Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus C, Denmark.
Department of Public Health, Aarhus University, Aarhus C, Denmark.
Fam Pract. 2019 Nov 18;36(6):751-757. doi: 10.1093/fampra/cmz013.
Ovarian cancer (OC) survival rates are lower in Denmark than in countries with similar health care. Prolonged time to diagnosis could be a contributing factor. The Danish cancer patient pathway (CPP) for OC was introduced in 2009. It provides GPs with fast access to diagnostic work-up.
To investigate cancer suspicion and pathway use among GPs and to explore the association between these factors and the diagnostic intervals (DIs).
We conducted a national population-based cohort study using questionnaires and national registers.
Of the 313 women with participating GPs, 91% presented with symptoms within 1 year of diagnosis, 61% presented vague non-specific symptoms and 62% were diagnosed with late-stage disease. Cancer was suspected in 39%, and 36% were referred to a CPP. Comorbidity [prevalence ratio (PR): 0.53, 95% confidence interval (CI): 0.29-0.98] and no cancer suspicion (PR: 0.35, 95% CI: 0.20-0.60) were associated with no referral to a CPP. The median DI was 36 days. Long DIs were associated with no cancer suspicion (median DI: 59 versus 20 days) and no referral to a CPP (median DI: 42 versus 23 days).
Nine in ten patients attended general practice with symptoms before diagnosis. Two-thirds initially presented with vague non-specific symptoms were less likely to be referred to a CPP and had longer DIs than women suspected of cancer. These findings underline the importance of supplementing the CPP with additional accelerated diagnostic routes.
丹麦的卵巢癌（OC）存活率低于医疗保健水平相似的国家。诊断时间延长可能是一个促成因素。丹麦的 OC 癌症患者途径（CPP）于 2009 年推出。它为全科医生提供了快速进行诊断性检查的途径。
调查全科医生的癌症怀疑和途径使用情况，并探讨这些因素与诊断间隔（DI）之间的关系。
我们使用问卷和国家登记册进行了一项全国性的基于人群的队列研究。
在参加的全科医生中，313 名女性中有 91%在诊断前 1 年内出现症状，61%出现模糊的非特异性症状，62%被诊断为晚期疾病。有 39%的医生怀疑患有癌症，有 36%的医生被转诊至 CPP。合并症（患病率比（PR）：0.53，95%置信区间（CI）：0.29-0.98）和无癌症怀疑（PR：0.35，95%CI：0.20-0.60）与未转诊至 CPP 相关。中位 DI 为 36 天。长 DI 与无癌症怀疑（中位 DI：59 比 20 天）和未转诊至 CPP（中位 DI：42 比 23 天）相关。
在诊断前，十分之九的患者因症状而就诊于普通科。三分之二最初表现为模糊的非特异性症状的患者不太可能被转诊至 CPP，并且与怀疑患有癌症的患者相比，他们的 DI 更长。这些发现强调了在 CPP 中补充额外的加速诊断途径的重要性。
