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Presentations to general practice before a cancer diagnosis in Victoria: a cross‐sectional survey
Author(s) -
Lacey Karen,
Bishop James F,
Cross Hannah L,
Chondros Patty,
Lyratzopoulos Georgios,
Emery Jon D
Publication year - 2016
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja15.01169
Subject(s) - medicine , cancer , thyroid cancer , referral , breast cancer , odds ratio , cervical cancer , endometrial cancer , cross sectional study , colorectal cancer , confidence interval , pancreatic cancer , family medicine , pediatrics , pathology
Objective: To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist. Design, setting and participants: Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 2012 – 30 April 2013. Main outcome measures: The primary outcome was the proportion of patients who had had three or more GP consultations about cancer‐related health problems before being referred to hospital. The secondary outcome was the interval between the patient first suspecting a problem and their seeing a hospital specialist. Results: 34% of the patients included in the final analyses (426 of 1248) had visited a GP at least three times before referral to a hospital doctor. The odds ratios (reference: rectal cancer; adjusted for age, sex, language spoken at home, and socio‐economic disadvantage index score) varied according to cancer type, being highest for pancreatic cancer (3.2; 95% CI, 1.02–9.9), thyroid cancer (2.5; 95% CI, 0.9–6.6), vulval cancer (2.5; 95% CI, 0.7–8.7) and multiple myeloma (2.4; 95% CI, 1.1–5.5), and lowest for patients with breast cancer (0.4; 95% CI, 0.2–0.8), cervical cancer (0.5; 95% CI, 0.1–2.1), endometrial cancer (0.5; 95% CI, 0.2–1.4) or melanoma (0.7; 95% CI, 0.3–1.5). Cancer type also affected the duration of the interval from symptom onset to seeing a hospital doctor; it took at least 3 months for more than one‐third of patients with prostate or colon cancer to see a hospital doctor. Conclusion: Certain cancer types were more frequently associated with multiple GP visits, suggesting they are more challenging to recognise early. In Victoria, longer intervals from the first symptoms to seeing a hospital doctor for colon or prostate cancer may reflect poorer community symptom awareness, later GP referral, or limited access to gastroenterology and urology services.