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Sunderland Repository records the research produced by the University of Sunderland including practice-based research and theses.

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study.

Walter, Fiona M, Emery, Jon D, Mendonca, Silvia, Hall, Nicola, Morris, Helen C, Mills, Katie, Dobson, Christina, Bankhead, Clare, Johnson, Margaret, Abel, Gary A, Rutter, Matthew D, Hamilton, William and Rubin, Greg P (2016) Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study. British Journal of Cancer, 115 (5). pp. 533-541.

Item Type: Article




The objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis.


Prospective cohort study of participants referred for suspicion of CRC in two English regions. Data were collected using a patient questionnaire, primary care and hospital records. Descriptive and regression analyses examined associations between symptoms and patient factors with total diagnostic interval (TDI), patient interval (PI), health system interval (HSI) and stage.


A total of 2677 (22%) participants responded; after exclusions, 2507 remained. Participants were diagnosed with CRC (6.1%, 56% late stage), other cancers (2.0%) or no cancer (91.9%). Half the cohort had a solitary first symptom (1332, 53.1%); multiple first symptoms were common. In this referred population, rectal bleeding was the only initial symptom more frequent among cancer than non-cancer cases (34.2% vs 23.9%, P=0.004). There was no evidence of differences in TDI, PI or HSI for those with cancer vs non-cancer diagnoses (median TDI CRC 124 vs non-cancer 138 days, P=0.142). First symptoms associated with shorter TDIs were rectal bleeding, change in bowel habit, ‘feeling different' and fatigue/tiredness. Anxiety, depression and gastro-intestinal co-morbidities were associated with longer HSIs and TDIs. Symptom duration-dependent effects were found for rectal bleeding and change in bowel habit.


Doctors and patients respond less promptly to some symptoms of CRC than others. Healthcare professionals should be vigilant to the possibility of CRC in patients with relevant symptoms and mental health or gastro-intestinal comorbidities.

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Depositing User: Wendy Tasker


Item ID: 7931
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Date Deposited: 04 Oct 2017 09:39
Last Modified: 04 Oct 2017 09:39


Author: Fiona M Walter
Author: Jon D Emery
Author: Silvia Mendonca
Author: Nicola Hall
Author: Helen C Morris
Author: Katie Mills
Author: Christina Dobson
Author: Clare Bankhead
Author: Margaret Johnson
Author: Gary A Abel
Author: Matthew D Rutter
Author: William Hamilton
Author: Greg P Rubin

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Faculty of Health Sciences and Wellbeing


Sciences > Health Sciences

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