Diagnostic intervals before and after implementation of cancer patient pathways – a GP survey and registry based comparison of three cohorts of cancer patients

Jensen, Henry; Tørring, Marie Louise; Olesen, Frede; Overgaard, Jens; Fenger‐Grøn, Morten; Vedsted, Peter

doi:10.1186/s12885-015-1317-7

Cited by 69 publications

(74 citation statements)

References 32 publications

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“…9 Good access to primary care could be a factor in providing improved diagnosis of cancer, although evidence that reform of access to specialist assessment could reduce time to diagnosis is stronger. 303 By contrast with this view, evidence showed an association between low cancer survival and the strength of the gatekeeper system, although other country-level factors (such as service organisation) might also be involved. 44 Such an association suggests that, in some health-care systems, the gatekeeper is rationing the use of investigations by setting a high threshold for referral.…”

mentioning

confidence: 95%

“…[304][305][306] In Denmark, the diagnostic interval has shortened signifi cantly, and direct access to investigations has been appropriately used. 303,307 Progress can also be made by technological innovation in point-of-care testing and detailed clinical audit studies. However, any system making referrals that are contingent on the presence of symptoms with high positive predictive values risks delays in the diagnosis of those with less specifi c symptoms.…”

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confidence: 99%

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The expanding role of primary care in cancer control

Rubin

Berendsen

Crawford

et al. 2015

The Lancet Oncology

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448

450

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The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise-from epidemiologists, psychologists, policy makers, and cancer specialists-has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to eff ect change are outlined. The strengths of primary care-its continuous, coordinated, and comprehensive care for individuals and families-are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.

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confidence: 95%

mentioning

confidence: 99%

The expanding role of primary care in cancer control

Rubin

Berendsen

Crawford

et al. 2015

The Lancet Oncology

Self Cite

448

450

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“…24,25 Unfortunately, in the same period, a longer delay has been observed for patients not referred in an NCPP. 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.…”

Section: Discussionmentioning

confidence: 91%

“…We observed that crude odds for ''no primary surgery'' were significantly higher among patients with comorbidity (CCI = 1: OR, 1. 24 Univariate and multivariate logistic regression analyses for the association between system delay and comorbidity are presented in Table 5. No significant association between any level of comorbidity and system delay was observed for patients treated with NACT in neither univariate nor adjusted analyses (Table 3).…”

Section: Resultsmentioning

confidence: 99%

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

Noer

Sperling

Ottesen

et al. 2017

Int J Gynecol Cancer

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“…We divided the comorbidity scores into “none” (no recorded disease), “moderate” (score of 1 or 2) and “high” (score of 3 or more) [15]. …”

Section: Methodsmentioning

confidence: 99%

Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

et al. 2017

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BackgroundDetection of cancer in general practice is challenging because symptoms are diverse. Even so-called alarm symptoms have low positive predictive values of cancer. Nevertheless, appropriate referral is crucial. As 85% of cancer patients initiate their cancer diagnostic pathway in general practice, a Continuing Medical Education meeting (CME-M) in early cancer diagnosis was launched in Denmark in 2012. We aimed to investigate the effect of the CME-M on the primary care interval, patient contacts with general practice and use of urgent cancer referrals.MethodsA before-after study was conducted in the Central Denmark Region included 396 general practices, which were assigned to one of eight geographical clusters. Practices were invited to participate in the CME-M with three-week intervals between clusters. Based on register data, we calculated urgent referral rates and patient contacts with general practice before referral. Information about primary care intervals was collected by requesting general practitioners to complete a one-page form for each urgent referral during an 8-month period around the time of the CME-Ms. CME-M practices were compared with non-participating reference practices by analysing before-after differences.ResultsForty percent of all practices participated in the CME-M. There was a statistically significant reduction in the number of total contacts with general practice from urgently referred patients in the month preceding the referral and an increase in the proportion of patients who waited 14 days or more in general practice from the reported date of symptom presentation to the referral date from before to after the CME-M in the CME-M group compared to the reference group.ConclusionsWe found a reduced number of total patient contacts with general practice within the month preceding an urgent referral and an increase in the reported primary care intervals of urgently referred patients in the CME-M group. The trend towards higher urgent referral rates and longer primary care intervals may suggest raised awareness of unspecific cancer symptoms, which could cause the GP to register an earlier date of first symptom presentation. The standardised CME-M may contribute to optimising the timing and the use of urgent cancer referral.Trial registration NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0607-3) contains supplementary material, which is available to authorized users.

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Diagnostic intervals before and after implementation of cancer patient pathways – a GP survey and registry based comparison of three cohorts of cancer patients

Cited by 69 publications

References 32 publications

The expanding role of primary care in cancer control

The expanding role of primary care in cancer control

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

Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners - a before-after study

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