Abstract
BackgroundKnowledge of patterns in cancer patients’ health care utilisation around the time of diagnosis may guide health care resource allocation and provide important insights into this groups’ demand for health care services. The health care need of patients with comorbid conditions far exceeds the oncology capacity and it is therefore important to elucidate the role of both primary and secondary care. The aim of this paper is to describe the use of health care services amongst incident cancer patients in Denmark one year before and one year after cancer diagnosis.MethodsThe present study is a national population-based case–control (1:10) registry study. All incident cancer patients (n = 127,210) diagnosed between 2001 and 2006 aged 40 years or older were identified in the Danish Cancer Registry. Data from national health registries were provided for all cancer patients and for 1,272,100 controls. Monthly consultation frequencies, monthly proportions of persons receiving health services and three-month incidence rate ratios for one year before and one year after the cancer diagnosis were calculated. Data were analysed separately for women and men.ResultsThree months before their diagnosis, cancer patients had twice as many general practitioner (GP) consultations, ten to eleven times more diagnostic investigations and five times more hospital contacts than the reference population. The demand for GP services peaked one month before diagnosis, the demand for diagnostic investigations one month after diagnosis and the number of hospital contacts three months after diagnosis. The proportion of cancer patients receiving each of these three types of health services remained more than 10% above that of the reference population from two months before diagnosis until the end of the study period.ConclusionsCancer patients’ health service utilisation rose dramatically three months before their diagnosis. This increase applied to all services in general throughout the first year after diagnosis and to the patients’ use of hospital contacts in particular. Cancer patients’ heightened demand for GP services one year after their diagnosis highlights the importance of close coordination and communication between the primary and the secondary healthcare sector.
Highlights
Knowledge of patterns in cancer patients’ health care utilisation around the time of diagnosis may guide health care resource allocation and provide important insights into this groups’ demand for health care services
Apart from a comprehensive British survey which showed much variation in the number of consultations with cancer symptoms before hospital referral for suspected cancer [8], most previous studies have included fewer than 500 cancer patients and have suggested that before the time of diagnosis, cancer patients use their general practitioner (GP) less than controls [9,10] with GP consultation frequencies peaking in the first month after diagnosis [11]
An interview study combined with data from hospital records of gastrointestinal cancer patients found a mean interval of 10 weeks between GP consultation and hospital referral [26], while we found a time interval of some months between the start of attending general practice and the start of treatment for cancer patients as a group
Summary
Knowledge of patterns in cancer patients’ health care utilisation around the time of diagnosis may guide health care resource allocation and provide important insights into this groups’ demand for health care services. Up to 2020, we expect to see a 20% increase in the incidence of cancer; a growth that may be attributed to demographic changes and advances in medicine which means that more citizens will be living with cancer [5] In this context, more knowledge of cancer patients’ patterns of demand for health care services before as well as after their diagnosis is critical to identifying possibilities for improving both patient pathways and health care resource allocation. More detailed knowledge of cancer patients’ health care resource demands and utilization patterns around the time of diagnosis may undoubtedly allow us to better organize health care supply and further shorten the time to cancer diagnosis, notably if particular health care utilizations patterns can be identified in large population-based cohorts Data from such studies may prove even more valuable if combined with information on referral to diagnostic investigations and use of hospital services which would help us identify specific patterns of health care use rooted in current clinical or organizational inexpediencies. Apart from a comprehensive British survey which showed much variation in the number of consultations with cancer symptoms before hospital referral for suspected cancer [8], most previous studies have included fewer than 500 cancer patients and have suggested that before the time of diagnosis, cancer patients use their general practitioner (GP) less than controls [9,10] with GP consultation frequencies peaking in the first month after diagnosis [11]
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