One in five bowel cancer 'red flag' symptoms missed

One in five bowel cancer patients diagnosed in an emergency had "red flag" symptoms that should have been picked up earlier, a study in the British Journal of Cancer suggests.

And 16% of emergency bowel cancer patients had seen their GP three times or more with relevant symptoms.

Overall, these symptoms were less common in patients diagnosed at an emergency stage rather than earlier on.

The study looked at data on diagnoses in England from 2005 to 2006.

The researchers, from University College London and the London School of Hygiene and Tropical Medicine, focused on what had happened to patients in the five years leading up to their cancer diagnosis.

They analysed National Cancer Registry data that was linked to GP data for 1,606 patients from more than 200 GP practices.

Opportunities

They found that in England 22% of bowel cancers - colon and rectal cancer - were diagnosed after an emergency presentation.

Although many of these patients often did not display obvious symptoms for bowel cancer, making it harder for GPs to diagnose their cancer early, 17.5% of colon cancer patients and 23% of rectal cancer patients did have "red flag" symptoms.

The researchers say this indicates there could have been opportunities to pick up the disease earlier.

"I was begging them for help"

Paul, 47, from Manchester, started to feel unwell in 2007. He had no energy and constantly felt worn out.

Something was wrong, but the GP told him to lose some weight and come back if things did not improve.

He did go back - several times - and eventually, after he noticed blood in his stools, his GP arranged for a sample to be sent away for tests.

But there was a delay after his name was not put on his sample. And then, the test came back saying everything was OK.

However, he was increasingly concerned at feeling tired all the time. Sometimes after work, as a self-employed builder, he had to go straight to bed.

Finally, early in 2008, with the encouragement of his family and friends, he decided to pay to see a specialist privately.

Within days of having an internal examination and a scan, he was diagnosed with bowel cancer that had spread to his liver and lungs.

The following week, Mr Muscovitch had the first of several major operations to remove the cancer.

He says: "I was practically begging them in the end to do something.

"They told me that if I'd left it another couple of months, the cancer would have spread and I would have had no chance."

Doctors removed more than 2ft (60cm) of his bowel before taking half of his liver out too, then chemotherapy followed.

"My energy levels are back to a certain extent, but I'll never be the same as I was," he says.

"I can't do all the things I used to do because of all the surgery I've had - but I count my blessings."

Most patients, regardless of how they were diagnosed, visited their doctor in the year before their diagnosis.

And patients tended to see their doctors more often in the months and days leading up to their cancer diagnosis - whether it happened in an emergency or not.

The research team suggested that specially trained nurses could support GPs and act as a safety net during consultations.

Easier access to specialist advice for GPs was also important, the study said.

Most common symptoms during year before diagnosis among colon cancer patients:

abdominal pain
anaemia
diarrhoea
rectal bleeding

Among rectal cancer patients:

rectal bleeding
change in bowel habits
diarrhoea
abdominal pain

Cristina Renzi, lead researcher from University College London, said patients diagnosed with cancer after an emergency presentation did not fare as well as patients diagnosed by their GP.

"However, in most cases they visit their doctor for various reasons multiple times during the months leading up to their diagnosis, which could represent opportunities to diagnose the cancer earlier.

She added: "It's important to find ways to ensure these patients can be diagnosed at an early stage.

"And this study highlights the need to support GPs and give them the tools to diagnose and refer patients promptly when they feel it's necessary."

Dr Julie Sharp, head of patient information and health at Cancer Research UK, said diagnosing patients who were not showing typical symptoms of bowel cancer was very difficult.

"So research like this, to understand more about people's symptom histories, is crucial to find better ways to diagnose the disease at an early stage, when treatment is more likely to be successful."

http://www.bbc.com/news/health-37493706?yptr=yahoo

The Anger of Cancer

By SUSAN GUBAR

AUGUST 11, 2016 6:00 AM

LIVING WITH CANCER

Susan Gubar writes about life with ovarian cancer.

While dealing with lung cancer, my friend Nancy K. Miller seethed in her blog at pharmaceutical advertisements and hospital commercials that bombard us daily with pictures of joyous cancer patients supported by doting intimates. These jubilant characters have nothing to do with the frustrated people we know who periodically erupt in righteous indignation. I often must remind myself that anger needs to be understood as the flip side of the roiling fear that cancer instills in patients and also in caregivers.

Over the past few years, every member of my support group has bristled over well-intentioned but hurtful relatives.

Carrol enjoyed her Joan of Arc post-chemo look until her 82-year-old mother asked, “Why aren’t you wearing your wig to cover up?”

Carrol’s loyal husband, cross at her decision to retire, refused to discuss end-of-life planning. He wanted her to keep on fighting, whereas she wanted to cope with the recurrence that she expected and that did, to his great sorrow, soon end her life.

Our group ponders the marital feuds of a woman weakened by late-stage disease. Her traveling husband insists on a hired helper in the house, but she does not want her privacy invaded. With less equanimity, we hear Dana recount the desolation of an acquaintance whose partner deemed her reconstructed breasts “repulsive.”

It is hard not to smolder over people exploiting cancer as an opportunity to disappear. Many patients feel bereft of friends who find cancer socially awkward. Not knowing the “right thing to say or do,” they invent reasons to withdraw. Several books, like Letty Cottin Pogrebin’s “How to Be a Friend to a Friend Who’s Sick,” instruct the disappeared on what they might say or do. But why are such manuals necessary, since saying something like “I’m sorry, how can I help?” or “if you want to talk, I want to listen” is all that is needed?

Paradoxically, those who do the abandoning may dread abandonment. I have a friend who at the beginning of my illness — during surgery and chemotherapy — was exceptionally helpful. Yet while I went through a bad patch, all communication ceased. In my diary, I fumed at her selfishness. Only months later, after my condition stabilized, did she resurface to confess how shaken she had been at the thought of the chasm my death would leave in her life. But later, during another stressful period, she disappeared again. Chronic disease takes a toll.

Of course the rancor circulating among intimates can escalate if and when patients become infuriated by slipshod treatments: incensed at interminable waiting, indeterminate tests, bollixed scans, incomprehensible or aloof physicians, demeaning and debilitating protocols.

The actor Evan Handler and the psychologist Dan Shapiro have both written memoirs about careless or callous care that sparked their ire. Mr. Handler, dealing with leukemia, and Dr. Shapiro, with Hodgkin’s disease, fantasize about retaliating against incompetent or unfeeling medical professionals.

In a host of breast cancer memoirs, patients with a genetic mutation known as BRCA1 or 2 describe themselves as time bombs. Expressing anger not at doctors but at disease, the metaphor captures their anticipation of an imminent recurrence, but also their short fuse of alarm. They have been set to explode and it’s only a matter of ticking seconds before they do.

At some level, most of these patients probably know that their anger is a deflection of their misery at the indignities and suffering inflicted by cancer or its treatments. But they need to shoot off their mouths — as I do occasionally to my husband. When I erupt, the casualties may be innocent bystanders. I fulminate about a brilliant (healthy) colleague who repeatedly assures me that we are all terminal. Yeah, I think, but not exactly in the same way.

Such major and minor skirmishes are a reflex of the insidious dread generated by cancer in patients and in those with whom we interact. We must deal with panic about loss of control, fear of mutilation and pain, grief over disability and mortality. For cancer immerses us in frightful not-knowing: unknowingness of our changing bodies, of the causes of cancer, of when there is a recurrence, of other people about the nature of our disease, of how to estimate our odds or the length of our future, of how to make difficult medical and economic and familial decisions, of whether or where the cancer is spreading, of dying and death.

Historically, the appearance of cancer was (wrongly) attributed to the repressed anger of patients. In fact, contagious rage is not the cause but may be an effect of diagnosis and treatment.

Although there are people who manage to attain serenity through mettle or grace, jolly commercials and upbeat advertisements only make matters worse. On the other hand, sometimes it feels good getting mad at them.

Susan Gubar is the author of the new book “Reading and Writing Cancer: How Words Heal.”

http://well.blogs.nytimes.com/2016/08/11/the-anger-of-cancer/?action=click&contentCollection=well&module=NextInCollection&region=Footer&pgtype=article&version=column&rref=collection%2Fcolumn%2Fliving-with-cancer

Wednesday, September 28, 2016