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Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children

The UK has a longstanding system of general practice which provides the vast majority of primary care, including that for children. It acts as a 'gatekeeper' to more specialist care. Parents may also use accident and emergency departments as their first point of medical contact for their c...

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Autores principales: Pritchard-Jones, Kathy, Graf, Norbert, van Tinteren, Harm, Craft, Alan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862069/
https://www.ncbi.nlm.nih.gov/pubmed/26948824
http://dx.doi.org/10.1136/archdischild-2015-309212
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author Pritchard-Jones, Kathy
Graf, Norbert
van Tinteren, Harm
Craft, Alan
author_facet Pritchard-Jones, Kathy
Graf, Norbert
van Tinteren, Harm
Craft, Alan
author_sort Pritchard-Jones, Kathy
collection PubMed
description The UK has a longstanding system of general practice which provides the vast majority of primary care, including that for children. It acts as a 'gatekeeper' to more specialist care. Parents may also use accident and emergency departments as their first point of medical contact for their children. Outcomes in the UK for many conditions in children appear to be worse than in comparable European countries where there is direct access to care by paediatricians. We have therefore looked at pathways to diagnosis and compared outcomes in the childhood kidney cancer, Wilms' tumour, which has been treated in the UK and Germany within the same clinical trial for over a decade. We find that Wilms' tumours are significantly larger in volume and have a more advanced tumour stage at diagnosis in the UK compared to Germany. There is a small (∼3%) difference in event free and overall survival between the two countries. Our data suggest that the system of primary care for children in the UK is less likely to result in the incidental finding of an abdominal mass in a child with no or vague symptoms. This may be a reason for the poorer outcome.
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spelling pubmed-48620692016-05-12 Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children Pritchard-Jones, Kathy Graf, Norbert van Tinteren, Harm Craft, Alan Arch Dis Child Leading Article The UK has a longstanding system of general practice which provides the vast majority of primary care, including that for children. It acts as a 'gatekeeper' to more specialist care. Parents may also use accident and emergency departments as their first point of medical contact for their children. Outcomes in the UK for many conditions in children appear to be worse than in comparable European countries where there is direct access to care by paediatricians. We have therefore looked at pathways to diagnosis and compared outcomes in the childhood kidney cancer, Wilms' tumour, which has been treated in the UK and Germany within the same clinical trial for over a decade. We find that Wilms' tumours are significantly larger in volume and have a more advanced tumour stage at diagnosis in the UK compared to Germany. There is a small (∼3%) difference in event free and overall survival between the two countries. Our data suggest that the system of primary care for children in the UK is less likely to result in the incidental finding of an abdominal mass in a child with no or vague symptoms. This may be a reason for the poorer outcome. BMJ Publishing Group 2016-05 2016-03-06 /pmc/articles/PMC4862069/ /pubmed/26948824 http://dx.doi.org/10.1136/archdischild-2015-309212 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
spellingShingle Leading Article
Pritchard-Jones, Kathy
Graf, Norbert
van Tinteren, Harm
Craft, Alan
Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
title Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
title_full Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
title_fullStr Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
title_full_unstemmed Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
title_short Evidence for a delay in diagnosis of Wilms’ tumour in the UK compared with Germany: implications for primary care for children
title_sort evidence for a delay in diagnosis of wilms’ tumour in the uk compared with germany: implications for primary care for children
topic Leading Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862069/
https://www.ncbi.nlm.nih.gov/pubmed/26948824
http://dx.doi.org/10.1136/archdischild-2015-309212
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