Abstract
BackgroundMany 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.MethodsWe 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.Results5,581 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.ConclusionsGPs 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.
Highlights
Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer
We estimated the associations between General practitioner (GP) symptom interpretation and diagnostic interval and between use of CPP and diagnostic interval using the ‘qcount’ procedure by Miranda [36] for quantile regression analysis [37] on the smoothed quantiles [38], as we considered the outcome to be count data
The response rate was higher for female patients, patients diagnosed with breast cancer and patients with high educational level
Summary
Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Standardised cancer patient pathways (CPPs) have been implemented during the last decade in many countries, including Denmark, to ensure fast diagnosis of patients suspected to have cancer. This strategy is intended to improve patient satisfaction, reduce waiting times and ensure earlier and faster diagnosis, which should improve the patient’s prognosis [1,2,3,4,5,6,7]. Previous studies of the British 2WW referrals have shown that the general practitioners’ (GPs) use of these referrals was from one in five to one in three of cancer patients and that patients not referred urgently had significantly longer duration of the time to diagnosis [8,9,10,11,12,13]
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