Abstract
BackgroundSome patients with cancer experience multiple pre-diagnostic consultations in primary care, leading to longer time intervals to specialist investigations and diagnosis. Patients with rarer cancers are thought to be at higher risk of such events, but concrete evidence of this is lacking.AimTo examine the frequency and predictors of repeat consultations with GPs in patients with rarer cancers.Design and settingPatient-reported data on pre-referral consultations from three English national surveys of patients with cancer (2010, 2013, and 2014), pooled to maximise the sample size of rarer cancers.MethodThe authors examined the frequency and crude and adjusted odds ratios for ≥3 (versus 1–2) pre-referral consultations by age, sex, ethnicity, level of deprivation, and cancer diagnosis (38 diagnosis groups, including 12 rarer cancers without prior relevant evidence).ResultsAmong 7838 patients with 12 rarer cancers, crude proportions of patients with ≥3 pre-referral consultations ranged from >30.0% to 60.0% for patients with small intestine, bone sarcoma, liver, gallbladder, cancer of unknown primary, soft-tissue sarcoma, and ureteric cancer. The range was 15.0–30.0% for patients with oropharyngeal, anal, parotid, penile, and oral cancer. The overall proportion of responders with any cancer who had ≥3 consultations was 23.4%. Multivariable logistic regression indicated concordant patterns, with strong evidence for variation between rarer cancers (P <0.001).ConclusionPatients with rarer cancers experience pre-referral consultations at frequencies suggestive of middle-to-high diagnostic difficulty. The findings can guide the development of new diagnostic interventions and ‘safety-netting’ approaches for symptomatic presentations encountered in patients with rarer cancers.
Highlights
Most patients with cancer first present with symptoms, typically to non-specialists;[1,2] ongoing initiatives in several countries aim to improve diagnostic timeliness for these patients.[3,4,5,6] Promptly suspecting the diagnosis in patients with rarer cancers who are symptomatic may be challenging, given their overall rarity and heterogeneous nature
The findings can guide the development of new diagnostic interventions and ‘safety-netting’ approaches for symptomatic presentations encountered in patients with rarer cancers
A key marker of diagnostic timeliness in patients who are symptomatic and subsequently diagnosed with cancer is the number of consultations they have with a GP before a specialist referral is made, which is highly correlated with the ‘primary care interval’
Summary
Most patients with cancer first present with symptoms, typically to non-specialists;[1,2] ongoing initiatives in several countries aim to improve diagnostic timeliness for these patients.[3,4,5,6] Promptly suspecting the diagnosis in patients with rarer cancers who are symptomatic may be challenging, given their overall rarity and heterogeneous nature. A key marker of diagnostic timeliness in patients who are symptomatic and subsequently diagnosed with cancer is the number of consultations they have with a GP before a specialist referral is made, which is highly correlated with the ‘primary care interval’ (time from first presentation to referral).[8,9] National audit data indicate primary care intervals of approximately 1, 1.5, and 3 months in patients who experience 3, 4, and ≥5 or more pre-referral consultations. Some patients with cancer experience multiple pre-diagnostic consultations in primary care, leading to longer time intervals to specialist investigations and diagnosis. Patients with rarer cancers are thought to be at higher risk of such events, but concrete evidence of this is lacking
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