Improving Specialist Referral Times for Patients at Low Risk for Colorectal Cancer

Patients with colorectal cancer (CRC) who present with no alarming symptoms may encounter a longer time to referral of a specialist, according to a study published in Annals of Family Medicine.

The researchers retrospectively reviewed data for 309 patients (mean age, 66.7 years) from the Julius General Practitioners’ Network database linked to the Netherlands Cancer Registry. Patients had a confirmed CRC diagnosis between 2007 and 2011 and presented to a primary care physician with symptoms.

Factors associated with longer time to specialist referral

Women, those without a registered family history of CRC, those with a history of malignancy, patients who did not present with alarm symptoms (e.g., anemia, a palpable tumor, rectal blood loss, or unintended weight loss), and those with hemorrhoids at physical examination that needs to be subjected to internal hemorrhoid treatment were at risk for longer time to specialist referral. Only presentation without alarming symptoms showed a statistically significant association with long duration (relative risk = 1.7; 95% CI, 1.1-2.6). Some patients waited as long as 59 days or longer.

Thematic exploration of the diagnostic routes to referral of patients with the longest conferred two themes: “alternative working diagnosis” and “suboptimal diagnostic strategies.” Subthemes included “omitting to reconsider an initial diagnosis” and “lacking follow-up.”

“There is potential for reducing the longest times to referral for patients with CRC in primary care, with earlier reconsideration of the initial hypothesis and implementation of strict follow-up consultations,” the researchers concluded.