Increased consultation frequency in primary care, a risk marker for cancer: a case–control study

Ewing, Marcela; Naredi, Peter; Nemes, Szilárd; Zhang, Chenyang; Månsson, Jörgen

doi:10.1080/02813432.2016.1183692

Cited by 28 publications

(27 citation statements)

References 29 publications

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“…Most patients with lung cancer first present to their general practitioner (GP) [ 13 – 16 ]. Lung cancer often presents with symptoms that are very commonly encountered in primary care, making early diagnosis challenging.…”

Section: Introductionmentioning

confidence: 99%

Recognising Lung Cancer in Primary Care

2018

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Significant advances in the management of both early and advanced stage lung cancer have not yet led to the scale of improved outcomes which have been achieved in other cancers over the last 40 years. Diagnosis of lung cancer at the earliest stage of disease is strongly associated with improved survival. Therefore, although recent advances in oncology may herald breakthroughs in effective treatment, achieving early diagnosis will remain crucial to obtaining optimal outcomes. This is challenging, as most lung cancer symptoms are non-specific or are common respiratory symptoms which usually represent benign disease. Identification of patients at risk of lung cancer who require further investigation is an important responsibility for general practitioners (GPs). Diagnosis has historically relied upon plain chest X-ray (CXR), organised in response to symptoms. The sensitivity of this modality, however, compares unfavourably with that of computed tomography (CT). In some jurisdictions screening high-risk individuals with low dose CT (LDCT) is now recommended. However uptake remains low and the eligibility for screening programmes is restricted. Therefore, even if screening is widely adopted, most patients will continue to be diagnosed after presenting with symptoms. Achieving early diagnosis requires GPs to maintain an appropriate level of suspicion and readiness to investigate in high-risk patients or those with non-resolving symptoms. This article discusses the early detection of lung cancer from a primary care perspective. We outline risk factors and epidemiology, the role of screening and offer guidance on the recognition of symptomatic presentation and the investigation and referral of suspected lung cancer.

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Section: Introductionmentioning

confidence: 99%

Recognising Lung Cancer in Primary Care

2018

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“…[21,26,27]. Consultancy frequency represents another criterion of interest for further study; an increased frequency of consultancies has been documented during the year prior to a diagnosis of cancer [28,29]. This criterion has been included among the Danish cancer patient pathway referral criteria for patients with nonspecific symptoms [23].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

et al. 2019

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Background: Fast-track referral is an increasingly used method for diagnostic evaluation of patients suspected of having cancer. This approach is challenging and not used as often for patients with only nonspecific symptoms. In order to expedite the diagnostics for these patients, we established Sweden's first Diagnostic Center (DC) focusing on outcomes related to diagnoses and diagnostic time intervals. Material and Methods: The study was designed as a prospective cohort study. Patients aged 18 years who presented in primary care with nonspecific symptoms of a serious disease were eligible for referral to the DC after having completed an initial investigation. Acceptable diagnostic time intervals were defined to be a maximum of 15 days in primary care and 22 days at the DC. Diagnostic outcome, length of diagnostic time intervals and patient satisfaction were evaluated. Results: A total of 290 patients were included in the study. Cancer was diagnosed in 22.1%, other diseases in 64.1%, and no diagnosis was identified in 13.8% of these patients. Patients diagnosed with cancer were older, had shorter patient interval (time from first symptom to help-seeking), shorter DCinterval (time from referral decision in primary care to diagnosis) and showed a greater number of symptoms compared to patients with no diagnosis. The median primary care interval was 21 days and the median DC interval was 11 days. Few symptoms, no diagnosis, female sex, longer patient interval, and incomplete investigations were associated with prolonged diagnostic time intervals. Patient satisfaction was high; 86% of patients reported a positive degree of satisfaction with the diagnostic procedures. Conclusions: We demonstrated that the DC concept is feasible with a diagnosis reached in 86.2% of the patients in addition to favorable diagnostic time intervals at the DC and a high degree of patient satisfaction. ARTICLE HISTORY

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“…Our findings of symptom prevalence across a representative cohort of patients diagnosed with 1 of 28 cancer sites substantially augment previous evidence dominated by cancer site-specific symptom studies. 25 – 27 , 30 , 34 …”

Section: Discussionmentioning

confidence: 99%

The nature and frequency of abdominal symptoms in cancer patients and their associations with time to help-seeking: evidence from a national audit of cancer diagnosis

Koo

Wagner

Abel

et al. 2018

Journal of Public Health

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BackgroundRaising awareness of possible cancer symptoms is important for timely help-seeking; recent campaigns have focused on symptom groups (such as abdominal symptoms) rather than individual alarm symptoms associated with particular cancer sites. The evidence base supporting such initiatives is still emerging however; understanding the frequency and nature of presenting abdominal symptoms among cancer patients could inform the design and evaluation of public health awareness campaigns.MethodsWe examined eight presenting abdominal symptoms (abdominal pain, change in bowel habit, bloating/distension, dyspepsia, rectal bleeding, dysphagia, reflux and nausea/vomiting) among 15 956 patients subsequently diagnosed with cancer in England. We investigated the cancer site case-mix and variation in the patient interval (symptom-onset-to-presentation) by abdominal symptom.ResultsAlmost a quarter (23%) of cancer patients presented with abdominal symptoms before being diagnosed with one of 27 common and rarer cancers. The patient interval varied substantially by abdominal symptom: median (IQR) intervals ranged from 7 (0–28) days for abdominal pain to 30 (4–73) days for dysphagia. This variation persisted after adjusting for age, sex and ethnicity (P < 0.001).ConclusionsAbdominal symptoms are common at presentation among cancer patients, while time to presentation varies by symptom. The need for awareness campaigns may be greater for symptoms associated with longer intervals to help-seeking.

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Increased consultation frequency in primary care, a risk marker for cancer: a case–control study

Cited by 28 publications

References 29 publications

Recognising Lung Cancer in Primary Care

Recognising Lung Cancer in Primary Care

Diagnostic spectrum and time intervals in Sweden’s first diagnostic center for patients with nonspecific symptoms of cancer

The nature and frequency of abdominal symptoms in cancer patients and their associations with time to help-seeking: evidence from a national audit of cancer diagnosis

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