Referral of Patients with Suspected Colorectal Cancer by Family Physicians and Other Primary Care Providers

Patient Population

Adult patients presenting in primary care settings comprise the target population.

This guideline does not provide recommendations for patients who present with alarming emergency symptoms and signs of hemodynamic instability, acute gastrointestinal hemorrhaging, acute intestinal obstructions, or unremitting abdominal pain. These patients should be immediately referred to emergency for assessment and treatment. In addition, this guideline does not address CRC screening for asymptomatic patients.

Intended Guideline Users

FPs, general practitioners, emergency room physicians, other PCPs (nurse practitioners, registered nurses, and physician assistants), surgeons and gastroenterologists.

For the purposes of this document, we have referred to FPs, general practitioners, emergency room physicians, and other PCPs as ‘FPs and other PCPs’. Along the diagnostic assessment pathway, FPs and other PCPs should apply the College of Physicians and Surgeons of Ontario’s policy on Test Results Management to ensure that an appropriate response to test results is met.

This guideline is also intended for policymakers to help ensure that resources are in place so that target wait times can be achieved.

Research Question(s)

Overall Question

• How should patients presenting to family physicians (FPs) and other primary care providers (PCPs) with signs and/or symptoms of colorectal cancer (CRC) be managed?

The following questions are the factors considered in answering the overall question:

1. What signs, symptoms, and other clinical features that present in primary care are predictive of CRC?
2. What is the diagnostic accuracy of investigations commonly considered for patients presenting with signs and/or symptoms of CRC?
3. What major, known risk factors increase the likelihood of CRC in patients presenting with signs and/or symptoms of CRC?
4. Which factors are associated with delayed referral? Which delay factors can be attributed to patients, and which factors can be attributed to providers? Does a delay in the time to consultation affect patient outcome?