1. Department of General Practice Aarhus University Diagnostic delay in cancer in primary health care Before and after introducing urgent referrals for suspected cancer Mette Bach Larsen 1,2, Peter Vedsted 1, Dorte Gilså Hansen 3, Frede Olesen 1 1. The Research Unit for General Practice, Aarhus University. Bartholins Allé 2, DK-8000 Aarhus C. 2. Department of General Medicine, Aarhus University. Bartholins Allé 2, DK-8000 Aarhus C. 3. The Research Unit for General Practice, University of Southern Denmark. J.B Winsløvsvej 9A, DK-5000 Odense C.

2. Department of General Practice Aarhus University Outline  Background  Methods  Results  Conclusion

3. Department of General Practice Aarhus University Urgent referrals for suspected cancer  Introduced in Denmark 1 April 2008  Head and neck cancer  Colorectal cancer  Lung cancer  Breast cancer  Aim  to reduce processing-times, in particular to reduce referral time, obtain faster diagnosing and quick onset of treatment

4. Department of General Practice Aarhus University Reasoned suspicion Colon cancer as an example  Main principle  All patients aged 40 years or older with symptoms of bleeding, longterm change in bowel habits or significant worsening in general condition  High-risk patients  Above mentioned symptoms and disease in first degree relatives

5. Department of General Practice Aarhus University Fast track diagnosis Colon cancer as example Weekday no.Procedure 0 Referral received from GP Triage and referral letter to patient 5 Sigmoidoscopy (and rectoscopy if needed) Informing the patient about the plan for fast track 7Chest x-ray and CT scan of the abdomen 8Radiological diagnosis 9 Preliminary examination by medical specialist Information on diagnosis and treatment Informed consent to treatment Date of operation Preoperative nurse consult 15Admission 16Operation

6. Department of General Practice Aarhus University Aim of this study

7. Department of General Practice Aarhus University Methods  Cross-sectional study of 7,080 incident cancer patients  Questionnaires to the patients’ GPs  Inclusion before and after introduction of urgent referrals for suspected cancer  Patients dichotomised into two groups with or without access to fast track diagnosis

8. Department of General Practice Aarhus University Flowchart Incident cancer patients Before GP confirmation: N=8118 Previously cancer diagnosis (n=173) No cancer (n=131) Not incident (n=704) No inclusion diagnosis (n=17) More than one cancer diagnosis (n=13) Patients eligible for inclusion After GP confirmation: N=7080 Patient refusing to participate (n=20) GP refusing to participate (n=29) Non-responders (n=1153) Completed questionnaires N=5878 (response rate: 83%) Complete data from first visit to referral n= 4201 (59%)

9. Department of General Practice Aarhus University Results Diagnoses without fast track

10. Department of General Practice Aarhus University Results Diagnoses with fast track

11. Department of General Practice Aarhus University Results Delay < 30 days  80-85% had a delay less than 30 days  No significant change after introducing fast track

12. Department of General Practice Aarhus University Conclusion  Overall diagnostic delay in primary health care is short  Significant wait for 15-20% of the patients  No effect of fast track on diagnostic delay in primary health care

13. Department of General Practice Aarhus University Further research  Further research on why 15-20% of the patients are waiting 1 month or more  Further research on the effects of fast track  Fast track diagnosis vs. conventional diagnosis  How to handle patients with uncharacteristic symptoms

14. Department of General Practice Aarhus University Thank you for your attention! mette.bach.larsen@alm.au.dk The project is financed by the The Novo Nordisk Foundation