Abstract
BackgroundLung cancer stage at diagnosis predicts possible curative treatment. In Denmark and the UK, lung cancer patients have lower survival rates than citizens in most other European countries, which may partly be explained by a comparatively longer diagnostic interval in these two countries. In Denmark, a pathway was introduced in 2008 allowing general practitioners (GPs) to refer patients suspected of having lung cancer directly to fast-track diagnostics. However, symptom presentation of lung cancer in general practice is known to be diverse and complex, and systematic knowledge of the routes to diagnosis is needed to enable earlier lung cancer diagnosis in Denmark. This study aims to describe the routes to diagnosis, the diagnostic activity preceding diagnosis and the diagnostic intervals for lung cancer in the Danish setting.MethodsWe conducted a national registry-based cohort study on 971 consecutive incident lung cancer patients in 2010 using data from national registries and GP questionnaires.ResultsGPs were involved in 68.3% of cancer patients’ diagnostic pathways, and 27.4% of lung cancer patients were referred from the GP to fast-track diagnostic work-up. A minimum of one X-ray was performed in 85.6% of all cases before diagnosis. Patients referred through a fast-track route more often had diagnostic X-rays (66.0%) than patients who did not go through fast-track (49.4%). Overall, 33.6% of all patients had two or more X-rays performed during the 90 days before diagnosis. Patients whose symptoms were interpreted as non-alarm symptoms or who were not referred to fast-track were more likely to experience a long diagnostic interval than patients whose symptoms were interpreted as alarm symptoms or who were referred to fast-track.ConclusionsLung cancer patients followed several diagnostic pathways. The existing fast-track pathway must be supplemented to ensure earlier detection of lung cancer. The high incidence of multiple X-rays warrants a continued effort to develop more accurate lung cancer tests for use in primary care.
Highlights
Lung cancer stage at diagnosis predicts possible curative treatment
Danish general practitioners (GPs) act as gatekeepers to the rest of the health-care system, except for emergencies; and 99% of all Danish citizens are registered with a general practice which they consult for medical advice
The National Patient Registry (NPR) is a national populationbased database containing admission and discharge dates for all Danish citizens treated at Danish hospitals; and all recorded diagnoses are classified according to the International Classification of Diseases (ICD-10)
Summary
Lung cancer stage at diagnosis predicts possible curative treatment. In Denmark and the UK, lung cancer patients have lower survival rates than citizens in most other European countries, which may partly be explained by a comparatively longer diagnostic interval in these two countries. In 2005–2007, the one-year relative survival for all lung cancers was 35% in Denmark compared with 44% in Sweden [2] This figure could be explained by later diagnosis of lung cancer in Denmark as increased waiting time and diagnostic delay are generally believed to allow tumour stage progression. Danish patients’ survival deficit may be related to the degree of cancer awareness and the extent of diagnostic activity at the level of primary care. This calls for further investigation of the diagnostic pathway in Danish lung cancer patients
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