department of general practice aarhus university diagnostic delay in cancer in primary health care...
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Department of General PracticeAarhus University
Diagnostic delay in cancer in primary health care
Before and after introducing
urgent referrals for suspected cancer
Mette Bach Larsen1,2, Peter Vedsted1, Dorte Gilså Hansen3, Frede Olesen1
1. The Research Unit for General Practice, Aarhus University. Bartholins Allé 2, DK-8000 Aarhus C.
2. Department of General Medicine, Aarhus University. Bartholins Allé 2, DK-8000 Aarhus C.
3. The Research Unit for General Practice, University of Southern Denmark. J.B Winsløvsvej 9A, DK-5000 Odense C.
Department of General PracticeAarhus University
Outline
Background
Methods
Results
Conclusion
Department of General PracticeAarhus University
Urgent referrals for suspected cancer Introduced in Denmark 1 April 2008
Head and neck cancer
Colorectal cancer
Lung cancer
Breast cancer
Aim
to reduce processing-times, in particular to reduce referral time, obtain faster diagnosing and quick onset of treatment
Department of General PracticeAarhus University
Reasoned suspicion Colon cancer as an example
Main principle
All patients aged 40 years or older with symptoms of bleeding, longterm change in bowel habits or significant worsening in general condition
High-risk patients
Above mentioned symptoms and disease in first degree relatives
Department of General PracticeAarhus University
Fast track diagnosisColon cancer as example
Weekday no. Procedure0 Referral received from GP
Triage and referral letter to patient5 Sigmoidoscopy (and rectoscopy if needed)
Informing the patient about the plan for fast track 7 Chest x-ray and CT scan of the abdomen8 Radiological diagnosis9 Preliminary examination by medical specialist
Information on diagnosis and treatmentInformed consent to treatmentDate of operationPreoperative nurse consult
15 Admission16 Operation
Department of General PracticeAarhus University
Aim of this study
First symptom
First contact with the GP
Initiation of investigation of cancer-related
symptoms
Referral to hospital
First in-hospital
visit
Diagnosis / referral to treatment
Initiation of treatment
Patient delay Doctor delay System delay
Diagnostic delay Treatment delay
Diagnostic delay Primary Health Care
Sektor
System delay Secondary Health Care
Department of General PracticeAarhus University
Methods
Cross-sectional study of 7,080 incident cancer patients
Questionnaires to the patients’ GPs
Inclusion before and after introduction of urgent referrals for suspected cancer
Patients dichotomised into two groups with or without access to fast track diagnosis
Department of General PracticeAarhus University
FlowchartIncident cancer patients
Before GP confirmation: N=8118
Previously cancer diagnosis (n=173)
No cancer (n=131)
Not incident (n=704)
No inclusion diagnosis (n=17)
More than one cancer diagnosis (n=13)
Patients eligible for inclusionAfter GP confirmation: N=7080
Patient refusing to participate (n=20)
GP refusing to participate (n=29)
Non-responders (n=1153)
Completed questionnairesN=5878 (response rate: 83%)
Complete data from first visit to referral n= 4201 (59%)
Department of General PracticeAarhus University
ResultsDiagnoses without fast track
Median 75% perc. 90% perc.4 days 23 days 76 days
010
020
030
040
0D
ela
y in
days
0 200 400 600 800 1000Patients
Delay over 1 year is set to 365 days
Before fast track diagnosisDiagnostic delay in primary health care: diagnoses without fast track
Median 75% perc. 90% perc.3 days 20 days 66 days
010
020
030
040
0D
ela
y in
days
0 200 400 600 800 1000Patients
Delay over 1 year is set to 365 days
After fast track diagnosisDiagnostic delay in primary health care: diagnoses without fast track
Department of General PracticeAarhus University
ResultsDiagnoses with fast track
Median 75% perc. 90% perc.0 days 13 days 56 days
010
020
030
040
0D
ela
y in
days
0 200 400 600 800 1000Patients
Delay over 1 year is set to 365 days
Before fast track diagnosisDiagnostic delay in primary health care: diagnoses with fast track
Median 75% perc. 90% perc.0 days 12 days 50 days
010
020
030
040
0D
ela
y in
days
0 200 400 600 800 1000Patients
Delay over 1 year is set to 365 days
After fast track diagnosisDiagnostic delay in primary health care: diagnoses with fast track
Department of General PracticeAarhus University
ResultsDelay < 30 days
80-85% had a delay less than 30 days
No significant change after introducing fast track
Department of General PracticeAarhus University
Conclusion
Overall diagnostic delay in primary health care is short
Significant wait for 15-20% of the patients
No effect of fast track on diagnostic delay in primary health care
Department of General PracticeAarhus University
Further research
Further research on why 15-20% of the patients are waiting 1 month or more
Further research on the effects of fast track
Fast track diagnosis vs. conventional diagnosis
How to handle patients with uncharacteristic symptoms
Department of General PracticeAarhus University
Thank you for your attention!
The project is financed by the The Novo Nordisk Foundation