Abstract
Background Early diagnosis of head and neck cancer (HNC) will improve patient outcomes. The low incidence of HNC renders its detection challenging for a general practitioner (GP) in primary health care (PHC). Patients and methods To examine these challenges, our cohort consisted of all patients visiting PHC centres in the City of Helsinki in 2016. We chose 57 ICD-10 codes representing a sign or symptom resulting from a possible HNC and compared data for all new HNC patients. Results A total of 242,211 patients (499,542 appointments) visited PHC centres, 11,896 (5%) of whom presented with a sign or symptom possibly caused by HNC. Altogether, 111 new HNCs were diagnosed within the Helsinki area, of which 40 (36%) were referred from PHC. The median delay from the initial PHC visit to the referral to specialist care was 5 days, whereby 88% of patients were referred within one month. Conclusions Despite the low incidence of HNC and the large number of patients presenting with HNC-related symptoms, GPs working in PHC sort out potential HNC patients from the general patient group in most cases remarkably effectively. KEY MESSAGES For every head and neck cancer (HNC) patient encountered in the primary health care, a general practitioner (GP) will meet approximately 6000 other patients, 100 of whom exhibit a sign or a symptom potentially caused by a HNC. Despite the low incidence of HNC, GPs referred patients to specialist care effectively, limiting the median delay from the initial appointment to referral to only 5 days.
Highlights
Any delay in the diagnosis and treatment of head and neck cancer (HNC) might affect patient outcome [1,2,3,4,5]
In Finland, it is compulsory for a general practitioner (GP) to select at least one diagnosis using the ICD-10 codes most accurately describing the reason for each primary health care (PHC) visit
We selected 57 ICD-10 codes we identified as representing a sign or symptom potentially caused by HNC, examining how often they were used in our patient population (Table 1)
Summary
Any delay in the diagnosis and treatment of head and neck cancer (HNC) might affect patient outcome [1,2,3,4,5]. In a recent Swedish study of 114,538 randomly selected adults from the general population, the prevalence of voice problems (tiring, strain or hoarseness) was 16.9% [7] Another population-based study among randomly selected adults from the United States found that symptoms indicative of chronic rhinosinusitis were reported by 11.5% of participants, 94–97% of whom experienced nasal congestion and/or obstruction [8]. These factors represent an immense challenge to GPs when sorting potential cancer patients from the general patient population. Conclusions: Despite the low incidence of HNC and the large number of patients presenting with HNC-related symptoms, GPs working in PHC sort out potential HNC patients from the general patient group in most cases remarkably effectively
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