Can safety-netting improve cancer detection in patients with vague symptoms?

Nicholson, Brian D; Mant, David; Bankhead, Clare

doi:10.1136/bmj.i5515

Cited by 58 publications

(87 citation statements)

References 32 publications

(6 reference statements)

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“…Because all such symptoms are unspecific and many are vague, the GP must gather further information for a rational follow-up and safety-netting in cancer detection [26, 27]. In our abdominal cancer patients, symptoms were recorded in only one third of the individuals.…”

Section: Discussionmentioning

confidence: 99%

Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer

Holtedahl

Vedsted

Borgqúist

et al. 2017

Heliyon

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BackgroundAbdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms.MethodsOver a 10-day period, 493 GPs in Norway, Denmark, Sweden, Belgium, the Netherlands, and Scotland, recorded consecutive consultations: sex, date of birth and any specified abdominal symptoms. For patients with abdominal symptoms, additional data on non-specific symptoms, GPs’ diagnostic suspicion, and features of the consultation were noted. Data on all cancer diagnoses among all included patients were requested from the GPs eight months later.FindingsConsultations with 61802 patients were recorded. Abdominal symptoms were recorded in 6264 (10.1%) patients. A subsequent malignancy was reported in 511 patients (0.8%): 441 (86.3%) had a new cancer, 70 (13.7%) a recurrent cancer. Abdominal symptoms were noted in 129 (25.2%) of cancer patients (P < 0.001), rising to 34.5% for the 89 patients with cancer located in the abdominal region. PPV for any cancer given any abdominal symptom was 2.1%.In symptomatic patients diagnosed with cancer, GPs noted a suspicion of cancer for 85 (65.9%) versus 1895 (30.9%) when there was no subsequent cancer (P < 0.001). No suspicion was noted in 32 (24.8%) cancer patients. The GP’s intuitive cancer suspicion was independently associated with a subsequent new cancer diagnosis (OR 2.11, 95% CI 1.15–3.89).Laboratory tests were ordered for 45.4% of symptomatic patients, imaging for 10.4%, referral or hospitalization for 20.0%: all were more frequent in subsequent cancer patients (P < 0.001).InterpretationAbdominal symptoms pointed to abdominal cancers rather than to other cancers. However, the finding of abdominal symptoms in only one third of patients with an abdominal cancer, and the lack of cancer suspicion in a quarter of symptomatic cancer patients, provide challenges for GPs’ diagnostic thinking and referral practices.

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Section: Discussionmentioning

confidence: 99%

Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer

Holtedahl

Vedsted

Borgqúist

et al. 2017

Heliyon

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“…Safety netting is a diagnostic strategy used when necessary in primary care to ensure that patients are monitored throughout the diagnostic process until their symptoms or signs are explained. 1 It is widely regarded as best practice in UK primary care to protect against inaccurate working diagnoses. [1][2][3][4] It is especially important where diagnostic uncertainty exists or there is potential for a serious underlying diagnosis, such as cancer.…”

Section: Introductionmentioning

confidence: 99%

“…1 It is widely regarded as best practice in UK primary care to protect against inaccurate working diagnoses. [1][2][3][4] It is especially important where diagnostic uncertainty exists or there is potential for a serious underlying diagnosis, such as cancer. Several communication models include it as a core component of every GP consultation since Roger Neighbour laid out three core safetynetting questions in his GP communication book The Inner Consultation.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9] It has since become a broader construct also including a range of clinician responsibilities and health system functions, such as developing systems to identify consultations for persistent or recurrent symptoms despite a negative initial evaluation, in order to ensure that all tests are performed, referrals are completed, and results are followed up. 1 Inadequate safety netting is a recognised cause of diagnostic error in primary care. 4,10,11 Marked variation is reported when it is utilised, uncertainty exists about the most effective way of implementing it, especially for vague symptoms, and there is no evidence about which safety-netting strategies are feasible.…”

Section: Introductionmentioning

confidence: 99%

“…4,10,11 Marked variation is reported when it is utilised, uncertainty exists about the most effective way of implementing it, especially for vague symptoms, and there is no evidence about which safety-netting strategies are feasible. 1,8,12,13 Significant event audits (SEAs) of emergency cancer presentations expose ineffective or nonexistent safety netting as a potential driver of late cancer presentation. 11,14,15 Safety-netting advice may not always be given or it may get minimal uptake from patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

GPs’ understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care

et al. 2018

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What are the similarities and differences in lung cancer symptom appraisal and help‐seeking according to smoking status? A qualitative study with lung cancer patients

Black

Whitaker

et al. 2022

Psycho-Oncology

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Objective: Lung cancer in never-smokers represents a growing proportion of patients. The relationship between smoking status, symptom appraisal and helpseeking behaviour is complex. Little is known about cancer symptom-related health behaviours according to smoking status. The aim of the study was to explore lung cancer patients' experiences of a lung cancer diagnosis, identifying differences by smoking history. Method:This was a qualitative study involving telephone interviews with 40 lung cancer patients (20 never smokers, 11 former smokers and 9 current smokers). We used framework analysis to analyse the data using the Common Sense Model of Illness Self-Regulation as a theoretical framework, developed after initial analysis.Results: All patients were likely to delay seeking help for symptoms in primary care regardless of smoking history, but for different reasons. Smoking history was instrumental to how individuals perceived and responded to early symptoms of lung cancer. Differences in interpretation and coping responses to new symptoms seemed to be caused by the higher presence of comorbidities due to smoking, and perceptions of the current state of health. Individuals with a smoking history reported acting with urgency in seeking help and follow up, whereas patients who experienced low levels of concern were more easily reassured by clinicians, resulting in delays.Conclusions: Never and former smokers perceive, interpret, and respond to symptoms of lung cancer differently to smokers. However, few people attribute their lung symptoms to cancer initially, even with a smoking history. Interventions that drive increased urgency and vigilance in never smokers may be effective.

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Can safety-netting improve cancer detection in patients with vague symptoms?

Cited by 58 publications

References 32 publications

Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer

Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer

GPs’ understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care

What are the similarities and differences in lung cancer symptom appraisal and help‐seeking according to smoking status? A qualitative study with lung cancer patients

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