Victorian Comprehensive Cancer Centre, Melbourne, VIC
Victorian Comprehensive Cancer Centre, Melbourne, VIC.
Med J Aust. 2016 Jul 18;205(2):66-71. doi: 10.5694/mja15.01169.
To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist.
DESIGN, SETTING AND PARTICIPANTS: Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 2012 - 30 April 2013.
The primary outcome was the proportion of patients who had had three or more GP consultations about cancer-related health problems before being referred to hospital. The secondary outcome was the interval between the patient first suspecting a problem and their seeing a hospital specialist.
34% of the patients included in the final analyses (426 of 1248) had visited a GP at least three times before referral to a hospital doctor. The odds ratios (reference: rectal cancer; adjusted for age, sex, language spoken at home, and socio-economic disadvantage index score) varied according to cancer type, being highest for pancreatic cancer (3.2; 95% CI, 1.02-9.9), thyroid cancer (2.5; 95% CI, 0.9-6.6), vulval cancer (2.5; 95% CI, 0.7-8.7) and multiple myeloma (2.4; 95% CI, 1.1-5.5), and lowest for patients with breast cancer (0.4; 95% CI, 0.2-0.8), cervical cancer (0.5; 95% CI, 0.1-2.1), endometrial cancer (0.5; 95% CI, 0.2-1.4) or melanoma (0.7; 95% CI, 0.3-1.5). Cancer type also affected the duration of the interval from symptom onset to seeing a hospital doctor; it took at least 3 months for more than one-third of patients with prostate or colon cancer to see a hospital doctor.
Certain cancer types were more frequently associated with multiple GP visits, suggesting they are more challenging to recognise early. In Victoria, longer intervals from the first symptoms to seeing a hospital doctor for colon or prostate cancer may reflect poorer community symptom awareness, later GP referral, or limited access to gastroenterology and urology services.
评估癌症诊断前全科医生就诊次数的变化，以及患者首次怀疑出现问题与就诊于医院专科医生之间的时间间隔的变化。
设计、地点和参与者：对 2012 年 10 月 1 日至 2013 年 4 月 30 日在维多利亚综合癌症中心 5 家医院之一接受治疗的 19 种癌症类型之一的 1552 名癌症患者进行的癌症患者体验调查（CPES）数据进行分析（调查应答率为 37.7%）。
主要结局是被转诊至医院的患者中，有 3 次或以上与癌症相关健康问题的全科医生就诊的比例。次要结局是患者首次怀疑出现问题与就诊于医院专科医生之间的时间间隔。
最终分析中包括的患者比例为 34%（426 例中有 1248 例），他们在被转诊至医院医生之前至少就诊过 3 次全科医生。根据癌症类型，比值比（参考：直肠癌；按年龄、性别、家庭语言和社会经济劣势指数评分调整）有所不同，胰腺癌最高（3.2；95%CI，1.02-9.9），甲状腺癌（2.5；95%CI，0.9-6.6），外阴癌（2.5；95%CI，0.7-8.7）和多发性骨髓瘤（2.4；95%CI，1.1-5.5），而乳腺癌（0.4；95%CI，0.2-0.8）、宫颈癌（0.5；95%CI，0.1-2.1）、子宫内膜癌（0.5；95%CI，0.2-1.4）或黑素瘤（0.7；95%CI，0.3-1.5）患者最低。癌症类型也影响从症状出现到就诊于医院医生的时间间隔；前列腺癌或结肠癌患者中，有超过三分之一的患者至少需要 3 个月才能就诊于医院医生。
某些癌症类型更常与多次全科医生就诊相关，这表明它们更难早期识别。在维多利亚，结肠癌或前列腺癌患者从出现症状到就诊于医院医生的时间间隔更长，可能反映出社区对症状的认识较差，全科医生的转介较晚，或胃肠病学和泌尿科服务的获取受限。
