Tumour stage and implementation of standardised cancer patient pathways: a comparative cohort study

TY - JOUR

T1 - Tumour stage and implementation of standardised cancer patient pathways

T2 - a comparative cohort study

AU - Jensen, Henry

AU - Tørring, Marie Louise

AU - Fenger-Grøn, Morten

AU - Olesen, Frede

AU - Overgaard, Jens

AU - Vedsted, Peter

N1 - © British Journal of General Practice 2016.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background Some European countries have introduced standardised cancer patient pathways (CPPs), including urgent referrals, with the aim of diagnosing cancer at an earlier stage. This is despite a lack of evidence, particularly in patients with symptomatic cancer diagnosed via general practice. Aim To compare tumour stages in patients with incident cancer diagnosed via general practice before, during, and after CPP implementation in Denmark in 2008-2009. Design and setting A comparative cohort study of data from GPS and registries on patients with incident cancer listed with a GP before (n = 1420), during (n = 5272), and after (n = 2988) CPP implementation. Method ?2 test was used to compare stage distributions and logistic regression to estimate odds ratios (OR) of having local cancer after versus before CPP implementation. Results Distribution of tumour stages did not differ statistically significantly across time (P = 0.494) or between CPP use (P = 0.202). For all cancers combined, the OR of having local cancer after CPP implementation was 0.88 (95% confidence interval [CI] = 0.73 to 1.06) compared with before. For CPP-referred patients, the OR of having local cancer was 0.77 (95% CI = 0.62 to 0.94) compared with all patients before CPP implementation; the corresponding OR for non-CPP-referred patients was 0.96 (95% CI = 0.80 to 1.14). Conclusion No clear tendencies were observed confirming earlier detection of cancer after rather than before CPP implementation. CPP-referred patients had lower odds of having local cancer after CPP implementation than all patients before CPP implementation; this could be because the GPS refer patients who are 'more ill' as urgent referrals.

AB - Background Some European countries have introduced standardised cancer patient pathways (CPPs), including urgent referrals, with the aim of diagnosing cancer at an earlier stage. This is despite a lack of evidence, particularly in patients with symptomatic cancer diagnosed via general practice. Aim To compare tumour stages in patients with incident cancer diagnosed via general practice before, during, and after CPP implementation in Denmark in 2008-2009. Design and setting A comparative cohort study of data from GPS and registries on patients with incident cancer listed with a GP before (n = 1420), during (n = 5272), and after (n = 2988) CPP implementation. Method ?2 test was used to compare stage distributions and logistic regression to estimate odds ratios (OR) of having local cancer after versus before CPP implementation. Results Distribution of tumour stages did not differ statistically significantly across time (P = 0.494) or between CPP use (P = 0.202). For all cancers combined, the OR of having local cancer after CPP implementation was 0.88 (95% confidence interval [CI] = 0.73 to 1.06) compared with before. For CPP-referred patients, the OR of having local cancer was 0.77 (95% CI = 0.62 to 0.94) compared with all patients before CPP implementation; the corresponding OR for non-CPP-referred patients was 0.96 (95% CI = 0.80 to 1.14). Conclusion No clear tendencies were observed confirming earlier detection of cancer after rather than before CPP implementation. CPP-referred patients had lower odds of having local cancer after CPP implementation than all patients before CPP implementation; this could be because the GPS refer patients who are 'more ill' as urgent referrals.

KW - Cancer

KW - Denmark

KW - Early diagnosis

KW - General practice

KW - Tumour stage

KW - Urgent referral

UR - http://www.scopus.com/inward/record.url?scp=84982166187&partnerID=8YFLogxK

U2 - 10.3399/bjgp16X684805

DO - 10.3399/bjgp16X684805

M3 - Journal article

C2 - 27025558

SN - 0960-1643

VL - 66

SP - 434

EP - 443

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 647

ER -