Risk of cancer and repeated urgent referral after negative investigation for cancer

Nielsen, Ninna; Vedsted, Peter; Jensen, Henry

doi:10.1093/fampra/cmx138

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…To our knowledge only one study has previously studied the outcome of organ specific Danish CPPs. In that study 7.1% of patients who entered a LCPP without being diagnosed with cancer were referred to a second CPP within 6 months of follow-up compared to 3.9% in the present study with a follow-up period of 10 days [15].…”

Section: Discussioncontrasting

confidence: 62%

Outcomes and characteristics of Danish patients undergoing a lung cancer patient pathway without getting a lung cancer diagnosis. A retrospective cohort study

Skadhede

Christensen

Andersen

et al. 2021

European Clinical Respiratory Journal

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Section: Discussioncontrasting

confidence: 62%

Outcomes and characteristics of Danish patients undergoing a lung cancer patient pathway without getting a lung cancer diagnosis. A retrospective cohort study

Skadhede

Christensen

Andersen

et al. 2021

European Clinical Respiratory Journal

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“…12 A Danish study showed that 6% of patients who received a negative result after single cancer site investigation were rereferred within 6 months to another, 4.4% of whom are diagnosed with cancer. 42 Our results show that unexpected weight loss is associated with several cancer sites and so a broader investigative strategy may be better suited to these patients than one focussed on ruling-out a single cancer site. Focus in Northern Europe has shifted to the role of multidisciplinary diagnostic centres (MDCs) to achieve this.…”

Section: Implications For Research and Practicementioning

confidence: 77%

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

et al. 2020

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Background We aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines. Methods This retrospective matched cohort study used cancer registry linked electronic health records from the UK’s Clinical Practice Research Datalink from between 2000 and 2014. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site and stage. Results In all, 63,973 patients had UWL recorded, of whom 1375 (2.2%) were diagnosed with cancer within 2 years (days-to-diagnosis: mean 181; median 80). Men with UWL (HR 3.28 (2.88–3.73)) and women (1.87 (1.68–2.08)) were more likely than comparators to be diagnosed with cancer within 3 months. The association was greatest in men aged ≥50 years and women ≥70 years. The commonest cancers were pancreas, cancer of unknown primary, gastro-oesophageal, lymphoma, hepatobiliary, lung, bowel and renal-tract. The majority were late-stage, but there was some evidence of association with stage II and stage III cancers. In the 3–24 months after presenting with UWL, cancer diagnosis was less likely than in comparators. Conclusion UWL recorded in primary care is associated with a broad range of cancer sites of early and late-stage.

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“…Since several of the findings and symptoms of cancer are included in different CPPs it is not always clear which CPP to select. One study from Denmark identified this as a medical risk by showing that patients who were cleared from cancer in one CPP had a significantly higher risk of presenting with another cancer within 6 months [20]. This study highlights possible improvements in current CPPs, for example, a finding of gastrointestinal bleeding is currently included in three different CPPs and macroscopic haematuria is included in two, both for suspected kidney cancer and for suspected urinary and bladder cancer.…”

Section: Meaning Of the Study: Possible Mechanisms And Implications For Clinicians Or Policy Makersmentioning

confidence: 87%

Knowledge of and support for cancer patient pathways among general practitioners and other physicians – a study from Sweden

Backman

Johansson

Hellgren

2021

Scandinavian Journal of Primary Health Care

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Objective To investigate the expertise in and support of the implemented new method of cancer patient pathways (CPPs) among general practitioners (GPs) and other working physicians in Sweden. Design A survey in the form of 10 knowledge-based multiple-choice questions (MCQs) and two general questions about CPPs. Setting Physicians from two different regions in Sweden answered the survey between December 2018 and January 2019. Subjects GPs in primary care compared to other physicians. 155 participants completed the survey and the response rate was 65%. Main outcome measures Physicians’ self-estimated knowledge of CPPs in general and opinion of CPPs effect on mortality and morbidity. Their scores on 10 different MCQs. Scores were analysed in subgroups related to the physicians medical specialty and experience. Results A majority of all physicians (63%) felt that they had insufficient knowledge regarding the procedure of CPPs, and the average score from the MCQs was 3.8 out of 10 correct answers. The results showed that GPs performed significantly better than specialists from other disciplines. Conclusions The low percentage of correctly answered MCQs shows that the information about the entry part of CPPs needs to be improved. The study demonstrates a support for the system with CPPs because the physicians believed in its’ positive effects on morbidity and mortality, however, it also reveals a lack of self-estimated knowledge about the system with CPPs. Key points Cancer patient pathways (CPPs) is a newly implemented method in Sweden that aims to equalize cancer care and reduce the time to diagnosis and treatment. The proficiency of when to initiate an investigation according to a specific CPP seems low. General practitioners (GPs) performed significantly better on knowledge-based questions than other specialists did. Physicians rated their knowledge as insufficient regarding the procedure of CPPs. A clear majority of physicians believed that CPPs promotes a lower mortality and morbidity in cancer.

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Risk of cancer and repeated urgent referral after negative investigation for cancer

Cited by 8 publications

References 19 publications

Outcomes and characteristics of Danish patients undergoing a lung cancer patient pathway without getting a lung cancer diagnosis. A retrospective cohort study

Outcomes and characteristics of Danish patients undergoing a lung cancer patient pathway without getting a lung cancer diagnosis. A retrospective cohort study

The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations

Knowledge of and support for cancer patient pathways among general practitioners and other physicians – a study from Sweden

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