Research into practice: prompt diagnosis of cancer in primary care

Rubin, Greg; Walter, Fiona M; Emery, Jon; Neal, Richard D; Hamilton, William; Wardle, Jane

doi:10.3399/bjgp14x681205

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…This is a key question as guidelines for urgent referral for suspected cancer are increasingly adopted and electronic tools are implemented, which provide estimates of the risk of undiagnosed cancer. Current thresholds range from 2% risk upwards, 125 but low thresholds are likely to increase the burden of low-risk patients being referred to specialist diagnostic services, with attendant costs in terms of psychological damage to patients and opportunity costs to the health service. Additionally, PCPs might become more risk averse and lower their thresholds in response to the public and political discourse around diagnostic delay.…”

Section: Resultsmentioning

confidence: 99%

“…Each epidemiological study has strengths and weaknesses, and provides diff erent, but complementary information that can help to improve the diagnostic accuracy of cancer in primary care. 125 Case-control studies, exemplifi ed by the Cancer Prediction in Exeter (CAPER) series of studies of colorectal, lung, prostate, brain, and ovarian cancers have made major contributions to this evidence base. 126 This methodological approach using large primary care databases has been extended to cover 16 cancers.…”

Section: Epidemiology Of Cancer Symptomsmentioning

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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Section: Resultsmentioning

confidence: 99%

Section: Epidemiology Of Cancer Symptomsmentioning

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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“…One-third of lung cancer patients have three or more pre-referral consultations compared with only 3% of patients diagnosed with breast cancer ( Lyratzopoulos et al , 2013 ). Furthermore, the pathway to diagnosis in primary care may be complex, and delays may occur with presentation complicated by comorbidity, false negative chest X-ray reports and delayed or declined referral ( Mitchell et al , 2013 ; Rubin et al , 2014 ).…”

mentioning

confidence: 99%

Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study

et al. 2015

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Background:This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis.Methods:Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage.Results:Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003).Conclusions:Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.

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“…For these 382 children of young adults diagnosed with breast cancer, only 117 (31%) had a family history recorded, coded as Family history of cancer (65), Family history of breast cancer (50), or Family history of neoplasm of breast (2). Only one child of the 198 male patients with breast cancer had a family history recorded.…”

Section: Current Family History Capture and Usementioning

confidence: 99%

“…Rubin et al presented a model in the BJGP to improve early diagnosis from referral to treatment. 2 In this Debate and Analysis we argue for an earlier step -linking patient-led online family pedigree tools with primary care electronic health records to inform early risk assessment, lifestyle choices, and diagnostic screening instead of waiting for patients to present with signs of illness.…”

mentioning

confidence: 99%