Pre-diagnostic routes to colorectal cancer in Central New Zealand: factors that lead to emergency presentation and longer diagnostic intervals at primary and secondary level care
Melissa Warren 1 2 * , Jon Emery 3 , Mei Krishnasamy 1 4 5 , Anne O'Donnell 6 , Karla Gough 1 71 Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Vic. 3010, Australia.
2 Breast Cancer Foundation New Zealand.
3 Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic., Australia.
4 VCCC Alliance, Melbourne, Vic., Australia.
5 Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.
6 Department of Medical Oncology, Capital and Coast District Health Board, Wellington, New Zealand.
7 Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.
Journal of Primary Health Care 14(1) 48-56 https://doi.org/10.1071/HC21107
Published: 13 April 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Although international large-scale studies have investigated routes to diagnosis for colorectal cancer, there is limited information on how New Zealanders seek help for bowel symptoms across different pre-diagnostic routes.
Aim: To better understand pre-diagnostic routes for colorectal cancer, including the characteristics of patients and key events associated with each route.
Methods: This study was a retrospective audit of hospital administrative and medical records for 120 patients with a confirmed diagnosis of colorectal cancer between 2016 and 2017. All patients were receiving care at one of two hospitals in central New Zealand; one urban and one rural. Extracted data were used to: categorise pre-diagnostic routes for colorectal cancer; describe the characteristics of people who presented by each route; and compare key events in the diagnostic and treatment intervals for people who presented by each route.
Results: Six routes to the diagnosis of colorectal cancer were identified. The three main routes included: routine general practitioner (GP) referral (28%, 95% CI: 21–37%), emergency presentation (27%, 95% CI: 20–35%), and other outpatient services (26%, 95% CI: 19–34%). Patients diagnosed by routine GP referral had the longest time to diagnosis, impacting on timeliness of treatment.
Discussion: This study has generated detailed insights about pre-diagnostic routes for colorectal cancer in New Zealand and shown consistency with findings from previously published international research. The granular findings can now inform areas for person- and system-level interventions that, in turn, could be tested in future studies to minimise emergency department and late presentations for colorectal cancer treatment in New Zealand.
Keywords: Bowel symptoms; cancer diagnosis; colorectal cancer; diagnosis delay; general practice; health-care access; hospital care; New Zealand.
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