From: Risk prediction models for colorectal cancer in people with symptoms: a systematic review
Author, date, country, setting | Qualityf | Outcome | Data collection | Selection of variables | Identification of study population | Identification of outcome cases | Exclusions | Study population | ||
---|---|---|---|---|---|---|---|---|---|---|
Model development; Case-control studies | Ā | Ā | Ā | Ā | Ā | Ā | Ā | |||
Ā | Ā | Cases | Controls | Ā | Ā | Cases | Controls | |||
į Hamilton, 2005, UK, primary care [22] | M | CRC | Primary care records from 21 practices | Occurring in at least 2.5Ā % of cases or controls | >40Ā years with primary CRC | 5 controls per case matched for sex, general practice and age and alive at point of case diagnosis | Cancer registry at one hospital | Unobtainable records, no consultations in 2Ā years before diagnosis, previous CRC, residence outside Exeter at time of diagnosis. | 349 | 1,744 |
į Hamilton, 2009, UK, primary care [23] | M | CRC | THIN database | Literature review | > 30Ā years with CRC | Up to 7 controls without CRC matched for practice, sex and age | Diagnosis of CRC within study period | < 2Ā years of full electronic records before date of case diagnosis. | 5,477 | 38,314 |
Model development and external validation; Case-control study | Ā | Ā | Ā | Ā | Ā | Ā | Ā | |||
Ā | Ā | Cases | Controls | Ā | Ā | Cases | Controls | |||
į Marshall, 2011, UK, primary care [24] | H | CRC | BB equation development and CAPER Score external validation | |||||||
Ā | Ā | Ā | See Hamilton, 2009 [23] | As in Hamilton, 2009 plus patients with severe anaemia (Hbā<ā10Ā g/dl), rectal bleeding, abnormal rectal examination or positive FOBT, or without any of abdominal pain, weight loss, diarrhoea or constipation | 117 | 433 | ||||
Ā | Ā | CRC | CAPER Score development and BB equation external validation | |||||||
Ā | Ā | Ā | See Hamilton, 2005 [22] | |||||||
Model development and random split-sample internal validation; Cohort studies | Ā | Ā | Ā | Ā | Ā | Ā | ||||
Ā | Ā | Ā | Ā | Ā | Included | Cases (% of included) | ||||
į Hippisley-Cox, 2012, UK, primary care į (QCancerĀ® (colon)) [25] | H | CRC | QResearch database | 'Established predictor variables' and red flag symptoms | 30ā84 year-old patients registered with practices between 1/1/2000 and 30/09/2010 and without CRC | Incident cancer diagnosis in the 2Ā years after cohort entry recorded in GP records or ONS cause-of-death record | History of CRC, recorded red flag symptomf in the 12Ā months preceding the study date, or missing Townsend deprivation score. | Development | ||
F: 1,172,670 | F:4,798 (0.2Ā %) | |||||||||
M:1,178,382 | M:4,798 (0.2Ā %) | |||||||||
Internal validation | ||||||||||
F: 616,361 | F: 2603 (0.2Ā %) | |||||||||
M: 620,240 | M:2603 (0.2Ā %) | |||||||||
į Hippisley-Cox, 2013 (female), UK, primary care į (QCancerĀ® (combined)) [26] | H | CRC and 11 other cancersa | QResearch database | Previous study, and literature review | 25ā89 year-old patients registered with practices between 1/1/2000 and 1/04/2012 and without CRC | Incident cancer diagnosis in the 2Ā years after cohort entry recorded in GP records or ONS cause-of-death record | Recorded red flag symptomf in the 12Ā months before the study entry date, or missing Townsend deprivation score. | Development | ||
1,240,864 | 2607 (0.18Ā %) | |||||||||
Internal validation | ||||||||||
679,174 | 1725 (0.25Ā %) | |||||||||
į Hippisley-Cox, 2013 (male), UK, primary care į (QCancerĀ® (combined)) [27] | H | CRC and 9 other cancersb | QResearch database | Previous study, and literature review | 25ā89 year-old patients registered with practices between 1/1/2000 and 1/04/2012 and without CRC | Incident cancer diagnosis in the 2Ā years after cohort entry recorded in GP records or ONS cause-of-death record | Recorded red flag symptomf in the 12Ā months before the study entry date, or missing Townsend deprivation score. | Development | ||
1,263,071 | 3250 (0.26Ā %) | |||||||||
Internal validation | ||||||||||
667,603 | 1356 (0.2Ā %) | |||||||||
Model development; Cross-sectional studies | Ā | Ā | Ā | Ā | Ā | Ā | ||||
Ā | Ā | Ā | Ā | Ā | Included | Cases (% of included) | ||||
į Adelstein, 2010, Australia, secondary care [32] | H | CRC | Self-administered questionnaire | Not reported | Patientsā>ā18Ā years old scheduled for colonoscopy at hospitals | Complete colonoscopy and histology | Completion of questionnaireā>ā6Ā months before colonoscopy, advanced adenomac, incomplete colon evaluation | 7,736 | 159 (2.1Ā %) | |
į Adelstein, 2011, Australia, secondary care [31] | H | CRC | See Adelstein 2010 [32] | Completion of questionnaireā>ā6Ā months before colonoscopy, adenomad, incomplete colon evaluation | 6943 | 159 (2.3Ā %) | ||||
į Fijten, 1995, Netherlands, primary care [21] | L | CRC | Patient and doctor questionnaires, and blood sample | Literature review | Patients presenting to 83 GP practices with overt rectal bleeding or a history of visible rectal blood loss in previous 3Ā months. | Medical record review coded using the International Classification of Primary Care for diagnostic classification | Patients aged <18 or >75, pregnancy, urgent admission to hospital or follow-up not available. | 290 | 9 (3.4Ā %) | |
į Hurst, 2007, UK, secondary care [28] | M | CRC or pre-malignant adenomas | Proforma-based history, examination and blood sample | Not reported | All adult patients referred to a specialist colorectal clinic | Patients tracked until a definitive diagnosis was reached | Patients not further investigated after initial consultation or who did not attend follow up | 300 | 95 (31.7Ā %) | |
į Lam, 2002, Hong Kong, secondary care [20] | L | CRC or significant neoplasiae | Questionnaire conducted by non-medically trained interviewers | Not reported | New patients attending surgical department for rectal bleeding | Rigid sigmoidoscopy and proctoscopy, followed by barium enema or colonoscopy at the physician's discretion | Refusal for colonoscopy or barium enema | 174 | 29 (16.7Ā %) | |
į Mahadavan, 2011, UK, secondary care [29] | M | CRC | Self-administered questionnaire, history, faecal, blood and rectal samples | Not reported | All patients >40Ā years referred to a surgical clinic via the 2wwg system for colorectal cancer | Incident diagnosis of CRC within 6Ā months of study entry from primary care or hospital records confirmed histologically | Previous confirmed IBD, GI cancer, investigation of the bowel within the last 6Ā months or absent rectal sampling result | 714 | 72 (10.1Ā %) | |
Model development and external validation; Cross-sectional study | Ā | Ā | Ā | Ā | Ā | Ā | ||||
Ā | Ā | Ā | Ā | Ā | Included | Cases (% of included) | ||||
į Selvachandran, 2002, UK, secondary care (WNS) [30] h | H | CRC | Self-administered questionnaire | Not reported | Patients referred by GPs with symptoms suggestive of distal colonic or anorectal disease | Not reported (all patient's received endoscopy) | Not reported | 2,268 | 95 (4.2Ā %) | |
Model external validation; Cohort study | Ā | Ā | Ā | Ā | Ā | Ā | ||||
Ā | Ā | Model(s) validated | Ā | Ā | Ā | Ā | Ā | Ā | Included | Cases (% of included) |
į Collins, 2012, UK, primary care [33] | H | QCancerĀ® (colon) (female and male) [25] | THIN database | N/A | 30ā84 year-old patients registered with practices between 1/1/2000 and 30/09/2010 and without CRC | Incident cancer diagnosis of CRC in the 2Ā years after cohort entry | Patients with a history of CRC, a recorded red flag symptomf in the 12Ā months preceding the study date, registered <12Ā months with practice or with invalid dates | Female: 1,075,775 | Female:1,676 (0.15Ā %) | |
Ā | Ā | Ā | Ā | Ā | Ā | Ā | Ā | Ā | Male: 1,059,765 | Male: 2,036 (0.19Ā %) |
Model external validation; Cross-sectional studies | Ā | Ā | Ā | Ā | Ā | Ā | ||||
Ā | Ā | Model(s) Validated | Ā | Ā | Ā | Ā | Ā | Ā | Included (% of eligible) | Cases (% of included) |
į Ballal, 2009, UK, secondary care [35] | H | WNS [30] | Self-administered questionnaire | N/A | Patients with colorectal symptoms referred by GPs | A combination of rigid sigmoidoscopy, flexible sigmoidoscopy, colonoscopy or barium enema | Patients thought (on the basis of the referral) most likely to have right-sided CRC, or but did not attend for investigation | 3,457 | 186 (5.4Ā %) | |
į Hodder, 2005, UK, secondary care [34] | H | Self-administered questionnaire | N/A | Patients referred from primary care with colorectal symptoms | Secondary care investigations - minimum flexible sigmoidoscopy | Not reported | 3,302 | 156 (4.7Ā %) | ||
į Rai, 2008, UK, secondary care [11] | H | WNS [30] | Self-administered questionnaire | N/A | GP referral with any of: lower bowel-related symptoms, unexplained iron deficiency anaemia, positive FOBT, or palpable rectal/abdominal mass | Follow up during course of hospital investigations until a final diagnosis made | Patients admitted hospital as an emergency and subsequently diagnosed with CRC | 1,422 | 83 (5.84Ā %) | |
Model utility; cohort study | Ā | Ā | Ā | Ā | Ā | Ā | ||||
Ā | Ā | Model used | Ā | Ā | Ā | Ā | Outcome measures | Ā | Included | Interviews |
į Hamilton, 2013, UK, primary care [19] | L | Hamilton 2005 [22] | GP usage and outcomes from practices and local trusts; qualitative interviews | Not reported | Risk assessment tools (RATs) supplied to 614 GPs at 164 practices for 6Ā months; interviews with GP cancer network leads and sample of GP users from practices with differing patient demographics. | Number of 2WW referrals and colonoscopies for patients >40; symptoms used in RATs; qualitative interview data. | RATs performed on patients <40; RATs that did not identify the reported symptoms. | 1433 | 23 GP responders |