Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
Fam Pract. 2012 Feb;29(1):69-78. doi: 10.1093/fampra/cmr044. Epub 2011 Aug 9.
The principal aim of this study was to determine the feasibility of a large-scale comparative study, between the UK, the Netherlands and Sweden, to investigate whether delays in the diagnostic pathway of cancer might explain differences in cancer survival between countries.
Following a planning meeting to agree the format of a data collection instrument, data on delays in the cancer diagnostic pathway were abstracted from primary care-held medical records. Data were collected on 50 cases each (total of 150) from practices in each of Grampian, Northeast Scotland; Maastricht, the Netherlands and Skane, Sweden. Data were entered into SPSS 18.0 for analysis.
Data on delays in the cancer diagnostic pathway were readily available from primary care-held case records. However, data on demographic variables, cancer stage at diagnosis and treatment were less well recorded. There was no significant difference between countries in the way in which cases were referred from primary to secondary care. There was no significant difference between countries in the time delay between a patient presenting in primary care and being referred to secondary care. Median delay between referral and first appointment in secondary care [19 (8.0-47.5) days] was significantly longer in Scotland that in Sweden [1.0 (0-31.5) days] and the Netherlands [5.5 (0-31.5) days] (P < 0.001). Secondary care delay (between first appointment in secondary care and diagnosis) in Scotland [22.5 (0-39.5) days] was also significantly longer than in Sweden [14.0 (4.5-31.5) days] and the Netherlands [3.5 (0-16.5) days] (P = 0.003). Finally, overall delay in Scotland [53.5 (30.3-96.3) days] was also significantly longer than in Sweden [32.0 (14.0-71.0) days] and the Netherlands [22.0 (7.0-60.3) days] (P = 0.003).
A large-scale study comparing cancer delays in European countries and based on primary care-held records is feasible but would require supplementary sources of data in order to maximize information on demographic variables, the cancer stage at diagnosis and treatment details. Such a large-scale study is timely and desirable since our findings suggest systematic differences in the way cancer is managed in the three countries.
本研究的主要目的是确定在英国、荷兰和瑞典之间进行大规模比较研究的可行性，以调查癌症诊断途径的延迟是否可以解释国家间癌症生存率的差异。
在一次规划会议上，同意了数据收集工具的格式，从初级保健记录中提取了癌症诊断途径延迟的数据。从苏格兰东北部的 Grampian、荷兰的马斯特里赫特和瑞典的斯科讷的每个实践中收集了 50 例（共 150 例）的数据。数据输入到 SPSS 18.0 进行分析。
癌症诊断途径延迟的数据可从初级保健记录中轻松获得。然而，关于人口统计学变量、诊断时的癌症分期和治疗的记录较差。国家之间从初级保健向二级保健转诊的方式没有显著差异。患者在初级保健就诊和转诊到二级保健之间的时间延迟也没有显著差异。在二级保健中的首次预约之前的中位延迟[19（8.0-47.5）天]在苏格兰显著长于瑞典[1.0（0-31.5）天]和荷兰[5.5（0-31.5）天]（P < 0.001）。苏格兰的二级保健延迟（在二级保健中的首次预约和诊断之间）[22.5（0-39.5）天]也显著长于瑞典[14.0（4.5-31.5）天]和荷兰[3.5（0-16.5）天]（P = 0.003）。最后，苏格兰的总延迟[53.5（30.3-96.3）天]也显著长于瑞典[32.0（14.0-71.0）天]和荷兰[22.0（7.0-60.3）天]（P = 0.003）。
一项比较欧洲国家癌症延迟的大型研究，基于初级保健记录是可行的，但需要补充数据来源，以便最大限度地获取人口统计学变量、诊断时的癌症分期和治疗细节方面的信息。这种大规模的研究是及时和可取的，因为我们的发现表明在这三个国家中，癌症的管理方式存在系统性差异。
