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Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study
BACKGROUND: Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Yet, studies are sparse on the impact of such CPPs, and few have distinguished between referral routes. For incident cancer patients, we aimed to d...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164756/ https://www.ncbi.nlm.nih.gov/pubmed/25175155 http://dx.doi.org/10.1186/1471-2407-14-636 |
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author | Jensen, Henry Tørring, Marie Louise Olesen, Frede Overgaard, Jens Vedsted, Peter |
author_facet | Jensen, Henry Tørring, Marie Louise Olesen, Frede Overgaard, Jens Vedsted, Peter |
author_sort | Jensen, Henry |
collection | PubMed |
description | BACKGROUND: Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Yet, studies are sparse on the impact of such CPPs, and few have distinguished between referral routes. For incident cancer patients, we aimed to determine how often GPs suspected cancer at the time of first presentation of symptoms in general practice and to describe the routes of referral for further investigation. In addition, we aimed to analyse if the GP’s suspicion of cancer could predict the choice of referral to a CPP. Finally, we aimed to analyse associations between not only cancer suspicion and time to cancer diagnosis, but also between choice of referral route and time to cancer diagnosis. METHODS: We conducted a population-based, cross-sectional study of incident cancer patients in Denmark who had attended general practice prior to their diagnosis of cancer. Data were collected from GP questionnaires and national registers. We estimated the patients’ chance of being referred to a CPP (prevalence ratio (PR)) using Poisson regression. Associations between the GP’s symptom interpretation, use of CPP and time to diagnosis were estimated using quantile regression. RESULTS: 5,581 questionnaires were returned (response rate: 73.8%). A GP was involved in diagnosing the cancer in 4,101 (73.5%) cases (3,823 cases analysed). In 48.2% of these cases, the GP interpreted the patient’s symptoms as ‘alarm’ symptoms suggestive of cancer. The GP used CPPs in 1,426 (37.3%) cases. Patients, who had symptoms interpreted as ‘vague’ had a lower chance of being referred to a CPP than when interpreted as ‘alarm’ symptoms (PR = 0.53 (95%CI: 0.48;0.60)). Patients with ‘vague’ symptoms had a 34 (95% CI: 28;41) days longer median time to diagnosis than patients with ‘alarm’ symptoms. CONCLUSIONS: GPs suspect cancer more often than they initiate a CPP, and patients were less likely to be referred to a CPP when their symptoms were not interpreted as alarm symptoms of cancer. The GP’s choice of referral route was a strong predictor of the duration of the diagnostic interval, but the GP’s symptom interpretation was approximately twice as strong an indicator of a longer diagnostic interval. |
format | Online Article Text |
id | pubmed-4164756 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-41647562014-09-17 Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study Jensen, Henry Tørring, Marie Louise Olesen, Frede Overgaard, Jens Vedsted, Peter BMC Cancer Research Article BACKGROUND: Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Yet, studies are sparse on the impact of such CPPs, and few have distinguished between referral routes. For incident cancer patients, we aimed to determine how often GPs suspected cancer at the time of first presentation of symptoms in general practice and to describe the routes of referral for further investigation. In addition, we aimed to analyse if the GP’s suspicion of cancer could predict the choice of referral to a CPP. Finally, we aimed to analyse associations between not only cancer suspicion and time to cancer diagnosis, but also between choice of referral route and time to cancer diagnosis. METHODS: We conducted a population-based, cross-sectional study of incident cancer patients in Denmark who had attended general practice prior to their diagnosis of cancer. Data were collected from GP questionnaires and national registers. We estimated the patients’ chance of being referred to a CPP (prevalence ratio (PR)) using Poisson regression. Associations between the GP’s symptom interpretation, use of CPP and time to diagnosis were estimated using quantile regression. RESULTS: 5,581 questionnaires were returned (response rate: 73.8%). A GP was involved in diagnosing the cancer in 4,101 (73.5%) cases (3,823 cases analysed). In 48.2% of these cases, the GP interpreted the patient’s symptoms as ‘alarm’ symptoms suggestive of cancer. The GP used CPPs in 1,426 (37.3%) cases. Patients, who had symptoms interpreted as ‘vague’ had a lower chance of being referred to a CPP than when interpreted as ‘alarm’ symptoms (PR = 0.53 (95%CI: 0.48;0.60)). Patients with ‘vague’ symptoms had a 34 (95% CI: 28;41) days longer median time to diagnosis than patients with ‘alarm’ symptoms. CONCLUSIONS: GPs suspect cancer more often than they initiate a CPP, and patients were less likely to be referred to a CPP when their symptoms were not interpreted as alarm symptoms of cancer. The GP’s choice of referral route was a strong predictor of the duration of the diagnostic interval, but the GP’s symptom interpretation was approximately twice as strong an indicator of a longer diagnostic interval. BioMed Central 2014-08-30 /pmc/articles/PMC4164756/ /pubmed/25175155 http://dx.doi.org/10.1186/1471-2407-14-636 Text en © Jensen et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Jensen, Henry Tørring, Marie Louise Olesen, Frede Overgaard, Jens Vedsted, Peter Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study |
title | Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study |
title_full | Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study |
title_fullStr | Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study |
title_full_unstemmed | Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study |
title_short | Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study |
title_sort | cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based gp survey and registry study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164756/ https://www.ncbi.nlm.nih.gov/pubmed/25175155 http://dx.doi.org/10.1186/1471-2407-14-636 |
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