The pattern of distant tumour stage according to usual GP consultation frequency was similar for both women and men, but with slightly higher proportion of distant cancers for men than women data not shown. Low usual GP consultation frequency was associated with distant tumour stage Table 3.
The odds of having distant tumour stage was 1. Patients with one or two GP consultations during the same period had ORs of 1. The same pattern was observed among consulters who consulted their GP once during the period 19 to 36 months prior to diagnosis, for all cancer types investigated with ORs ranging from 1. After adjustment for tumour stage at diagnosis, the association between usual GP consultation frequency and mortality attenuated. However, the same pattern was observed as in the fully adjusted model without tumour stage Supporting Information Appendix Table A 3 , with a HR of 1.
The association was strongest for patients who did not consult their GP during the 19 to 36 months before their diagnosis. Adjusting for age, comorbidity, and socioeconomic position explained the poorer prognosis among patients with high consultation frequency in general practice, but it did not explain the poor prognosis among patients with low usual GP consultation frequency. This reduced the risk of selection and information bias. Furthermore, the large study population provided high statistical precision.
The risk of misclassifications concerning the usual GP consultation frequency among the patients use was thereby minimised. Additionally, the grouping of cancer patients by number of contacts reflects the true usual GP consultation pattern. Some patients may prefer telephone consultations, and we have underestimated the total number of contacts between the patients and the GP.
As these factors are strongly associated with income and educational level, 40 , 41 a part of their potential confounding effect has already been accounted for. Thus, we believe that the possible effect of e. Despite its high specificity, the Charlson Comorbidity Index CCI does not measure comorbidity as precise as clinical data. Consequently, the CCI score might be too low in the patient groups with low levels of GP consultations.
Nevertheless, we observed almost no changes in the estimates for the outcomes of interest when we adjusted for comorbidity, which indicates that the impact is negligible.
Tumour stage is likely to be misclassified due to missing data on tumour stage in the DCR. Misclassification of tumour stage in the DCR cannot be ruled out. Therefore, these results should be interpreted with caution. Direct comparison with other studies of the association between consultation frequency in general practice and mortality is not possible due to the absence of similar studies. Nevertheless, studies measuring continuity of care have reported an association between higher continuity of care in primary care and lower mortality.
Patients with low GP consultation frequency are known to have a higher mortality. This difference applies to 11, patients who usually never consulted their GP, which suggests that These deaths correspond to deaths annually. This number is not a trivial figure in the Danish setting; it is slightly more than the annual deaths caused by cervical cancer each year in Denmark. The data from this study did not allow us to investigate why these patients had low healthcare seeking.
It may be explained by other diseases, e. The association between GP consultation frequency and mortality is a combination of at least two things: a mechanism through more advanced tumour stage and other independent factors. To develop future interventions that may improve the prognosis for patients with low usual consultation frequency in general practice, the characteristics of these patients should be described and the processes behind their consultation pattern should be explored. The study was approved by the Danish Data Protection Agency file no.
According to Danish law, the study did not require approval from the Committee on Health Research Ethics of the Central Denmark Region as no biomedical intervention was performed. The data that support the findings of this study are stored and maintained electronically at Statistics Denmark. The data are not publicly available due to the Danish legislation on data privacy as the data contains information that could compromise the privacy of the research participants. The data can only be accessed by approved collaborative partners via a secured virtual private network VPN.
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Patients often go to their local chemist for repeated purchases of cough medicines, and pharmacists are in a good position to identify patients and advise them to go and see their GP to ask whether a chest X-ray may be required. Any queries other than missing content should be directed to the corresponding author for the article. Colorectal cancer CRC is the second most common cancer and the second most common cause of cancer-related death in Europe, with approximately , new patients with CRC and , CRC-related deaths annually. Blackwell Publishing; Forgot your username? Website for young people living with cancer provides printed and audio-visual resources free of charge , including:. L ung cancer is one of the commonest forms of cancer in the developed world.
Volume , Issue The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. International Journal of Cancer Volume , Issue Cancer Epidemiology Free Access. Henry Jensen Corresponding Author E-mail address: henry. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access.
Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract Cancer survival rates are lower in Denmark than in comparable European countries.
Setting The 5. Study population The cancer cohort was identified in the Danish Cancer Registry DCR , which holds information on the date of diagnosis and the tumour characteristics of all cancers diagnosed in Denmark. Exposure The primary exposure in the study was the patient's usual i. Covariates We collected demographic and socioeconomic information from Statistics Denmark. Data was analysed using the statistical software Stata Usual use of general practice A stable usual use of general practice was seen for both cancer patients and comparison subjects in the 19—36 months prior to diagnosis, although fewer cancer patients had a low GP use compared to the comparison subjects 9.
Figure 1 Open in figure viewer PowerPoint. Cancer patients Distant stage ORs of having distant tumour stage adjusted for age, sex, education, income, marital status, and comorbidity a a In the total analyses, estimates were also adjusted for cancer type.
Delay in the diagnosis of cancer in general practice can cause distress to every physician. This useful manual aims to aid the general practitioner in a timely. (The triad pain in the flank, haematuria and palpable tumour to-. gether. is. rare, perhaps in one of ten patients. However, each of these. three symptoms occurs.
Mortality according to usual GP consultation frequency conditioned on tumour stage After adjustment for tumour stage at diagnosis, the association between usual GP consultation frequency and mortality attenuated. Comparison with relevant literature and interpretation Direct comparison with other studies of the association between consultation frequency in general practice and mortality is not possible due to the absence of similar studies. Supporting Information Additional Supporting Information may be found in the online version of this article.
Fatigue is also a very common feature of lung cancer. If there is still a high index of clinical suspicion of lung cancer, the patient should be referred. Specialist lung cancer referral clinics started to appear in the s but have become standard now in almost all parts of the UK. The NICE guideline on The diagnosis and treatment of lung cancer recommends that they should be used where possible.
One of the reasons why lung cancer outcomes have been poor in the past is that many patients were never referred to see a specialist. The lung cancer specialist MDTs are now well established and, in general, deliver a high standard of care. The opportunity and responsibility for identifying lung cancer patients early in primary care should not rest entirely in the hands of the GP.
Patients see many other professionals, including nurses, receptionists, physiotherapists, and pharmacists. Patients often go to their local chemist for repeated purchases of cough medicines, and pharmacists are in a good position to identify patients and advise them to go and see their GP to ask whether a chest X-ray may be required. Late diagnosis is the major reason why the outcomes for lung cancer patients are so poor.
This is probably a greater factor in the UK than in some other developed countries and is likely to be part of the explanation for the comparatively worse survival statistics. Delays in primary care are part of the problem.
Commissioned by Janssen-Cilag Ltd. Dr Sadaf Haque picks out five key learning points from the updated NICE prostate cancer guideline that are relevant to primary care. Dr Richard Simcock and Dr Nicola Harker offer 10 top tips on early breast cancer diagnosis and treatment, based on recent recommendations and research.
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Skip to main content Skip to navigation. Dr Michael Peake outlines the difficulties with early recognition of disease and highlights recommendations in the NICE guidelines for GPs on identification and referral. High-risk groups —it is important that GPs are alert to whether the patient is in a high-risk group. Indicators of this are: 9—12 age over 50 years—however, although less common, lung cancer does occur in patients well under 50 years 1 smoker or ex-smoker—around half of newly-diagnosed cases of lung cancer occur in people who had previously given up smoking, 1 but based on an estimate of 37, new cases per year in the UK, 1 in 7 cases of lung cancer occur in those who have never smoked presence of chronic obstructive pulmonary disease COPD —increases risk two-fold to four-fold, independent of smoking history 13 previous history of head and neck, bladder or renal cancers other factors such as exposure to asbestos, or living in a high radon exposure area.
Chest X-ray —clinicians in primary care should set a low threshold for requesting chest X-rays and should not be afraid to repeat the film in a few months if symptoms persist. Involving the whole primary care team The opportunity and responsibility for identifying lung cancer patients early in primary care should not rest entirely in the hands of the GP. An urgent referral for chest X-ray should be made in patients presenting with: haemoptysis any of the following unexplained persistent i.
An urgent specialist referral should be made for any of the following: persistent haemoptysis in smokers or ex-smokers aged 40 or over although a chest X-ray should still be carried out as part of the referral process if a chest X-ray or chest computed tomography is suggestive of lung cancer including pleural effusion and slowly resolving consolidation 3.
Available from www. Topics Cancer Lung cancer.