癌症诊断延迟与前往卫生服务机构的距离：丹麦全国队列研究。

Cancer diagnostic delays and travel distance to health services: A nationwide cohort study in Denmark.

机构信息

Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.

Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark; The Danish Clinical Registries (RKKP), Olof Palmes Allé 15, 8200, Aarhus N, Denmark; Cancer Epidemiology & Population Health, King's College London, Strand, London, WC2R 2LS, UK.

出版信息

Cancer Epidemiol. 2019 Apr;59:115-122. doi: 10.1016/j.canep.2019.01.018. Epub 2019 Feb 7.

DOI:10.1016/j.canep.2019.01.018

PMID:30738284

Abstract

BACKGROUND

This study aims to investigate the association between distance to health services and intervals in the cancer diagnostic pathway, and explore whether the diagnostic difficulty of the cancer influences this association.

METHOD

A nationwide cohort study was conducted based on data from both questionnaires and registries. Danish cancer patients diagnosed in 2005-2016 and their general practitioner (GP) were included if enrolled in the Danish Cancer in Primary Care (CaP) cohort (n = 37,872). The CaP cohorts provided data on intervals assessed by patients and GPs. The Geographical Information System (GIS) was used to calculate travel distances from the residence of the patient to their GP surgery and to the hospital of diagnosis.

RESULTS

Longer travel distance to the hospital of diagnosis was associated with longer diagnostic interval. This association was strongest in the period before the implementation of Cancer Patient Pathways (CPP) in 2010. Patients with a cancer categorised as ´hard to diagnose´ contributed mostly to the association. Longer travel distance to the GP was associated with shorter patient interval and primary care interval for patients diagnosed with cancer types ´intermediate to diagnose´.

CONCLUSION

Travel distance to cancer diagnostic health care services was associated with interval length in the diagnostic pathway. This association was less pronounced in the period after introducing CPPs and also strongly depending of the underlying cancer type and symptomatology.

摘要

背景

本研究旨在探讨医疗服务距离与癌症诊断路径间隔之间的关联，并探讨癌症诊断难度是否会影响这种关联。

方法

本研究基于问卷调查和登记数据开展了一项全国性队列研究。研究纳入了在 2005 年至 2016 年期间被诊断为癌症且参加了丹麦初级保健中的癌症研究（CaP）队列的丹麦癌症患者及其全科医生（GP）。CaP 队列提供了患者和 GP 评估的间隔数据。地理信息系统（GIS）用于计算患者居住地到 GP 诊所和诊断医院的出行距离。