Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Denmark.
Department of Public Health, Research Unit for General Practice, Aarhus University, Denmark.
Int J Cancer. 2017 Dec 15;141(12):2400-2409. doi: 10.1002/ijc.30916. Epub 2017 Sep 29.
Cancer survival rates are lower in Denmark than in comparable European countries. This may partly be attributable to subgroups of cancer patients who seek medical attention at late disease stages. It is unknown if differences in usual (i.e. customary) consultation frequency in general practice are associated with cancer prognosis. We aimed to estimate the cancer prognosis of cancer patients stratified by their usual consultation frequency in general practice. We performed a population-based cohort study including 123,943 incident cancer patients aged 50 to 89 years diagnosed in Denmark in 2009 to 2013. We estimated associations between the patient's usual general practitioner (GP) consultation frequency 19 to 36 months before the cancer diagnosis and all-cause mortality by using hazard ratios (HR), estimated by Cox proportional hazards regression. We also estimated the associations between the patient's usual GP consultation frequency and tumour stage, by using logistic regression estimates of odds ratios (ORs). Patients who usually did not see their GP (non-consulters) had higher all-cause mortality [HR = 1.39 (95% CI: 1.33-1.44)] compared to patients who usually saw their GP three to five times during an 18 months period (average consulters). Non-consulters had higher odds of having distant tumour stage [OR = 1.46 (95% CI: 1.38-1.57)] than average consulters. Similar, yet less strong, patterns were seen among patients with low usual GP consultation frequency, yet not statistically significant for all cancer types. In conclusion, the association between usual GP non-consultation and cancer prognosis is a combination of at least two things: a mechanism through more advanced tumour stage and other independent factors.
丹麦的癌症存活率低于可比的欧洲国家。这可能部分归因于癌症患者亚组，他们在疾病晚期寻求医疗关注。目前尚不清楚普通（即习惯）咨询频率的差异是否与癌症预后相关。我们旨在根据癌症患者在普通实践中的常规就诊频率来评估癌症的预后。我们进行了一项基于人群的队列研究，纳入了 2009 年至 2013 年在丹麦诊断出的 123943 名年龄在 50 至 89 岁的癌症患者。我们通过使用 Cox 比例风险回归估计风险比（HR），估计了癌症诊断前 19 至 36 个月患者的通常全科医生（GP）就诊频率与全因死亡率之间的关联。我们还通过使用逻辑回归估计的比值比（OR），估计了患者的通常 GP 就诊频率与肿瘤分期之间的关联。与通常看 3 到 5 次 GP 的患者（普通就诊者）相比，不常看 GP（不就诊者）的患者全因死亡率更高[HR=1.39（95%CI：1.33-1.44）]。不就诊者发生远处肿瘤分期的可能性更高[OR=1.46（95%CI：1.38-1.57）]比普通就诊者。在通常就诊频率较低的患者中也出现了类似的模式，但对于所有癌症类型，这些模式均不具有统计学意义。总之，通常不看 GP 与癌症预后之间的关联是至少两个因素的结合：通过更晚期的肿瘤阶段和其他独立因素起作用的机制。
