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Vol 60: august @BULLET août 2014 | Canadian Family Physician @BULLET Le Médecin de famille canadien 717 Guideline for referral of patients with suspected colorectal cancer by family physicians and other primary care providers

This paper is available in a repository.
This paper is available in a repository.

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Postprint: policy unknown
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Abstract

Objective The aim of this guideline is to assist FPs and other primary care providers with recognizing features that should raise their suspicions about the presence of colorectal cancer (CRC) in their patients. Composition of the committee Committee members were selected from among the regional primary care leads from the Cancer Care Ontario Provincial Primary Care and Cancer Network, the members of the Ontario Colorectal Cancer Screening Advisory Committee, and the members of the Cancer Care Ontario Gastrointestinal Cancer Disease Site Group. Methods This guideline was developed through systematic review of the evidence base, synthesis of the evidence, and formal external review involving Canadian stakeholders to validate the relevance of recommendations. Report Evidence-based guidelines were developed to improve the management of patients presenting with clinical features of CRC within the Canadian context. Conclusion The judicious balancing of suspicion of CRC and level of risk of CRC should encourage timely referral by FPs and primary care providers. This guideline might also inform indications for referral to CRC diagnostic assessment programs. C olorectal cancer (CRC) is one of the most common types of cancer in Canada. 1 Patients who present to FPs with symptoms of CRC are often at later stages of the disease. 2 In attempts to improve the rate of early detection of CRC, many jurisdictions across Canada have introduced population-based screening programs. Although CRC screening rates are increasing, they are low, and even with screening, patients with CRC can be missed. 2 Therefore, patients presenting with signs and symptoms predictive of CRC will depend on their FPs and other primary care providers (PCPs) to recognize, investigate, and refer them for further assessment and management of CRC. 3 In order to provide guidance for the introduction of CRC diagnostic assessment programs (DAPs) in Ontario, the Cancer Care Ontario (CCO) Provincial Primary Care and Cancer Network initiated collaboration in February 2009 with CCO's Program in Evidence-based Care (PEBC) to form the Colorectal Cancer Referral Working Group. The working group was tasked with determining how patients presenting to FPs and other PCPs with signs or symptoms of CRC should be managed. The following questions were evaluated in completing this overall objective. • What signs, symptoms, and other clinical features that present in primary care are predictive of CRC? • What is the diagnostic accuracy of investigations commonly con sidered for patients presenting with signs or symptoms of CRC? • What main known risk factors increase the likelihood of CRC in patients presenting with signs or symptoms of CRC? • Which patient and provider factors are associated with delayed referral?