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Colorectal cancer outcomes determined by mode of presentation: analysis of population data in England between 2010 and 2014

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Abstract

Background

The purpose of this study was to investigate associations between mode of presentation; categorized as emergency, suspected cancer outpatient referral pathway (2-week wait or 2WW pathway), non-cancer suspected outpatient referral (non-2-week wait pathway) or following screening, and stage of diagnosis and survival in patients with colorectal cancer in England.

Methods

This was a retrospective cohort observational study of patients diagnosed with colorectal cancer between January 2010 and December 2014 in England using data from Public Health England collated from regional cancer registries.

Results

The most common route to diagnosis among 167,501 patients diagnosed with colorectal cancer was via the non-cancer suspect (non-2WW) outpatient referral pathway (35.1%) followed by the suspected cancer (2WW) referral pathway (31.6%), emergency presentation (22.8%) and most infrequently following screening (10.6%) (p < 0.01).

Screening confers the greatest likelihood of early-stage diagnosis (61.6%) compared to other modes of presentation. The 5-year overall survival was 81.8%, 53.3%, 53.0% and 27.6% in those diagnosed via screening, 2WW, non-2WW pathway and emergency presentation, respectively.

Patients from most deprived regions were more likely to be diagnosed following emergency presentation (27.7 vs 19.7%, p < 0.01) and less likely via screening (8.1 vs 12%, p < 0.01).

Conclusions

Asymptomatic individuals diagnosed following screening have earlier stage cancers and better survival, the opposite was observed in those diagnosed following emergency presentation. Patients referred via the 2WW pathway do not have better survival outcomes when compared to those referred via the non-2WW pathway. In addition, this study has identified socio-economic groups that need to be targeted with public health campaigns to improve screening uptake.

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Acknowledgements

The authors would like to acknowledge Public Health England for providing the data required from the cancer registries.

Funding

This work is funded by Bowel Cancer West, Grant No. David Darke Grant, Joshua Franklyn.

Author information

Authors and Affiliations

  1. Basingstoke and North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstok, RG249NA, UK

    J. Franklyn & B. Moran

  2. University of Plymouth, Plymouth, UK

    J. Lomax & A. Baker

  3. University Hospital Plymouth NHS Trust, Plymouth, UK

    J. Franklyn, P. Labib & S. Smolarek

  4. Medical Statistics, University of Plymouth, Plymouth, UK

    J. Hosking

  5. Peritoneal Malignancy Institute Basingstoke, Basingstoke and North Hampshire Hospitals, Basingstok, UK

    B. Moran

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  1. J. Franklyn
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Contributions

JF, PZL, BM and SS designed the study and developed the protocol and analysis plan. JL, AB and JH provided statistical support. All authors contributed to the study by revising the manuscript and drafting parts of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. JF and SS are the guarantors.

Corresponding author

Correspondence to J. Franklyn.

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Conflict of interest

All authors declare no financial or non-financial competing interest.

Ethical statement

The retrospective research project did not require ethical approval as all data provided was anonymised.

Informed consent

For this type of study formal consent is not required.

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Supplementary Information

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10151_2022_2574_MOESM1_ESM.docx

Supplementary file1 Supplementary Fig. S1-Age distribution of colorectal cancer in England. The dotted lines encompass the current screening age indicating that many fall outside this range (DOCX 19 KB)

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Franklyn, J., Lomax, J., Labib, P. et al. Colorectal cancer outcomes determined by mode of presentation: analysis of population data in England between 2010 and 2014. Tech Coloproctol 26, 363–372 (2022). https://doi.org/10.1007/s10151-022-02574-4

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  • DOI: https://doi.org/10.1007/s10151-022-02574-4

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