Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia, and Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IECH), UCL, London, UK.
Victorian Comprehensive Cancer Centre (VCCC), VCCC Alliance, and Australian and New Zealand Children's Haematology/Oncology Group (ANZCHOG), Melbourne, Australia.
Br J Gen Pract. 2024 Jul 25;74(745):e508-e516. doi: 10.3399/BJGP.2023.0610. Print 2024 Aug.
Increased time to diagnosis in sarcoma is associated with poor prognosis and patient outcomes. Research is needed to identify whether opportunities to expedite the diagnosis of sarcoma in general practice exist.
To examine pre-diagnostic GP clinical activity before sarcoma diagnosis.
An Australian retrospective cohort study using hospital registry data (Australian Comprehensive Cancer Outcomes and Research Database [ACCORD]) linked to two primary care datasets (Patron and MedicineInsight).
The frequency of general practice healthcare utilisation events (general practice attendances, prescriptions, blood test, and imaging requests) were compared in 377 patients with soft tissue sarcoma (STS) and 64 patients with bone sarcoma (BS) in the year pre-diagnosis. Poisson regression models were used to calculate monthly incidence rate ratios (IRR) for the 24 months pre-diagnosis and estimate inflection points for when healthcare use started to increase from baseline.
In the 6 months pre-diagnosis, patients with sarcoma had a median of 3-4 general practice attendances, around one-third had a GP imaging request (33% [ = 21] BS and 36% [ = 134] STS), and approximately one in five had multiple imaging requests (19% [ = 12] BS and 21% [ = 80] STS). GP imaging requests progressively increased up to eight-fold from 6 months before sarcoma diagnosis (IRR 8.43, 95% confidence interval [CI] = 3.92 to 18.15, <0.001) and general practice attendances increased from 3 months pre-diagnosis.
Patients with sarcoma have increased GP clinical activity from 6 months pre-diagnosis, indicating a diagnostic window where potential opportunities exist for earlier diagnosis. Interventions to help identify patients and promote appropriate use of imaging and direct specialist centre referrals could improve earlier diagnosis and patient outcomes.
肉瘤诊断时间的延长与预后不良和患者结局相关。需要研究是否存在在全科医疗中加快肉瘤诊断的机会。
检查肉瘤诊断前的全科医生临床活动。
这是一项澳大利亚回顾性队列研究，使用了医院登记数据（澳大利亚综合癌症结局和研究数据库[ACCORD]），并与两个初级保健数据集（Patron 和 MedicineInsight）进行了链接。
在肉瘤诊断前 1 年，比较了 377 例软组织肉瘤（STS）患者和 64 例骨肉瘤（BS）患者的全科医疗服务利用事件（全科医生就诊、处方、血液检查和影像请求）的频率。使用泊松回归模型计算了诊断前 24 个月的每月发生率比（IRR），并估计了从基线开始医疗保健使用开始增加的拐点。
在诊断前 6 个月，肉瘤患者平均有 3-4 次全科医生就诊，约三分之一的患者有全科医生的影像请求（33%[=21]BS 和 36%[=134]STS），大约五分之一的患者有多次影像请求（19%[=12]BS 和 21%[=80]STS）。从肉瘤诊断前 6 个月开始，全科医生的影像请求逐渐增加了 8 倍（IRR 8.43，95%置信区间[CI] = 3.92 至 18.15，<0.001），全科医生就诊次数从 3 个月前开始增加。
肉瘤患者从诊断前 6 个月开始，全科医生的临床活动增加，这表明存在潜在的早期诊断机会。干预措施可以帮助识别患者，并促进适当使用影像检查和直接转介至专科中心，这可能会改善早期诊断和患者结局。
