Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study

Abstract

Background: Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Yet, studies are sparse on the impact of such CPPs, and few have distinguished between referral routes. For incident cancer patients, we aimed to determine how often GPs suspected cancer at the time of first presentation of symptoms in general practice and to describe the routes of referral for further investigation. In addition, we aimed to analyse if the GP's suspicion of cancer could predict the choice of referral to a CPP. Finally, we aimed to analyse associations between not only cancer suspicion and time to cancer diagnosis, but also between choice of referral route and time to cancer diagnosis.

Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

“…Patients presenting with alarm symptoms were less likely to be diagnosed with cancer following emergency admission, perhaps because patients with alarming symptoms are more likely to be referred using standard referral pathways. 13 Unlike a previous study that associated alarm symptoms with better survival, 25 this analysis could not confirm that finding.…”

“…There have been few meaningful attempts to compare urban and rural cancer diagnosis at the level of GP-patient interactions. Cancer is easier to detect and refer when alarm symptoms are present, 13,14 and harder when symptoms are atypical. 15 Subsequent diagnosis after presentation with non-alarm symptoms may therefore require more frequent engagement with health services, which may be hindered by poor accessibility.…”

Ovarian Cancer and Comorbidity: Is Poor Survival Explained by Choice of Primary Treatment or System Delay?

“…It has therefore been suggested that the NCPPs have benefited only patients with cancer-specific symptoms and potentially may do more harm than good to patients with unspecific symptoms who are not referred in the NCPP. 26 Our findings do however not support this hypothesis because we have not been able to demonstrate any benefit in regard to survival of treatments within NCPP limits. In contrast, we actually observe a significant better prognosis for patients experiencing delay longer than NCPP requirement.…”

Tumour stage and implementation of standardised cancer patient pathways: a comparative cohort study

“…35 Clearly, the chance of being referred to CPP increases as the underlying disease evolves and produces more severe symptoms. 36 This may also be why tumour stages tend to differ according to referral routes (CPP or not) in other studies, 7,9,18-20 may explain why GPs select the most severely ill cases for CPP referral, 37 and may explain why the patients referred and diagnosed within the 2-week wait framework had higher tumour stage than other patients. 38 Therefore, the level of disease may in itself be a confounder and thus may constitute an unacknowledged methodological problem, which challenges testing the effect of CPP implementation on earlier detection of cancer in symptomatic patients.…”