Abstract

IntroductionFast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries. Our objective was to analyze time intervals in the diagnostic routes of patients diagnosed with cancer at Sweden’s first Diagnostic Center (DC) for nonspecific symptoms and compare with time intervals of matched control patients.MethodsAdult patients with nonspecific symptoms that could not be explained by an initial investigation in primary care were eligible for referral to the DC. Patients diagnosed with cancer were matched with patients at another hospital within the same healthcare organization. We aimed for two control patients per DC-patient and matched on tumor type, age and sex. Five time intervals were compared: 1) patient interval (first symptom—primary care contact), 2) primary care interval (first visit—referral to the DC/secondary care), 3) diagnostic interval (first visit—cancer diagnosis), 4) information interval (cancer diagnosis—patient informed) and 5) treatment interval (cancer diagnosis—treatment start). Comparisons between groups and matched cohort analyses were made.ResultsSixty-four patients (22.1%) were diagnosed with cancer at the DC, of which eight were not matchable. Forty-two patients were matched with two controls and 14 were matched with one control. There were no significant differences in patient-, primary care-, or diagnostic intervals between the groups. The information interval was shorter at the DC compared to the control group (difference between matched pairs 7 days, p = 0.001) and the treatment interval was also shorter at the DC with significant differences in the matched analysis (difference between matched pairs 13 days, p = 0.049). The findings remained the same in four sensitivity analyses, made to compensate for differences between the groups.ConclusionsUp to diagnosis, we could not detect significant differences in time intervals between the DC and the control group. However, the shorter information and treatment intervals at the DC should be advantageous for these patients who will get timely access to treatment or palliative care. Due to limitations regarding comparability between the groups, the results must be interpreted with caution and further research is warranted.Trial registration ClinicalTrials.gov-ID: NCT01709539. Registration-date: October 18, 2012.

Highlights

  • Fast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries

  • A total of 64 patients were diagnosed with cancer at the diagnostic center (DC) during the study period

  • When introducing the DC-model, the goal was a primary care interval that should not exceed 15 days, but in a previous study, we found that only 41% of the patients diagnosed at the DC fulfilled the time goal in primary care and only 28% had gone through all recommended investigations prior to DC-referral [3]

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Summary

Introduction

Fast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries. Our objective was to analyze time intervals in the diagnostic routes of patients diagnosed with cancer at Sweden’s first Diagnostic Center (DC) for nonspecific symptoms and compare with time intervals of matched control patients. When Denmark presented its NSSC-CPP concept, researchers at the Regional Cancer Center in southern Sweden became interested and started a project with a similar pathway for patients in primary care that showed one or more of a number of pre-specified nonspecific symptoms. This resulted in Sweden’s first diagnostic center (DC), which was established at the central hospital of Kristianstad. At the DC, which has direct access to imaging facilities (computed tomography, positron emission tomography, ultrasound, and magnetic resonance imaging) and consultants specializing in different medical areas, a comprehensive investigation was performed until diagnosis was identified or ruled out [3]

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