Pritchard-Jones Kathy, Graf Norbert, van Tinteren Harm, Craft Alan
University College London Institute of Child Health, London, UK.
Department of Paediatric Oncology/Hematology, Saarland University Hospital Homburg, Homburg, Germany.
Arch Dis Child. 2016 May;101(5):417-20. doi: 10.1136/archdischild-2015-309212. Epub 2016 Mar 6.
The UK has a longstanding system of general practice which provides the vast majority of primary care, including that for children. It acts as a 'gatekeeper' to more specialist care. Parents may also use accident and emergency departments as their first point of medical contact for their children. Outcomes in the UK for many conditions in children appear to be worse than in comparable European countries where there is direct access to care by paediatricians. We have therefore looked at pathways to diagnosis and compared outcomes in the childhood kidney cancer, Wilms' tumour, which has been treated in the UK and Germany within the same clinical trial for over a decade. We find that Wilms' tumours are significantly larger in volume and have a more advanced tumour stage at diagnosis in the UK compared to Germany. There is a small (∼3%) difference in event free and overall survival between the two countries. Our data suggest that the system of primary care for children in the UK is less likely to result in the incidental finding of an abdominal mass in a child with no or vague symptoms. This may be a reason for the poorer outcome.
英国拥有一个长期存在的全科医疗体系，该体系提供绝大多数的初级医疗服务，包括为儿童提供的服务。它充当着通往更专科护理的“守门人”。家长们也可能会将急诊部门作为孩子就医的首选。在英国，许多儿童疾病的治疗结果似乎比在欧洲可比国家更差，在那些国家，儿科医生可直接提供医疗服务。因此，我们研究了诊断途径，并比较了儿童肾癌（威尔姆斯瘤）的治疗结果，在长达十多年的同一临床试验中，英国和德国都对这种疾病进行了治疗。我们发现，与德国相比，英国的威尔姆斯瘤在诊断时体积明显更大，肿瘤分期也更晚。两国之间的无事件生存率和总生存率存在微小（约3%）差异。我们的数据表明，英国的儿童初级医疗体系不太可能偶然发现无症状或症状不明确的儿童腹部肿块。这可能是导致治疗结果较差的一个原因。
