Cancer suspicion in general practice, urgent referral and time to diagnosis: A population-based GP survey and registry study

136Citations
Citations of this article
145Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

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.

References Powered by Scopus

Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012

4379Citations
N/AReaders
Get full text

Updating and validating the charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries

4291Citations
N/AReaders
Get full text

Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio

3019Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Symptom Signatures and Diagnostic Timeliness in Cancer Patients: A Review of Current Evidence

118Citations
N/AReaders
Get full text

The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers

110Citations
N/AReaders
Get full text

The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer-a cross-sectional study of patient characteristics and cancer probability

97Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Jensen, H., Tørring, M. L., Olesen, F., Overgaard, J., & Vedsted, P. (2014). Cancer suspicion in general practice, urgent referral and time to diagnosis: A population-based GP survey and registry study. BMC Cancer, 14(1). https://doi.org/10.1186/1471-2407-14-636

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 56

62%

Researcher 29

32%

Lecturer / Post doc 3

3%

Professor / Associate Prof. 2

2%

Readers' Discipline

Tooltip

Medicine and Dentistry 60

75%

Nursing and Health Professions 10

13%

Social Sciences 7

9%

Neuroscience 3

4%

Article Metrics

Tooltip
Mentions
Blog Mentions: 1

Save time finding and organizing research with Mendeley

Sign up for free