Variations in symptoms, endoscopy use and emergency diagnosis of colorectal cancer by body mass index: a retrospective cohort study using linked electronic health records in England.
Body mass index (BMI) confers a higher risk of colorectal cancer (CRC) and may influence cancer diagnostic pathways. We investigated variations in diagnostic pathways by BMI category among patients with symptomatic CRC.
Retrospective cohort study using linked cancer registry, primary, and secondary care data.
England PARTICIPANTS: 5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015.
Route to CRC diagnosis (emergency presentation and fast-track referrals among patients with new-onset red flag symptoms), presenting symptoms and pre-diagnostic endoscopy use.
Red-flag symptoms (change in bowel habit, rectal bleeding) were more frequently recorded among patients with rectal cancer with obesity and overweight versus normal weight (65.2% and 65.5% vs 56.8%, respectively). Among colon cancer patients endoscopy during the year pre-diagnosis was used in a greater proportion of patients with obesity versus normal weight (72.8% vs 64.4%, p<0.001). Among patients with colon cancer with red-flag symptoms, being overweight versus normal weight was associated with higher odds of fast-track referral compared with diagnosis through other routes (OR: 1.48, 95% CI 1.16 to 1.88). Obesity was associated with lower odds of emergency presentation, compared with normal weight (colon 23.6% vs 32.1%; adjusted OR: 0.72, 95% CI 0.57 to 0.90; rectum 8.3% vs 14.8%; OR: 0.57, 95% CI 0.35 to 0.92).
Patients with CRC with higher BMI are more likely to be referred urgently and less likely to experience emergency cancer diagnosis than normal weight patients.
Retrospective cohort study using linked cancer registry, primary, and secondary care data.
England PARTICIPANTS: 5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015.
Route to CRC diagnosis (emergency presentation and fast-track referrals among patients with new-onset red flag symptoms), presenting symptoms and pre-diagnostic endoscopy use.
Red-flag symptoms (change in bowel habit, rectal bleeding) were more frequently recorded among patients with rectal cancer with obesity and overweight versus normal weight (65.2% and 65.5% vs 56.8%, respectively). Among colon cancer patients endoscopy during the year pre-diagnosis was used in a greater proportion of patients with obesity versus normal weight (72.8% vs 64.4%, p<0.001). Among patients with colon cancer with red-flag symptoms, being overweight versus normal weight was associated with higher odds of fast-track referral compared with diagnosis through other routes (OR: 1.48, 95% CI 1.16 to 1.88). Obesity was associated with lower odds of emergency presentation, compared with normal weight (colon 23.6% vs 32.1%; adjusted OR: 0.72, 95% CI 0.57 to 0.90; rectum 8.3% vs 14.8%; OR: 0.57, 95% CI 0.35 to 0.92).
Patients with CRC with higher BMI are more likely to be referred urgently and less likely to experience emergency cancer diagnosis than normal weight patients.
Authors
Kurland Kurland, Kaushal Kaushal, Benitez Majano Benitez Majano, Lyratzopoulos Lyratzopoulos, Renzi Renzi
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