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

• Published in: Family practice Vol. 36; no. 6; pp. 751 - 757
• Main Authors: Baun, Marie-Louise L, Jensen, Henry, Falborg, Alina Z, Heje, Hanne N, Petersen, Lone K, Vedsted, Peter
• Format: Journal Article
• Language: English
• Published: England 18.11.2019
• Subjects: Adult; Aged; Aged, 80 and over; Cohort Studies; Delayed Diagnosis - statistics & numerical data; Denmark - epidemiology; Early Detection of Cancer - standards; Early Detection of Cancer - statistics & numerical data; Female; General Practice; Humans; Middle Aged; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - epidemiology; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Quality of Health Care - standards; Referral and Consultation - standards; Referral and Consultation - statistics & numerical data; Registries; Surveys and Questionnaires; Denmark; Denmark; ovarian neoplasms; symptom assessment; referral; general practice; time to diagnosis
• ISSN: 1460-2229; 1460-2229
• 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.