Abstract
Background Sarcoma is a rare type of cancer with nonspecific symptoms and uncertain aetiology. Thus, timely diagnosis of sarcomas is a clinical challenge. The aim of this study was to investigate the use of healthcare services 24 months preceding a sarcoma diagnosis compared to a matched cohort. Materials and Methods The study was a retrospective, population-based, matched cohort registry-study. Patients with sarcoma in Denmark in 2000–2013 were identified in the Danish Sarcoma Registry (n = 2167) and matched 1 : 10 on gender, age, and listed general practice. Using a binomial regression model, incidence rate ratios were calculated for face-to-face contacts in general practice, inpatient and outpatient visits, surgery, paraclinical examinations, and diagnostic imaging. Analyses were stratified for sarcoma subtypes, grade, stage, gender, and presence of comorbidity. Results The sarcoma patients had significantly increased incidence rate ratios in use of healthcare services compared to the matched cohort a year before their diagnoses. An increase in consultation rates was seen 11 months before diagnosis for inpatient visits, 9 months before diagnosis in general practice and outpatient visits, 8 months before diagnosis for paraclinical examinations, and 4 and 3 months before diagnosis for diagnostic imaging and surgery, respectively. There were no clinical significant differences in length of increased consultation rates between sarcoma type, stage, and grade. Sarcoma patients with comorbidity had persistently higher consultation rates compared to patients without comorbidity. Conclusions The use of healthcare services among sarcoma patients increased several months before diagnosis in all healthcare sectors. The results reveal a diagnostic time window and a potential to refer, diagnose, and treat sarcoma patients in a timelier manner.
Highlights
Sarcoma is a rare cancer representing 1% of all newly diagnosed malignancies in Denmark [1]. e aetiology is generally unknown, and the symptoms mimic many benign conditions
An earlier diagnosis may have an impact on the size and stage at diagnosis and improve outcome, though different studies point towards contradictory results [3, 10,11,12]. e introduction of fast-track cancer referral pathways seems to have reduced the time from referral and until the sarcoma is diagnosed [13]. e largest part of waiting time before referral to a sarcoma centre can be ascribed to the patient and the local hospital [14]. us, the key to reduce time from symptom to treatment might lie in Sarcoma the time before the patient gets referred to a sarcoma centre [13]
From the Danish Sarcoma Registry (DSR), we identified patients ≥15 years of age with a histopathologically verified soft tissue or bone sarcoma located in the extremities or trunk wall diagnosed from 1 January 2000 till 31 December 2013 (n 2167). e index date was defined as the date of the final pathology report and the histopathological diagnosis of the sarcoma. e date of diagnosis was chosen based on the hierarchy produced by the European Network of Cancer Registries [20]. e DSR is a validated, national, population-based clinical database containing all patients with sarcoma in the extremities or trunk wall from 2000 onwards and holds information on patient characteristics and detailed data on tumour characteristics, surgical and oncological treatment, local and distant recurrences, and death [21, 22]
Summary
Sarcoma is a rare type of cancer with nonspecific symptoms and uncertain aetiology. us, timely diagnosis of sarcomas is a clinical challenge. e aim of this study was to investigate the use of healthcare services 24 months preceding a sarcoma diagnosis compared to a matched cohort. E aim of this study was to investigate the use of healthcare services 24 months preceding a sarcoma diagnosis compared to a matched cohort. E sarcoma patients had significantly increased incidence rate ratios in use of healthcare services compared to the matched cohort a year before their diagnoses. An increase in consultation rates was seen 11 months before diagnosis for inpatient visits, 9 months before diagnosis in general practice and outpatient visits, 8 months before diagnosis for paraclinical examinations, and 4 and 3 months before diagnosis for diagnostic imaging and surgery, respectively. Ere were no clinical significant differences in length of increased consultation rates between sarcoma type, stage, and grade. E use of healthcare services among sarcoma patients increased several months before diagnosis in all healthcare sectors. Conclusions. e use of healthcare services among sarcoma patients increased several months before diagnosis in all healthcare sectors. e results reveal a diagnostic time window and a potential to refer, diagnose, and treat sarcoma patients in a timelier manner
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