Allgar Victoria L, Neal Richard D, Ali Nasreen, Leese Brenda, Heywood Phil, Proctor Gill, Evans Joyce
Centre for Research in Primary Care, Institute of Health Sciences and Public Health Research, University of Leeds, Leeds.
Br J Gen Pract. 2006 May;56(526):355-62.
The UK urgent cancer referral guidance was introduced between 1999-2000. There is a dearth of literature relating to the effectiveness in detecting cancer of urgent suspected cancer referrals and general practitioners' compliance with the guidance.
This paper aims to determine the diagnostic yield from urgent referrals for suspected colorectal, lung, ovarian and prostate cancer, and the proportion of patients with cancer who were urgently referred. Secondary aims are to determine the association of these findings with age, ethnicity, sex and marital status, and to determine the proportions of patients who fulfilled the urgent referral criteria.
Detailed notes analysis of all urgent referrals and all cancer diagnoses.
One hospital trust in England.
Data regarding all urgent referrals and all cancer diagnoses were obtained from one hospital trust over a 2-year period. Data analysis was undertaken to determine, diagnostic yields and their association with sociodemographic factors, trends over time and fulfilment of the guidance.
The percentages of urgent referrals diagnosed with cancer were colorectal 11%, lung 42%, ovarian 20%, and prostate 50%. The percentages of patients with cancer referred urgently were colorectal 21%, lung 23%, ovarian 24%, and prostate 32%. Patients who were urgently referred without cancer were younger than those with cancer for all but prostate. There were no significant differences by sex, marital status or ethnicity. For patients with cancer there were no differences for any sociodemographic factors in whether or not they were referred urgently.
The predictive power of the referral guidance as a marker for cancer is low, resulting in significant numbers of patients being urgently referred without cancer. A large majority of patients not diagnosed with cancer through the urgent referral route did fulfil the criteria for urgent referral, suggesting that with more widespread use of the guidance the diagnostic yields will be higher. This has implications for patients, on hospital diagnostic systems, and for patients presenting through other pathways.
英国紧急癌症转诊指南于1999年至2000年间推出。关于紧急疑似癌症转诊在癌症检测方面的有效性以及全科医生对该指南的遵守情况，相关文献匮乏。
本文旨在确定疑似结直肠癌、肺癌、卵巢癌和前列腺癌紧急转诊的诊断率，以及紧急转诊的癌症患者比例。次要目的是确定这些结果与年龄、种族、性别和婚姻状况的关联，并确定符合紧急转诊标准的患者比例。
对所有紧急转诊和所有癌症诊断进行详细的病历分析。
英格兰的一家医院信托机构。
在两年期间从一家医院信托机构获取了所有紧急转诊和所有癌症诊断的数据。进行数据分析以确定诊断率及其与社会人口学因素的关联、随时间的趋势以及对指南的遵守情况。
被诊断患有癌症的紧急转诊患者百分比分别为：结直肠癌11%，肺癌42%，卵巢癌20%，前列腺癌50%。紧急转诊的癌症患者百分比分别为：结直肠癌21%，肺癌23%，卵巢癌24%，前列腺癌32%。除前列腺癌外，未患癌症而被紧急转诊的患者比患癌症的患者年轻。在性别、婚姻状况或种族方面无显著差异。对于患癌症的患者，在是否被紧急转诊方面，任何社会人口学因素均无差异。
转诊指南作为癌症标志物的预测能力较低，导致大量未患癌症的患者被紧急转诊。通过紧急转诊途径未被诊断出癌症的绝大多数患者确实符合紧急转诊标准，这表明随着该指南的更广泛应用，诊断率将会更高。这对患者、医院诊断系统以及通过其他途径就诊的患者都有影响。
