Direct-access to abdominal ultrasonic investigation from general practice--the role in earlier cancer diagnosis

Ingeman, Mads Lind; Ormstrup, Tina; Vedsted, Peter

doi:10.1093/fampra/cmv004

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Gastroscopy was the most commonly studied DA test (27 studies), followed by lower GI endoscopy (proctoscopy, flexible sigmoidoscopy, or colonoscopy, 15 studies), [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] CT (three studies -two head, one chest), [65][66][67] ultrasound (three studiestwo abdominal, one gynaecological), [68][69][70] MRI (three studies), [71][72][73] X-ray (two studies), 74,75 gastroscopy and lower endoscopy combined (two studies), 76,77 mammogram (one study), 78 mammogram and ultrasound combined (one study), 79 MRI and CT combined (one study), 80,81 transvaginal sonography (one study), 82 and a range of radiological tests including MRI, CT, and barium meal (one study). 83 Fifty-seven studies (95%) reported DA testing performed in a hospital or specialist clinic setting, one utilised a DA test located in primary care, 28 and two did not specify location.…”

Section: Resultsmentioning

confidence: 99%

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

et al. 2018

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“…Of 1278 patients referred to the NSSC-CPP pathway by their general practitioners (GPs), a cross-sectional study reported that 16% of patients were diagnosed with cancer. 13 The most common symptoms recorded were weight loss (53%), fatigue (50%) and pain (37%). The most common clinical findings were ‘affected general condition’ (36%), GP ‘gut feeling’ (23%) and abnormal abdominal examination (13%).…”

Section: Introductionmentioning

confidence: 99%

“…Cancer was diagnosed across a broad range of 18 subgroups, the most common of which were lung (18%), colorectal (13%), haematological (10%), pancreatic (9%) and upper gastrointestinal (8%). 13 A later cohort study including 938 patients referred to the NSSC-CPP reported that 35% were diagnosed with serious disease within 3 months, of which one-third had cancer. 14 …”

Section: Introductionmentioning

confidence: 99%

The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

et al. 2018

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IntroductionCancer survival in England lags behind most European countries, due partly to lower rates of early stage diagnosis. We report the protocol for the evaluation of a multidisciplinary diagnostic centre-based pathway for the investigation of ‘low-risk but not no-risk’ cancer symptoms called the Suspected CANcer (SCAN) pathway. SCAN is a new standard of care being implemented in Oxfordshire; one of a number of pathways implemented during the second wave of the Accelerate, Coordinate, Evaluate (ACE) programme, an initiative which aims to improve England’s cancer survival rates through establishing effective routes to early diagnosis.Methods and analysisTo evaluate SCAN, we are collating a prospective database of patients referred onto the pathway by their general practitioner (GP). Patients aged over 40 years, with non-specific symptoms such as weight loss or fatigue, who do not meet urgent cancer referral criteria or for whom symptom causation remains unclear after investigation via other existing pathways, can be referred to SCAN. SCAN provides rapid CT scanning, laboratory testing and clinic review within 2 weeks. We will follow all patients in the primary and secondary care record for at least 2 years. The data will be used to understand the diagnostic yield of the SCAN pathway in the short term (28 days) and the long term (2 years). Routinely collected primary and secondary care data from patients not referred to SCAN but with similar symptoms will also be used to evaluate SCAN. We will map the routes to diagnosis for patients referred to SCAN to assess cost-effectiveness. Acceptability will be evaluated using patient and GP surveys.Ethics and disseminationThe Oxford Joint Research Office Study Classification Group has judged this to be a service evaluation and so outside of research governance. The results of this project will be disseminated by peer-reviewed publication and presentation at conferences.

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“…[304][305][306] In Denmark, the diagnostic interval has shortened signifi cantly, and direct access to investigations has been appropriately used. 303,307 Progress can also be made by technological innovation in point-of-care testing and detailed clinical audit studies. However, any system making referrals that are contingent on the presence of symptoms with high positive predictive values risks delays in the diagnosis of those with less specifi c symptoms.…”

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confidence: 99%

The expanding role of primary care in cancer control

Rubin

Berendsen

Crawford

et al. 2015

The Lancet Oncology

437

450

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The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise-from epidemiologists, psychologists, policy makers, and cancer specialists-has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to eff ect change are outlined. The strengths of primary care-its continuous, coordinated, and comprehensive care for individuals and families-are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.

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Direct-access to abdominal ultrasonic investigation from general practice--the role in earlier cancer diagnosis

Abstract: The findings in this study might indicate that GPs refer patients assessed to have a higher risk of cancer through direct-access US. The finding was statistically non-significant, and further research is required to confirm this result.

Cited by 4 publications

References 14 publications

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

Direct access cancer testing in primary care: a systematic review of use and clinical outcomes

The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer

The expanding role of primary care in cancer control

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