Healthcare utilisation in general practice and hospitals in the year preceding a diagnosis of cancer recurrence or second primary cancer: a population-based register study

Abstract

BackgroundThe organisation of cancer follow-up is under scrutiny in many countries, and general practice is suggested to become more involved. A central focus is timely detection of recurring previous cancer and new second primary cancer. More knowledge on the patient pathway before cancer recurrence and second primary cancer is warranted to ensure the best possible organisation of follow-up. We aimed to describe the healthcare utilisation in the year preceding a diagnosis of cancer recurrence or second primary cancer.MethodsThis nationwide register study comprises patients diagnosed with bladder, breast, colorectal, endometrial, lung, malignant melanoma and ovarian cancer in Denmark in 2008–2016. The frequency of healthcare contacts during the 12 months preceding a cancer recurrence or second primary cancer was estimated and compared to the frequency of cancer survivors in cancer remission. The main analyses were stratified on sex and healthcare setting. Furthermore, two sub-analyses were stratified on 1) sex, healthcare setting and age group and on 2) sex, healthcare setting and comorbidity status.ResultsThe study population consisted of 7832 patients with recurrence and 2703 patients with second primary cancer. On average, the patients were in contact with general practice one time per month in the 12th month preceding a new cancer diagnosis (recurrence or second primary cancer). Increasing contact rates were seen from 7 months before diagnosis in general practice and from 12 months before diagnosis in hospitals. This pattern was more pronounced in patients with cancer recurrence, younger patients and patients with no comorbidity. For instance, the contact rate ratios for hospital contacts in non-comorbid women with recurrence demonstrated 30% more contacts in the 12th month before recurrence and 127% more contacts in the 2nd month before recurrence.ConclusionsThe results show that cancer survivors are already seen in general practice on a regular basis. The increasing contact rates before a diagnosis of cancer recurrence or second primary cancer indicate that a window of opportunity exists for more timely diagnosis; this is seen in both general practice and in hospitals. Thus, cancer survivors may benefit from improvements in the organisation of cancer follow-up.

A nationwide register‐study of healthcare utilisation in the year preceding a colorectal cancer recurrence diagnosis

“…The pattern of healthcare utilisation in general practice and in hospitals is similar to the pattern found in a previous study on survivors of seven different cancer types (Rasmussen et al, 2019a). Still, we found a clearer pattern of more contacts in general practice for CRC survivors who were later diagnosed with recurrence compared with recurrencefree CRC survivors.…”

“…Still, we found a clearer pattern of more contacts in general practice for CRC survivors who were later diagnosed with recurrence compared with recurrencefree CRC survivors. This was seen despite less statistical precision caused by a smaller study population (Rasmussen et al, 2019a).…”

“…They have increased consultation rates in general practice for up to 6 years after a CRC diagnosis (Brandenbarg et al, 2017;Christensen et al, 2012). In Denmark, patients diagnosed with cancer recurrence have been shown to have increased number of contacts to general practice from 7 months before the recurrence diagnosis (Rasmussen et al, 2019a). These findings suggest that GPs are involved in cancerrelated care and recurrence detection.…”

Screening for second malignancies in mycosis fungoides: non‐Hodgkin lymphoma, Hodgkin lymphoma, lung cancer, bladder cancer and melanoma

“…These data show that patients with MF/NHL, MF/lung cancer and MF/bladder cancer have better prognosis than single malignancy patients alone, which suggests that either there is either some biological factor driving slower progression and thus facilitating diagnosis at an earlier stage, or more likely, that the Screening for second malignancies in MF increased contact with the healthcare system that comes with having a lymphoma (MF) has allowed these malignancies to be identified earlier. 19,20 Given decreases in immune surveillance in the setting of MF, the former is less likely. If the latter is true, it sharply underscores the importance of the dermatologist in identifying second malignancies.…”

Health care utilisation preceding relapse or second malignant neoplasm after childhood acute lymphoblastic leukaemia: a population-based matched cohort study

“…A recent study examining use of health care before a cancer recurrence or an SMN in adult cancer survivors reported increased use of health care up to a year before diagnosis among patients diagnosed with a wide range of solid tumours. 24 Based on knowledge on health care use before a primary cancer, it is expected that patients with solid tumours have a longer interval of increased health care utilisation. 15 17 …”