Predictive patient characteristics and symptoms in patients with colorectal cancer in MST

Brunninkhuis, J.D.M. (2013) Predictive patient characteristics and symptoms in patients with colorectal cancer in MST. thesis, Medicine.

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Abstract

Introduction: Colorectal cancer (CRC) is a common disease, with a ten-year prevalence of more than 61,000 in the Netherlands. Prevalence rates and mortality of CRC is high in the East of the Netherlands (Twente). In September 2011 Coloncare started at the gastrointestinal (GI) department of a large teaching hospital in this region (Medical Spectrum Twente, (MST)), in order to standardize and fasten the diagnostic path of the patients after they had their colonoscopy. Patients from this Coloncare path were analyzed in this study. The purpose of this study is to gain insight in the demographics, risk factors and symptoms of these patients with CRC who had the diagnosis at the GI department in MST. Materials and methods: This study consists of two parts. The first compromises a description of the patients diagnosed with CRC at the GI department of the MST in the period from September 2011 - September 2012. Demographic data, risk factors, tumor characteristics and symptoms of these patients were analyzed by chart review. Using statistical analyses, differences between patients with a different tumor localization were analyzed. The second part is a nested case-control study, for this part also patients without CRC (control patients) were included. Using statistical analyses differences in patient characteristics and symptoms between the patients with CRC and control patients were analyzed. In addition, a prediction model for CRC was generated, using multiple logistic regression analysis. Results: 99 patients with CRC (mean age 69 ± 9 years, 72% male, mean BMI 27 ± 4 kg/m2) were included. In 12 %, there was a positive family history of CRC. 65% of the patients with CRC had a tumor located in the colon, 32% in the rectum and 3% in both colon and rectum. Patients with CRC presented with a mean duration of symptoms of 20 weeks. No relationship was found between duration of symptoms and stage of cancer. Most common symptoms in patients with CRC were a change in bowel habit (65%), rectal bleeding (53%) and abdominal pain (51%). A change in bowel habit and rectal bleeding were significantly associated with a distal localization of the tumor whereas anemia and fatigue were more often seen with a proximal localization. Abdominal pain was significantly associated with a tumor located in the colon and anal pain with a tumor located in the rectum. The comparison with 300 control patients showed that CRC patients were significantly older and more likely to be male. In addition, patients with CRC had significantly more symptoms compared to the controls and significantly more often rectal bleeding, weight loss, fatigue, anemia and (change in) flatulence. On the basis of the differences between patients with and without CRC, a prediction model was generated which included the following independent risk factors: age, male sex, the presence of rectal bleeding, the presence of fatigue and the use of iron supplementation. This prediction model for CRC has an area under the ROC curve of 0.79. Conclusions: Analysis of the 99 patients with CRC who presented at the GI department of the MST between September 2011 - September 2012 showed that the patients were elderly, mainly male and overweight. They presented with a change in bowel habit, rectal bleeding and abdominal pain as most common symptoms. Symptoms differed between patients with a different tumor localization. The nested case-control study indicated differences between the patients with CRC and control patients, making it possible to create a prediction model for CRC in this population including the independent variables of age, a male sex, the presence of rectal bleeding, the presence of fatigue and the use of iron supplementation. This model might help general practitioners and medical specialists to estimate the probability of CRC in individual patients, which will require further research.

Item Type:	Thesis (Thesis)
Supervisor name:	Guichelaar, Dr. M.M.J. and Department of Gastroenterology and and Hepatology and Medical Spectrum Twente, Enschede
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:57
Last Modified:	25 Jun 2020 10:57
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1793

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