The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability

Abstract

BackgroundA Danish cancer pathway has been implemented for patients with serious non-specific symptoms and signs of cancer (NSSC-CPP). The initiative is one of several to improve the long diagnostic interval and the poor survival of Danish cancer patients. However, little is known about the patients investigated under this pathway. We aim to describe the characteristics of patients referred from general practice to the NSSC-CPP and to estimate the cancer probability and distribution in this population.MethodsA cross-sectional study was performed, including all patients referred to the NSSC-CPP at the hospitals in Aarhus or Silkeborg in the Central Denmark Region between March 2012 and March 2013. Data were based on a questionnaire completed by the patient’s general practitioner (GP) combined with nationwide registers. Cancer probability was the percentage of new cancers per investigated patient. Associations between patient characteristics and cancer diagnosis were estimated with prevalence rate ratios (PRRs) from a generalised linear model.ResultsThe mean age of all 1278 included patients was 65.9 years, and 47.5 % were men. In total, 16.2 % of all patients had a cancer diagnosis after six months; the most common types were lung cancer (17.9 %), colorectal cancer (12.6 %), hematopoietic tissue cancer (10.1 %) and pancreatic cancer (9.2 %). All patients in combination had more than 80 different symptoms and 51 different clinical findings at referral. Most symptoms were non-specific and vague; weight loss and fatigue were present in more than half of all cases. The three most common clinical findings were ‘affected general condition’ (35.8 %), ‘GP’s gut feeling’ (22.5 %) and ‘findings from the abdomen’ (13.0 %). A strong association was found between GP-estimated cancer risk at referral and probability of cancer.ConclusionsIn total, 16.2 % of the patients referred through the NSSC-CPP had cancer. They constituted a heterogeneous group with many different symptoms and clinical findings. The GP’s gut feeling was a common reason for referral which proved to be a strong predictor of cancer. The GP’s overall estimation of the patient’s risk of cancer at referral was associated with the probability of finding cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1424-5) contains supplementary material, which is available to authorized users.

Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data

“…Recent research has highlighted the range of biopsychosocial, contextual, and cultural influences on the ways in which people recognise, interpret, and act on symptoms. 21 The findings of this study add to this by suggesting that further influences, such as comorbidity, can complicate the diagnosis, as patients may not recognise symptoms as indicative of cancer and GPs may not act on them due to the known comorbidity. The authors also found that some patients experienced a 'gut feeling' that further influenced their diagnosis pathway.…”

Whole-Body 18F-FDG PET/CT Is Superior to CT as First-Line Diagnostic Imaging in Patients Referred with Serious Nonspecific Symptoms or Signs of Cancer: A Randomized Prospective Study of 200 Patients

“…Currently, 18 F-FDG PET/CT is not recommended as the primary method for investigation in this group of patients (24). However, because the estimated prevalence of cancer in patients referred to DOC is approximately 10-fold higher than in the abovementioned studies (9,10), the FP rate is expected to be substantially lower and 18 F-FDG PET/CT cannot be ruled out as the best firstline imaging modality in a high-cancer-prevalence population. Furthermore, the most common noncancer findings in this population of patients are rheumatoid or infectious diseases for which 18 F-FDG PET/CT has shown a better detection rate than routine CT (27).…”

“…The referral was typically prompted by one or more of the following observations: increasing health service-seeking behavior; weight loss; tiredness; or a group of unspecific symptoms, which did not fit into any of the organ-specific established cancer investigation programs. A cancer prevalence of 16%-18% was found in patients investigated at DOC for NSSC in Denmark (9,10).…”

Quality Development in Health Care: Participation vs. Accreditation

“…A need for a process-oriented quality program like DQM remains, even though formally DQM has been abolished for Danish hospitals (the secondary health care sector). National political decisions result in new aims and goals, such as the Danish cancer pathway program (Ingeman et al, 2015). Initiated by parliament, it offers all patients a national standard program within guaranteed deadlines.…”