Australian GPs told to shake up colorectal cancer referral system
medwireNews: General practitioners (GPs) should take a more defined and systematic approach to the management of colorectal cancer, say Australian researchers who found that their involvement in the referral pathway was associated with poorer care.
David Goldsbury (Cancer Council New South Wales, Sydney, Australia) and colleagues found that patients who consulted their GP between colonoscopy and surgery waited a median of 12 additional days for surgery over those who did not.
They suggest that improved guidance could promote important GP engagement in early diagnosis without leading to delays in treatment.
"A more systematic approach might be needed for GP involvement in the treatment pathway, perhaps including official guidelines from primary care/GP organisations," the authors write in BMJ Open.
In a sample of 407 colorectal cancer patients in New South Wales who underwent colonoscopy and surgery between 2004 and 2007, 43% had at least one GP consultation between diagnosis and surgery.
Having a GP consultation between diagnosis and treatment was more common in patients who had self-reported poor health such as those with diabetes, chronic obstructive pulmonary disease, and previous smokers, and these patients were also more likely to consult the GP after their surgery. This indicates that GP consultations were primarily for patients in high-risk groups, say the authors.
However, the association between delay to surgery and GP consultation remained after adjustment for cancer site, comorbidities, disadvantage, and health status.
The authors say that it is not possible to determine cause from effect in their study. It could be that an increased time between diagnosis and surgery allowed for more GP consultations, they suggest. Alternatively, GP consultations could reflect the GP's engagement and time to consider the optimal referral pathway.
However, the finding that rectal cancer patients (n=142) who consulted their GP before surgery were no more likely to undergo treatment at a center with radiotherapy access than those who did not (21 vs 25%), indicated that continuity of care may not be a consequence of greater GP involvement.
Goldsbury and colleagues say that action is needed, particularly given plans to expand the Australian bowel cancer screening program.
"There is some urgency to optimise the potential benefits of engagement of GPs (eg, in providing better guidance about where to refer), and a need to address the potential reasons for an increased interval between diagnosis and treatment associated with consulting a GP, especially for patients with rectal cancer," they conclude.
By Kirsty Oswald, medwireNews Reporter