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

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

3. 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

4.  640 000 inhabitants  Appr. 3000 new cancers/year  Appr. 500 GPs  640 000 inhabitants  Appr. 3000 new cancers/year  Appr. 500 GPs County of Aarhus

5. 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

6. Total delay

7. System delay 25% percentile: 32 days Median: 55 days 75% percentile: 93 days 0 100 200 300 400 Delay in days 050010001500 Patients

8. Doctor delay

9. Patient delay

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

11. All delay types

12. 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

13. System delay

14. 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

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

16. 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