Research Unit for General Practice U N I V E R S I T Y O F A A R H U S Department of General Practice Do cancer patients’ symptoms influence the pattern of delay? Rikke Pilegaard Hansen MD, PhD

Delay - definition  The interval between a patient’s first symptoms and initiation of treatment

Delay First symptom First contact with the GP Referral to hospital Initiation of investigation of cancer- related symptoms First hospital visit Diagnosis/ referral to treatment Initiation of treatment System delay Doctor delayPatient delay

 inhabitants  Appr new cancers/year  Appr. 500 GPs  inhabitants  Appr new cancers/year  Appr. 500 GPs County of Aarhus

Method  Questionnaires to GPs  Patients’ diagnostic pathways (delay)  Cancer symptoms  GPs’ interpretation of these symptoms:  Alarm symptoms  General symptoms  Non-cancer-specific symptoms  Median patient, doctor, system and total delays related to the symptoms were analysed and compared

Total delay

System delay 25% percentile: 32 days Median: 55 days 75% percentile: 93 days Delay in days Patients

Doctor delay

Patient delay

Symptoms  Symptom interpretation by GPs:  Alarm symptoms: 49%  General symptoms: 24%  Non-cancer-specific symptoms: 27%

All delay types

Delay First symptom First contact with the GP Referral to hospital Initiation of investigation of cancer- related symptoms First hospital visit Diagnosis/ referral to treatment Initiation of treatment System delay Doctor delayPatient delay

System delay

Conclusion  Only 49% of patients presented with alarm symptoms => reduced use of fast track referral for suspected cancer  Alternative referral pathways for cancer patients with non-specific symptoms is needed

Research Unit for General Practice U N I V E R S I T Y O F A A R H U S Department of General Practice Thank you for your attention

Delay Patient delayDoctor delaySystem delayTotal delay Median (IQI*)21 days (7-56)0 days (0-2)55 days (32-93)98 days(57-168) *Interquartile interval