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The role of general practice in routes to diagnosis of lung cancer in Denmark: a population-based study of general practice involvement, diagnostic activity and diagnostic intervals.

Guldbrandt LM, Fenger-Grøn M, Rasmussen TR, Jensen H, Vedsted P - BMC Health Serv Res (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. louise.guldbrandt@ph.au.dk.

ABSTRACT

Background: 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 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.

Methods: We conducted a national registry-based cohort study on 971 consecutive incident lung cancer patients in 2010 using data from national registries and GP questionnaires.

Results: GPs 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.

Conclusions: Lung 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.

No MeSH data available.


Related in: MedlinePlus

Routes to diagnosis for consecutive primary lung cancer patients.
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Fig1: Routes to diagnosis for consecutive primary lung cancer patients.

Mentions: A total of 990 lung cancer patients were identified in the NPR. We excluded 14 patients because the diagnosis could not be validated in the DCR. Five patients registered with a lung cancer diagnosis in the DCR before 1 January 2010 were also excluded. A questionnaire was sent to the GPs of the remaining 971 patients; 690 (71.1%) GPs responded (Figure 1). Patients listed with responding GPs had more advanced tumour stage at diagnosis (Table 2). Patients whose GPs were not involved in the diagnosis tended to be older and they were more likely to be living alone and to have a higher comorbidity score.Figure 1


The role of general practice in routes to diagnosis of lung cancer in Denmark: a population-based study of general practice involvement, diagnostic activity and diagnostic intervals.

Guldbrandt LM, Fenger-Grøn M, Rasmussen TR, Jensen H, Vedsted P - BMC Health Serv Res (2015)

Routes to diagnosis for consecutive primary lung cancer patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307896&req=5

Fig1: Routes to diagnosis for consecutive primary lung cancer patients.
Mentions: A total of 990 lung cancer patients were identified in the NPR. We excluded 14 patients because the diagnosis could not be validated in the DCR. Five patients registered with a lung cancer diagnosis in the DCR before 1 January 2010 were also excluded. A questionnaire was sent to the GPs of the remaining 971 patients; 690 (71.1%) GPs responded (Figure 1). Patients listed with responding GPs had more advanced tumour stage at diagnosis (Table 2). Patients whose GPs were not involved in the diagnosis tended to be older and they were more likely to be living alone and to have a higher comorbidity score.Figure 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark. louise.guldbrandt@ph.au.dk.

ABSTRACT

Background: 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 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.

Methods: We conducted a national registry-based cohort study on 971 consecutive incident lung cancer patients in 2010 using data from national registries and GP questionnaires.

Results: GPs 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.

Conclusions: Lung 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.

No MeSH data available.


Related in: MedlinePlus