Diagnostic delay in cancer in primary health care Before and after introducing urgent referrals for suspected cancer

1
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.

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Outline

• Background
• Methods
• Results
• Conclusion

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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 

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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

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Fast track diagnosisColon cancer as example
Weekday no. Procedure
0 Referral received from GP Triage and referral letter to patient
5 Sigmoidoscopy (and rectoscopy if needed) Informing the patient about the plan for fast track
7 Chest x-ray and CT scan of the abdomen
8 Radiological diagnosis
9 Preliminary examination by medical specialist Information on diagnosis and treatment Informed consent to treatment Date of operation Preoperative nurse consult
15 Admission
16 Operation
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Aim of this study
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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

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Flowchart
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ResultsDiagnoses without fast track
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ResultsDiagnoses with fast track
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ResultsDelay lt 30 days

• 80-85 had a delay less than 30 days
• No significant change after introducing fast
  track

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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

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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

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Thank you for your attention!

• mette.bach.larsen_at_alm.au.dk
• The project is financed by the The Novo Nordisk
  Foundation