Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC H3S 1Z1, Canada.
Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montreal, QC H3A 1G1, Canada.
Curr Oncol. 2021 Jan 11;28(1):378-389. doi: 10.3390/curroncol28010040.
Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral.
In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling ( = 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities.
68% of the patients followed a pathway where family physician (FP) visits were dominant ("FP-centric") and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant ("ED-centric"). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12-111) vs. 22 (IQR: 5-69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit.
Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.
肺癌通常在晚期诊断，死亡率较高。及时诊断取决于及时转介给呼吸科专家；然而，在加拿大，人们对患者如何通过初级保健转至呼吸科专家知之甚少。因此，我们旨在确定并描述初级保健中从首次就诊到转介的肺癌预诊断途径。
在这项回顾性队列研究中，从魁北克省蒙特利尔的肺癌中心连续抽样（n=50）招募了原发性肺癌患者。通过病历回顾和结构化患者访谈收集初级保健中医疗服务利用的数据，并使用潜在类别分析来识别具有相似预诊断途径的患者群体。根据患者和肿瘤相关特征以及利用活动的顺序描述每个群体。
68%的患者遵循以家庭医生就诊为主的途径（“以家庭医生为中心”），32%的患者遵循以就诊诊所和急诊就诊为主的途径（“以急诊为中心”）。家庭医生组的转诊时间是急诊组的两倍（45 天（IQR：12-111）比 22 天（IQR：5-69）），且疾病更为晚期（65%比 50%）。在家庭医生组中，29%的患者在转介前看了家庭医生三次或更多次，41%的患者去过急诊。
我们的发现可能反映了在初级保健中诊断肺癌的挑战、错失早期诊断的机会以及初级保健和专科保健之间缺乏整合。
