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03-04-2013 | General practice | Article

GPs' referral wording can speed up childhood cancer diagnosis

Abstract

Free abstract

medwireNews: The wording of a general practitioner's (GP's) referral letter to the consultant has a significant impact on the time to diagnosis for pediatric cancer patients, Danish research shows.

Delays in diagnosis were substantially shorter when GPs made explicit reference to suspicion of cancer than when less specific referral reasons were given, while children referred by GPs who described their symptoms as "vague" had the longest diagnostic intervals.

"This study is an important reminder of the crucial role GPs play in early diagnosis of these diseases," said author Jette Ahrensberg (Aarhus University, Denmark) in a press statement.

Overall, 550 children who were diagnosed with malignancy or benign tumors of the central nervous system between January 2007 and December 2010 were sampled from the Danish Childhood Cancer Registry. The authors received questionnaire responses from 315 GPs who referred the children.

The median diagnostic interval was only a week when GPs stated "suspicion of cancer" in their referral letter compared with nearly a month when they merely stated "something wrong," report the authors in the British Journal of Cancer.

Symptoms were interpreted by GPs as "alarm" in 19% of cases, as "serious" in 50%, and "vague" in 25%. The authors found that the risk for long diagnostic interval (4th quartile) was threefold greater among patients whose symptoms were interpreted as "vague" by their GP than among those whose symptoms were interpreted as "alarm".

And, while no one symptom was a significant predictor of long diagnostic interval, when fatigue was noted, the risk for a long interval was reduced by 50% (median 7 vs 20 days).

Additionally, among patients with leukemia, reference to fatigue, anemia, or bruising in the GP's referral was associated with a shorter diagnostic interval, while reference to pain was associated with a 5.6-fold greater risk for long diagnostic interval. This may be because other explanations for bone pain in primary care are more likely than cancer, the authors say.

Conversely, pain reported in patients with lymphoma was associated with significantly shorter delays, as was vomiting in patients with central nervous system tumors.

Ahrensberg and colleagues say that their study shows that GPs play a key role in the timely referral of pediatric cancer patients.

"GPs may help accelerate the diagnostic pathway in secondary care by stating suspicion of cancer or another serious disease," the authors conclude.

By Kirsty Oswald, medwireNews Reporter

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