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Fam Pract. 2019 May 2. pii: cmz013. doi: 10.1093/fampra/cmz013. [Epub ahead of print]

Ovarian cancer suspicion, urgent referral and time to diagnosis in Danish general practice: a population-based study.

Author information

1
Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus C, Denmark.
2
Department of Public Health, Aarhus University, Aarhus C, Denmark.
3
Department of Gynaecology, Odense University Hospital, Odense, Denmark.

Abstract

BACKGROUND:

Ovarian cancer (OC) survival rates are lower in Denmark than in countries with similar health care. Prolonged time to diagnosis could be a contributing factor. The Danish cancer patient pathway (CPP) for OC was introduced in 2009. It provides GPs with fast access to diagnostic work-up.

OBJECTIVE:

To investigate cancer suspicion and pathway use among GPs and to explore the association between these factors and the diagnostic intervals (DIs).

METHODS:

We conducted a national population-based cohort study using questionnaires and national registers.

RESULTS:

Of the 313 women with participating GPs, 91% presented with symptoms within 1 year of diagnosis, 61% presented vague non-specific symptoms and 62% were diagnosed with late-stage disease. Cancer was suspected in 39%, and 36% were referred to a CPP. Comorbidity [prevalence ratio (PR): 0.53, 95% confidence interval (CI): 0.29-0.98] and no cancer suspicion (PR: 0.35, 95% CI: 0.20-0.60) were associated with no referral to a CPP. The median DI was 36 days. Long DIs were associated with no cancer suspicion (median DI: 59 versus 20 days) and no referral to a CPP (median DI: 42 versus 23 days).

CONCLUSIONS:

Nine in ten patients attended general practice with symptoms before diagnosis. Two-thirds initially presented with vague non-specific symptoms were less likely to be referred to a CPP and had longer DIs than women suspected of cancer. These findings underline the importance of supplementing the CPP with additional accelerated diagnostic routes.

KEYWORDS:

Denmark; general practice; ovarian neoplasms; referral; symptom assessment; time to diagnosis

PMID:
31046091
DOI:
10.1093/fampra/cmz013

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