Symptoms and risk factors to identify men with suspected cancer in primary care: derivation and validation of an algorithm

Hippisley‐Cox, Julia; Coupland, Carol

doi:10.3399/bjgp13x660724

Cited by 98 publications

(136 citation statements)

References 23 publications

(44 reference statements)

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“…The CAPER studies and QCancer algorithums have provided an evolving set of risk prediction models for cancer types, including lung cancer[27,28], and for the risk of cancer overall[29,30]. Nevertheless, of a sample of patients who subsequently developed lung cancer, between 17%-34% of symptoms presented in the previous 24 months were not caused by the cancer[31].…”

Section: Discussionmentioning

confidence: 99%

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

et al. 2016

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BackgroundLung cancer symptoms are vague and difficult to detect. Interventions are needed to promote early diagnosis, however health services are already pressurised. This study explored symptomology and help-seeking behaviours of primary care patients at ‘high-risk’ of lung cancer (≥50 years old, recent smoking history), to inform targeted interventions.MethodsMixed method study with patients at eight general practitioner (GP) practices across south England. Study incorporated: postal symptom questionnaire; clinical records review of participant consultation behaviour 12 months pre- and post-questionnaire; qualitative participant interviews (n = 38) with a purposive sample.ResultsA small, clinically relevant group (n = 61/908, 6.7%) of primary care patients was identified who, despite reporting potential symptoms of lung cancer in questionnaires, had not consulted a GP ≥12 months. Of nine symptoms associated with lung cancer, 53.4% (629/1172) of total respondents reported ≥1, and 35% (411/1172) reported ≥2. Most participants (77.3%, n = 686/908) had comorbid conditions; 47.8%, (n = 414/908) associated with chest and respiratory symptoms. Participant consulting behaviour significantly increased in the 3-month period following questionnaire completion compared with the previous 3-month period (p = .002), indicating questionnaires impacted upon consulting behaviour. Symptomatic non-consulters were predominantly younger, employed, with higher multiple deprivation scores than their GP practice mean. Of symptomatic non-consulters, 30% (18/61) consulted ≤1 month post-questionnaire, with comorbidities subsequently diagnosed for five participants. Interviews (n = 39) indicated three overarching differences between the views of consulting and non-consulting participants: concern over wasting their own as well as GP time; high tolerance threshold for symptoms; a greater tendency to self-manage symptoms.ConclusionsThis first study to examine symptoms and consulting behaviour amongst a primary care population at ‘high- risk’ of lung cancer, found symptomatic patients who rarely consult GPs, might respond to a targeted symptom elicitation intervention. Such GP-based interventions may promote early diagnosis of lung cancer or other comorbidities, without burdening already pressurised services.

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Section: Discussionmentioning

confidence: 99%

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

et al. 2016

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“…In the UK, guidelines for referral of symptomatic patients have an explicit threshold of estimated risk of cancer in adult patients of 3%, and if followed could double the number of patients tested or referred (NICE )). The UK approach is linked to extensive research on the predictive value of different symptoms and symptom combinations (Hamilton et al., ; Hippisley‐Cox & Coupland, ,b). In Denmark, several innovative programmes to improve investigation and referral processes have been developed and tested.…”

Section: Discussionmentioning

confidence: 99%

Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership

et al. 2017

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A national internet-based survey of New Zealand (NZ) primary care physicians (n = 192) used the survey instrument developed by the International Cancer Benchmarking Partnership (ICBP). Practitioners were recruited by a range of methods assisted by NZ general practice networks and contacts. Compared to 11 other ICBP jurisdictions, direct access to diagnostic tests was more limited and took more time than in most other areas; the average wait for a test to be done and reported was 3.0 weeks for X-rays and 8.0 for ultrasound, compared to ICBP averages of 1.6 and 4.7 weeks respectively. Forty-five per cent of respondents could get specialist advice within 48 hr. Sixty-six per cent were aware of NZ guidelines for cancer in primary care, and of those 44% consulted them sometimes or often. Access to tests was greater, and time required much less, in the private than the public care system. NZ respondents each answered two of five clinical vignettes, with results similar to other ICBP areas. The survey also included general practice trainees (N = 42); their results were similar to the main group. The results suggest that improvements in prompt access to diagnostic tests and referrals for suspected cancer need to be given priority in NZ.

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“…Despite the abovementioned low incidence of testicular neoplasm in the general population, according to recent published data from cancer databases from different European countries, in males aged 25-49, testicular cancer is the most common cancer, accounting for around 14% of all cases [10].…”

Section: Discussionmentioning

confidence: 99%

Ewing sarcoma of the testis: A case report and review of the literature

Peinado-Serrano¹,

Chinchón-Espino²,

Biscuola³

et al. 2017

Integr Cancer Sci Therap.

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Symptoms and risk factors to identify men with suspected cancer in primary care: derivation and validation of an algorithm

Cited by 98 publications

References 23 publications

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

Promoting Help-Seeking in Response to Symptoms amongst Primary Care Patients at High Risk of Lung Cancer: A Mixed Method Study

Investigations and referral for suspected cancer in primary care in New Zealand-A survey linked to the International Cancer Benchmarking Partnership

Ewing sarcoma of the testis: A case report and review of the literature

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