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Int J Cancer. 2017 Dec 15;141(12):2400-2409. doi: 10.1002/ijc.30916. Epub 2017 Sep 29.

Prognosis of cancer in persons with infrequent consultations in general practice: A population-based cohort study.

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Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Denmark.
Department of Public Health, Research Unit for General Practice, Aarhus University, Denmark.
Cancer Epidemiology and Population Health, King's College London, United Kingdom.


Cancer survival rates are lower in Denmark than in comparable European countries. This may partly be attributable to subgroups of cancer patients who seek medical attention at late disease stages. It is unknown if differences in usual (i.e. customary) consultation frequency in general practice are associated with cancer prognosis. We aimed to estimate the cancer prognosis of cancer patients stratified by their usual consultation frequency in general practice. We performed a population-based cohort study including 123,943 incident cancer patients aged 50 to 89 years diagnosed in Denmark in 2009 to 2013. We estimated associations between the patient's usual general practitioner (GP) consultation frequency 19 to 36 months before the cancer diagnosis and all-cause mortality by using hazard ratios (HR), estimated by Cox proportional hazards regression. We also estimated the associations between the patient's usual GP consultation frequency and tumour stage, by using logistic regression estimates of odds ratios (ORs). Patients who usually did not see their GP (non-consulters) had higher all-cause mortality [HR = 1.39 (95% CI: 1.33-1.44)] compared to patients who usually saw their GP three to five times during an 18 months period (average consulters). Non-consulters had higher odds of having distant tumour stage [OR = 1.46 (95% CI: 1.38-1.57)] than average consulters. Similar, yet less strong, patterns were seen among patients with low usual GP consultation frequency, yet not statistically significant for all cancer types. In conclusion, the association between usual GP non-consultation and cancer prognosis is a combination of at least two things: a mechanism through more advanced tumour stage and other independent factors.


(early) diagnosis; Denmark; general practice; mortality; neoplasm; neoplasm staging; non-attendance; prognosis

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