[Diagnostic testing practices of patients with early stage bowel cancer - without organ metastasis and synchronous cancer - between 2012 and 2020 within the publicly funded Hungarian healthcare].

Abstract

Introduction: Early detection and investigation of bowel cancers is crucial in order to increase the patients’ chances of survival, as failure and delay in diagnostic steps worsen survival results. Objective: To understand and characterize the diagnostic process of patients with early malignant bowel cancers, those having no organ metastasis and synchronous cancer, based on the analysis of patient visit data. Method: For our research, we used data of the outpatient care and hospital utilization provided by the National Health Insurance Fund for the period 2010–2021, of the demographics of the population with a social security identification number, and of the CT/MR examinations. Among the patients with ICD C17–C19 coded small, large bowel and ICD C20 coded rectal cancer, we assessed the examinations required to establish the diagnosis in the six months prior to the first therapeutic intervention: 1. faecal blood test; 2. ultrasound and/or X-ray; 3. biopsy, histology; 4. CT and/or PET/CT; 5. MR. In our analysis, we included patients with early-stage bowel cancer aged 30–89 years who were treated between 2012 and 2020. In addition to the demographic characteristics of the patients, descriptive statistical methods were used to measure the rate of examinations, the time elapsed between the first and last examination, the time between the last examination and the start of the first treatment, and the change over time. Results: Between 2012 and 2019, the proportion of patients without organ metastases and synchronous cancer improved from 63.2% to 68.4% in the C17–C19 group, and from 59.6% to 65.6% in the C20 group. In the small intestine-colon group, CT increased from 64.6% to 72.3%, and among rectal cancer patients, the proportion of those receiving MR examination increased from 9% to 33.5%. During the period, the proportion of patients receiving treatment within 14 days of the last diagnostic examination decreased moderately, by 8 percentage points. 6% of the treated patients had no previous documented diagnostic tests. Discussion: During the analysis period, we observed further improvements in imaging practice in line with international guidelines. Although more than half of the patients received care within 14 days of the last diagnostic step, the patient care pathway, which mostly consists of 2–4 steps, can be further shortened with appropriate support and coordination. Conclusion: Clinically relevant results can be generated from the patient visit data, which can be used by those involved in the field as well as in health policy and care management. The improvement of coding practices, the creation of domestic clinical guidelines, and the investigation and management of delays in the diagnostic steps are recommended. Orv Hetil. 2025; 166(20): 768–782.