Ovarian cancer suspicion, urgent referral and time to diagnosis in Danish general practice: a population-based study

Marie-Louise L Baun*, Henry Jensen, Alina Z Falborg, Hanne N Heje, Lone K Petersen, Peter Vedsted

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: 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.

OBJECTIVE: To investigate cancer suspicion and pathway use among GPs and to explore the association between these factors and the diagnostic intervals (DIs).

METHODS: We conducted a national population-based cohort study using questionnaires and national registers.

RESULTS: 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).

CONCLUSIONS: 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.

Original languageEnglish
JournalFamily Practice
Volume36
Issue number6
Pages (from-to)751-757
ISSN0263-2136
DOIs
Publication statusPublished - 18. Nov 2019

Keywords

  • Denmark
  • general practice
  • ovarian neoplasms
  • referral
  • symptom assessment
  • time to diagnosis

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