  
  Cohort study of colorectal cancers diagnosed in England 2005 and 2006 using cancer registration data individually linked to primary-care data (CPRD/GPRD), allowing a detailed analysis of clinical information referring to the 5-year pre-diagnostic period.
  
  
  
  Emergency diagnosis occurred in 35% and 15% of the 1029 colon and 577 rectal cancers. 'Background' primary-care consultations (2-5 years before diagnosis) were similar for either group. In the year before diagnosis, >95% of emergency and non-emergency presenters had consulted their doctor, but emergency presenters had less frequently relevant symptoms (colon cancer: 48% vs 71% (P<0.001); rectal cancer: 49% vs 61% (P=0.043)). 'Alarm' symptoms were recorded less frequently in emergency presenters (e.g., rectal bleeding: 9 vs 24% (P=0.002)). However, about 1/5 of emergency presenters (18 and 23% for colon and rectal cancers) had 'alarm' symptoms the year before diagnosis.
  
  
  
  Emergency presenters have similar 'background' consultation history as non-emergency presenters. Their tumours seem associated with less typical symptoms, however opportunities for earlier diagnosis might be present in a fifth of them.
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, WC1E 6BT London, UK.|Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Renzi
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, WC1E 6BT London, UK.|Cambridge Centre for Health Services Research, University of Cambridge, CB2 0SR Cambridge, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lyratzopoulos
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB Nottingham, UK.|Nottingham Digestive Diseases Centre Biomedical Research Unit, University of Nottingham, NG7 2UH Nottingham, UK.
authors.forename: T
authors.initials: T
authors.lastname: Card
authors.affiliation: Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, NG7 2UH Nottingham, UK.
authors.forename: T P C
authors.initials: TP
authors.lastname: Chu
authors.affiliation: Hull York Medical School, University of Hull, HU6 7RX Kingston upon Hull, UK.
authors.forename: U
authors.initials: U
authors.lastname: Macleod
authors.affiliation: Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Rachet
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D000740:Anemia / Q000209:etiology; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D004630:Emergencies; D004739:England / Q000453:epidemiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D063189:Symptom Assessment