Time to diagnosis of symptomatic gastric and oesophageal cancer in the Netherlands: Where is the room for improvement?

Abstract

Background An efficient diagnostic pathway and early stage diagnosis for cancer patients is widely pursued. This study aims to chart the duration of the diagnostic pathway for patients with symptomatic oesophageal and gastric cancer, to identify factors associated with long duration and to assess the association of duration with tumour stage at diagnosis. Methods This was a retrospective cohort study, using electronic health records of six routine primary care databases covering about 640,000 patients, partly linked to the Netherlands Cancer Registry. Symptomatic patients with oesophageal and gastric cancer (2010–2015) that presented in primary care were included. Duration of four diagnostic intervals was determined: patient interval; first symptoms to primary care consultation, primary care interval; consultation to referral, secondary care interval; referral to diagnosis, and the diagnostic interval; consultation to diagnosis. Characteristics associated with ‘long duration’ (≥P75 duration) were assessed using log-binomial regression. Median durations were stratified for tumour stages. Results Among 312 symptomatic patients with upper gastrointestinal cancer, median durations were: patient interval: 29 days (interquartile interval 15–73), primary care interval: 12 days (interquartile interval 1–43), secondary care interval: 13 days (interquartile interval 6–29) and diagnostic interval: 31 days (11–74). Patient interval duration was comparable for patients with and without alarm symptoms. Absence of cancer-specific alarm symptoms was associated with ‘long duration’ of primary care interval and secondary care interval: relative risk 5.0 (95% confidence interval 2.7–9.1) and 2.1 (95% confidence interval 1.3–3.7), respectively. Median diagnostic interval duration for local stage disease was 51 days (interquartile interval 13–135) versus 27 days (interquartile interval 11–71) for advanced stage ( p = 0.07). Conclusion In the diagnostic pathway of upper gastrointestinal cancers, the longest interval is the patient interval. Reducing time to diagnosis may be achieved by improving patients’ awareness of alarm symptoms and by diagnostic strategies which better identify cancer patients despite low suspicion.

Time intervals in the care pathway to cancer diagnosis during the COVID‐19 pandemic: A large retrospective study from a high‐volume center

“…A similar pattern was reported for esophageal and gastric cancers in a retrospective cohort study from the Netherlands. Whereas patient and secondary care intervals were similar or longer than patient and hospital intervals for our nonpandemic esophageal and gastric cancers, median PC intervals of the Dutch study were substantially shorter than PC/ED intervals reported here 39 …”

“…However, owing to the length of patient intervals in the early COVID period, the relative increase of PC/ED intervals during this period was only 18%. On closer examination of nonpandemic data, it became apparent that median PC/ED intervals contrasted sharply with median PC intervals reported in other world regions 37‐39 . By analyzing nearly 11 000 patients aged at least 15 years who presented with symptoms to PC in England and were subsequently diagnosed with one of 28 common and less common cancers, data from a national audit showed that, while varying by cancer type, median patient intervals were significantly longer than PC intervals for 18 of 28 cancer types, which included those analyzed here 37 .…”

UEGWeek: The modern School of Athens

“…Mean patient interval was 29 days (comparable for patients with and without alarm symptoms), primary care interval 12 days, secondary care interval 13 days, and diagnostic interval 31 days. Absence of cancer‐specific alarm symptoms was associated with “long duration” of primary and secondary care interval 21 …”

“…Among the almost 6000 abstracts submitted to 2019 and 2020 UEGWeek editions, 32 were then accepted as full‐text publication to UEG Journal 1–31 . Here we will summarize these “hot” papers (see also Figure 3).…”

Reducing time to diagnosis in gastroesophageal cancer is key to further improve outcome

“…5 In this issue of the United European Gastroenterology Journal, van Erp and colleagues evaluated the duration of different intervals in the diagnostic pathway of gastroesophageal cancer. 6 In this retrospective registry-based study, the authors identified patients registered with oesophageal or gastric cancer in the databases of six large general practice networks in The Netherlands. An attempt was made to reconstruct the diagnostic pathway through record linkage with the Netherlands Cancer Registry including information on clinical tumour stage.…”