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Br J Gen Pract. 2016 Jun;66(647):e434-43. doi: 10.3399/bjgp16X684805. Epub 2016 Mar 29.

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

Author information

1
Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice and Section for General Medical Practice, Department of Public Health;
2
Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health; Department of Anthropology, School of Culture and Society;
3
Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
4
Department of Public Health, Aarhus University, Aarhus, Denmark.
5
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.

Abstract

BACKGROUND:

Some European countries have introduced standardised cancer patient pathways (CPPs), including urgent referrals, with the aim of diagnosing cancer at an earlier stage. This is despite a lack of evidence, particularly in patients with symptomatic cancer diagnosed via general practice.

AIM:

To compare tumour stages in patients with incident cancer diagnosed via general practice before, during, and after CPP implementation in Denmark in 2008-2009.

DESIGN AND SETTING:

A comparative cohort study of data from GPs and registries on patients with incident cancer listed with a GP before (n = 1420), during (n = 5272), and after (n = 2988) CPP implementation.

METHOD:

χ(2) test was used to compare stage distributions and logistic regression to estimate odds ratios (OR) of having local cancer after versus before CPP implementation.

RESULTS:

Distribution of tumour stages did not differ statistically significantly across time (P = 0.494) or between CPP use (P = 0.202). For all cancers combined, the OR of having local cancer after CPP implementation was 0.88 (95% confidence interval [CI] = 0.73 to 1.06) compared with before. For CPP-referred patients, the OR of having local cancer was 0.77 (95% CI = 0.62 to 0.94) compared with all patients before CPP implementation; the corresponding OR for non-CPP-referred patients was 0.96 (95% CI = 0.80 to 1.14).

CONCLUSION:

No clear tendencies were observed confirming earlier detection of cancer after rather than before CPP implementation. CPP-referred patients had lower odds of having local cancer after CPP implementation than all patients before CPP implementation; this could be because the GPs refer patients who are 'more ill' as urgent referrals.

KEYWORDS:

Denmark; cancer; early diagnosis; general practice; tumour stage; urgent referral

PMID:
27025558
PMCID:
PMC4871309
DOI:
10.3399/bjgp16X684805
[Indexed for MEDLINE]
Free PMC Article

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