Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England

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• 作者：Dr Georgios Lyratzopoulos ; MD^a ; ^{gl290@medschl.cam.ac.uk} ; Richard D Neal ; PhD^b ; Josephine M Barbiere ; MPH^a ; Prof Gregory P Rubin ; FRCGP^c ; Gary A Abel ; PhD^a
• 刊名：Lancet Oncology
• 出版年：2012
• 期刊代码：184_14702045
• 类别：med
• 出版时间：April, 2012
• 卷：13
• 期：4
• 页码：353-365
• 文件大小：442 K

摘要

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Summary

Background

Information from patient surveys can help to identify patient groups and cancers with the greatest potential for improvement in the experience and timeliness of cancer diagnosis. We aimed to examine variation in the number of pre-referral consultations with a general practitioner between patients with different cancers and sociodemographic characteristics.

Methods

We analysed data from 41鈥?99 patients with 24 different cancers who took part in the 2010 National Cancer Patient Experience Survey in England. We examined variation in the number of general practitioner consultations with cancer symptoms before hospital referral to diagnose cancer. Logistic regression was used to identify independent predictors of three or more pre-referral consultations, adjusting for cancer type, age, sex, deprivation quintile, and ethnic group.

Findings

We identified wide variation between cancer types in the proportion of patients who had visited their general practitioner three or more times before hospital referral (7路4%[625 of 8408] for breast cancer and 10路1%[113 of 1124] for melanoma; 41路3%[193 of 467] for pancreatic cancer and 50路6%[939 of 1854] for multiple myeloma). In multivariable analysis, with patients with rectal cancer as the reference group, those with subsequent diagnosis of multiple myeloma (odds ratio [OR] 3路42, 95%CI 3路01-3路90), pancreatic cancer (2路35, 1路91-2路88), stomach cancer (1路96, 1路65-2路34), and lung cancer (1路68, 1路48-1路90) were more likely to have had three or more pre-referral consultations; conversely patients with subsequent diagnosis of breast cancer (0路19; 0路17-0路22), melanoma (0路34, 0路27-0路43), testicular cancer (0路47, 0路33-0路67), and endometrial cancer (0路59, 0路49-0路71) were more likely to have been referred to hospital after only one or two consultations. The probability of three or more pre-referral consultations was greater in young patients (OR for patients aged 16-24 years m>vsm> 65-74 years 2路12, 95%CI 1路63-2路75; p<0路0001), those from ethnic minorities (OR for Asian m>vsm> white 1路73, 1路45-2路08; p<0路0001; OR for black m>vsm> white 1路83, 1路51-2路23; p<0路0001), and women (OR for women m>vsm> men 1路28, 1路21-1路36; p<0路0001). We identified strong evidence of interactions between cancer type and age group and sex (p<0路0001 for both), and between age and ethnicity (p=0路0013). The model including these interactions showed a particularly strong sex effect for bladder cancer (OR for women m>vsm> men 2路31, 95%CI 1路98-2路69) and no apparent ethnic group differences in young patients aged 16-24 years, whilst the only cancers without an apparent age gradient were testicular cancer and mesothelioma.

Interpretation

Our findings could help to prioritise and stratify early diagnosis initiatives and research, focusing on patients with cancers and sociodemographic characteristics with the largest potential for improvement.

Funding

None.