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Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey

Lacey, K; Bishop, JF; Cross, HL; Chondros, P; Lyratzopoulos, G; Emery, JD; (2016) Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey. The Medical Journal of Australia , 205 (2) pp. 66-71. 10.5694/mja15.01169. Green open access

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Abstract

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.

Type: Article
Title: Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey
Open access status: An open access version is available from UCL Discovery
DOI: 10.5694/mja15.01169
Publisher version: http://dx.doi.org/10.5694/mja15.01169
Language: English
Additional information: Lacey K, Bishop JF, Cross HL, et al. Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey. Med J Aust 2016; 205 (2): 66-71. © Copyright 2016. The Medical Journal of Australia - reproduced with permission.
Keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, PRIMARY-CARE, PANCREATIC-CANCER, DELAY, OUTCOMES
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health
URI: https://discovery.ucl.ac.uk/id/eprint/10048914
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