Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care

Holtedahl, Knut; Hjertholm, Peter; Borgqúist, Lars; Donker, Gé; Buntinx, Frank; Weller, David; Br̈aaten, Tonje; Månsson, Jörgen; Strandberg, Eva Lena; Campbell, Christine; Korevaar, Joke C.; Parajuli, Ranjan

doi:10.3399/bjgp18x695777

Cited by 17 publications

(26 citation statements)

References 27 publications

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“…Eight models are specifically for colorectal cancer: the Bristol-Birmingham equation (Marshall [ 29 ]), a Dutch model (Fijten [ 28 ]), a machine learning algorithm (Kop [ 32 ]), a Danish model (Nørrelund [ 31 ]), Qcancer (Hippisley-Cox [ 22 ]), RAT 2005 (Hamilton [ 33 ]), RAT 2009 (Hamilton [ 34 ]) and RAT 2017 (Stapley [ 35 ]). One model relates to metastatic cancer (RAT, Hamilton [ 36 ]), and the remaining four models cover multiple cancer sites which include colorectal cancer: Qcancer for males (Hippisley-Cox [ 37 ]), Qcancer for females (Hippisley-Cox [ 38 ]), a model for abdominal complaints (Muris [ 30 ]), and a model for abdominal cancers (Holtedahl 2018 [ 39 ]). Elias [ 27 ] and Collins [ 23 ] reported on the validation of one or more of the above models.…”

Section: Resultsmentioning

confidence: 99%

“…1989 Muris 1995 [ 30 ] (Netherlands) External validation Prospective cohort The Netherlands CEDAR study: Patients referred to endoscopy centres by participating Dutch primary care practices. 2009–2012 Elias 2017 [ 27 ] Abdominal model, Holtedahl and colleagues (2018) 4 Symptoms, Patient demographics Apparent performance Prospective cohort Norway, Denmark, Sweden, Scotland, Belgium, Netherlands GP records from the participating countries Holtedahl, 2018 [ 39 ] Abbreviation : RAT(s) Risk assessment tool(s) …”

Section: Resultsmentioning

confidence: 99%

“…Holtedahl and colleagues (2018) [ 39 ] detail the development of a prediction model for abdominal cancers. These are defined as all cancers of the digestive organs, female genital organs and urinary organs (including testis).…”

Section: Resultsmentioning

confidence: 99%

“…The models are in various stages of development. A total of 5 models (or versions of models) have only assessed apparent performance [ 35 , 36 , 39 , 41 , 43 ], two models have been internally validated (Qcancer for males and Qcancer for females), one model was updated as a result of using a different data source [ 43 ]. One of the four Qcancer versions [ 22 ], one RAT version [ 33 ] and four of the other prediction models [ 28 – 31 ] have been externally validated, the highest level of evidence identified in this systematic review.…”

Section: Resultsmentioning

confidence: 99%

“… ? Prediction model for abdominal cancers (Holtedahl and colleagues, 2018) [ 39 ] Holtedahl, 2018 Apparent performance ? ✓ ?…”

Section: Resultsmentioning

confidence: 99%

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Development, validation and effectiveness of diagnostic prediction tools for colorectal cancer in primary care: a systematic review

et al. 2020

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Background Tools based on diagnostic prediction models are available to help general practitioners (GP) diagnose colorectal cancer. It is unclear how well they perform and whether they lead to increased or quicker diagnoses and ultimately impact on patient quality of life and/or survival. The aim of this systematic review is to evaluate the development, validation, effectiveness, and cost-effectiveness, of cancer diagnostic tools for colorectal cancer in primary care. Methods Electronic databases including Medline and Web of Science were searched in May 2017 (updated October 2019). Two reviewers independently screened titles, abstracts and full-texts. Studies were included if they reported the development, validation or accuracy of a prediction model, or assessed the effectiveness or cost-effectiveness of diagnostic tools based on prediction models to aid GP decision-making for symptomatic patients presenting with features potentially indicative of colorectal cancer. Data extraction and risk of bias were completed by one reviewer and checked by a second. A narrative synthesis was conducted. Results Eleven thousand one hundred thirteen records were screened and 23 studies met the inclusion criteria. Twenty-studies reported on the development, validation and/or accuracy of 13 prediction models: eight for colorectal cancer, five for cancer areas/types that include colorectal cancer. The Qcancer models were generally the best performing. Three impact studies met the inclusion criteria. Two (an RCT and a pre-post study) assessed tools based on the RAT prediction model. The third study looked at the impact of GP practices having access to RAT or Qcancer. Although the pre-post study reported a positive impact of the tools on outcomes, the results of the RCT and cross-sectional survey found no evidence that use of, or access to, the tools was associated with better outcomes. No study evaluated cost effectiveness. Conclusions Many prediction models have been developed but none have been fully validated. Evidence demonstrating improved patient outcome of introducing the tools is the main deficiency and is essential given the imperfect classification achieved by all tools. This need is emphasised by the equivocal results of the small number of impact studies done so far.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“… ? Prediction model for abdominal cancers (Holtedahl and colleagues, 2018) [ 39 ] Holtedahl, 2018 Apparent performance ? ✓ ?…”

Section: Resultsmentioning

confidence: 99%

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Development, validation and effectiveness of diagnostic prediction tools for colorectal cancer in primary care: a systematic review

et al. 2020

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Contacts to general practice in the 12 months preceding a diagnosis of an abdominal cancer: a national register-based cohort study

Jessen

Jensen

Falborg

et al. 2022

Scandinavian Journal of Primary Health Care

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Objective To compare the number of contacts to general practice across 11 types of abdominal cancer in the 12 months preceding a diagnosis. Design Nationwide register study. Setting Danish general practice. Subjects Forty-seven thousand eight hundred and ninety-eight patients diagnosed with oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney or bladder cancer in 2014–2018. Main outcome measures Monthly contact rates and incidence rate ratios (IRRs) of daytime face-to-face, email and telephone consultations in general practice across different abdominal cancers. The analyses were conducted for each sex and adjusted for age, comorbidity, marital status and education. Results Compared to women with colon cancer, women with rectal cancer had the lowest number of contacts to general practice (IRR 12 months pre-diagnostic (IRR –12 )=0.86 (95% CI: 0.80–0.92); IRR 1 month pre-diagnostic (IRR –1 )=0.85 (95% CI: 0.81–0.89)), whereas women with liver (IRR –12 =1.23 (95% CI: 1.09–1.38); IRR –1 =1.11 (95% CI: 1.02–1.20)), pancreatic (IRR –12 =1.08 (95% CI: 1.01–1.16); IRR 1 =1.52 (95% CI: 1.45–1.58)) and kidney cancer (IRR –12 =1.14 (95% CI: 1.05–1.23); IRR –1 =1.18 (95% CI: 1.12–1.24)) had the highest number of contacts. Men showed similar patterns. From seven months pre-diagnostic, an increase in contacts to general practice was seen in bladder cancer patients, particularly women, compared to colon cancer. Conclusions Using pre-diagnostic contact rates unveiled that liver, pancreatic, kidney and bladder cancers had a higher and more prolonged use of general practice. This may suggest missed opportunities of diagnosing cancer. Thus, pre-diagnostic contact rates may indicate symptoms and signs for cancer that need further research to ensure early cancer diagnosis. Key points The majority of cancer patients attend their general practitioner (GP) before diagnosis; however, little is known about the use of general practice across different abdominal cancers. This study suggests that a potential exists to detect some abdominal cancers at an earlier point in time. The contact patterns in general practice seem to be shaped by the degree of diagnostic difficulty. GPs may need additional diagnostic opportunities to identify abdominal cancer in symptomatic patients.

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Use of faecal immunochemical tests common in patients with suspected colorectal cancer but unrelated to travel distance to secondary care: a population-based study from Swedish primary care

Högberg

Cronberg

Thulesius

et al. 2022

Scandinavian Journal of Primary Health Care

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Background Evidence is increasing for the use of faecal immunochemical tests (FITs) for occult blood as diagnostic tools when colorectal cancer can be suspected. FITs have been used for this purpose in Swedish primary care since around 2005 despite absence of supporting guidelines. To our knowledge, the extent of this use has not been studied. Objective To investigate the use of FITs as diagnostic tools, and if the use was related to patient age, sex and travel time from primary care to diagnostic facilities in secondary care. Design Population-based retrospective study using data from electronic health records. Setting and subjects Patients ≥18 years that provided FITs in primary care in five Swedish health care regions during 2015. Driving times from their primary care centres to secondary care were calculated. Main outcome measures The proportion of patients that provided FITs was calculated for each region, different age intervals and grouped driving times. Results 18,913 patients provided FITs. The proportion of listed patients in the five regions that provided FITs increased with age: 0.86–1.2% for ages <65 years, 3.6–4.1% for ages 65–79 years and 3.8–6.1% for ages ≥80 years. Differences between the regions were small. There was no overall correlation between the proportion of patients that provided FITs and driving time to secondary care. Conclusion FITs were used extensively in Swedish primary care with a higher use in older age groups. There was no tendency towards a higher use of FITs at primary care centres with longer driving times to secondary care. Key Points Evidence is increasing for the use of faecal immunochemical tests (FITs) as diagnostic tools when colorectal cancer can be suspected. We investigated the use of FITs in Sweden. FITs were used extensively in primary care especially in older age groups. There were small differences in the use of FITs between five studied health care regions. There was no tendency towards a higher use of FITs at primary care centres with longer driving times to diagnostic facilities in secondary care.

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Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care

Cited by 17 publications

References 27 publications

Development, validation and effectiveness of diagnostic prediction tools for colorectal cancer in primary care: a systematic review

Development, validation and effectiveness of diagnostic prediction tools for colorectal cancer in primary care: a systematic review

Contacts to general practice in the 12 months preceding a diagnosis of an abdominal cancer: a national register-based cohort study

Use of faecal immunochemical tests common in patients with suspected colorectal cancer but unrelated to travel distance to secondary care: a population-based study from Swedish primary care

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