Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Oncologie in de huisartspraktijk : Het diagnostisch traject van zeldzame kankersoorten in de huisartspraktijk

(2018) Wiertsema, W.H.A.

Background: Early recognition of symptomatic cancer in primary care is important to optimize clinical outcomes. Aim of this study is to assess time to referral for patients with five relatively uncommon cancers and to identify characteristics associated with a relatively long diagnostic primary care interval. Method: Retrospective observational cohort-study using patient records from the Registration Network Groningen. Patients diagnosed with kidney-, bladder-, esophageal-, stomach-, and ovarian cancer between 2010 and 2015 were included. Time from consultation with first symptoms and referral was determined and patient- and presentation characteristics were collected. For these characteristics median duration of primary care interval was stratified and a logistic regression analyses were performed to assess their association with relatively long duration (≥75th percentile value). Cases with the longest duration (≥90th percentile value) were described and analysed. Results: Median duration of the primary care interval for all rare cancer types together is 12 (1-50) day, 20 (1-174) days for kidney cancer, 25 days (2-43) for bladder cancer, 7,5(1-20) days for esophageal cancer, 8 (1-78) days for stomach cancer and 1,5 (1-14) days for ovarian cancer. The absence of alarm symptoms of cancer at first consultation because of cancer were seen in 52% of the patients and resulted in longer durations of primary care interval (except for ovarian cancer). From the 75th percentile duration strongly increased. Female gender is associated with this long duration to referral (OR: 8,4 (2,53-27,94) P<0,000). Conclusions: Most of the patients were promptly referred to secondary care. There is room for improvement in the group with the relative longest duration. Therefore GPs should stay alert on relatively uncommon cancer types, mainly in women, if patients present with symptoms which seem innocent.

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