Referral challenges for early-onset colorectal cancer

: a qualitative study in UK primary care

Abstract

The Incidence of colorectal cancer (CRC) In adults aged under 50 years is increasing in several Western nations. In the United Kingdom incidence rates have increased in the 25-49 year age group by 48% since the early 1990s. Paradoxically, the incidence rates in older patients are decreasing or appear to have stabilised, which is believed to be due to the introduction of bowel screening and improved awareness of the disease within this population group. It is well documented that younger patients experience longer diagnostic delays than their older counterparts.

National surveys have highlighted significant barriers to younger patients access timely care, which may be contributing to the late stage of presentation commonly seen in this population group. The purpose of this research is to explore awareness amongst General Practitioners (GPs) of the increasing incidence of early onset colorectal cancer {EOCRC) and to understand the potential barriers or facilitators faced by GPs when reforming younger adults with features suspicious for EOCRC.

Qualitative methodology, using virtual semi-structured interviews with seventeen GPs within Northern Ireland (NI). Reflective thematic analysis was conducted with reference to Braun and Clarke’s framework.

Three main themes were identified regarding awareness, diagnostic and referral challenges amongst participating GPs. Awareness challenges focused on perceptions of EOCRC being solely associated with hereditary cancer syndromes and CRC being a condition of older adults. Key diagnostic challenges centred around the commonality of lower gastrointestinal complaints and overlap in EORC symptoms with benign conditions. Restrictions in age-based referral guidance, having a higher threshold for younger patients and a GP ‘guilt complex’ surrounding over-referral to an overburdened secondary care as well as the impact of waiting lists summarised the referral challenges. Young women were perceived as being particularly disadvantaged with regards to delays in diagnosis with their symptoms being more readily attributed to benign diagnosis.

Date of Award	Jul 2025
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	HSC Research & Development Northern Ireland
Supervisor	Helen Reid (Supervisor) & Helen Coleman (Supervisor)