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Childhood cancer and factors related to prolonged diagnostic intervals: a Danish population-based study
J M Ahrensberg1, F Olesen, R P Hansen
1Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark. jette.ahrensberg@alm.au.dk
Insights
General practitioners
Area of Science:
- Pediatric Oncology
- Diagnostic Pathways
- Primary Care Medicine
Background:
- Early diagnosis of childhood cancer significantly improves patient prognosis.
- Understanding the diagnostic interval (DI) in primary care is crucial for timely cancer detection.
- Key factors influencing DI include presenting symptoms, their interpretation by general practitioners (GPs), and referral letter content.
Purpose of the Study:
- To investigate the association between symptom interpretation, referral wording, and the diagnostic interval for childhood cancer.
- To identify factors contributing to delays in diagnosing pediatric cancers in primary care settings.
Main Methods:
- A nationwide Danish population-based study involving 550 children under 15 with incident cancer diagnoses.
- Data collected via questionnaires to parents and general practitioners (GPs).
- Diagnostic interval (DI) categorized as short or long; logistic regression used to assess variable associations.
Main Results:
- GP symptom interpretation varied by cancer type and was significantly associated with DI.
- Vomiting correlated with shorter DI for CNS tumors; pain correlated with longer DI for leukemia.
- Referral letter wording impacted DI, with explicit cancer suspicion leading to shortest intervals.
Conclusions:
- GPs are pivotal in recognizing early childhood cancer signs.
- GP symptom interpretation and referral letter content profoundly influence the diagnostic process and timeliness.
- Optimizing GP knowledge and communication strategies can shorten diagnostic intervals for pediatric cancers.
Background:
Early diagnosis of childhood cancer provides hope for better prognoses. Shorter diagnostic intervals (DI) in primary care require better knowledge of the association between presenting symptoms, interpretation of symptoms and the wording of the referral letter.
Methods:
A Danish nationwide population-based study. Data on 550 children aged <15 years with an incident cancer diagnosis (January 2007-December 2010) were collected through questionnaires to parents (response rate=69%) and general practitioners (GPs) (response rate=87%). The DI from the first presentation in general practice until diagnosis was categorised as short or long based on quartiles. Associations between variables and long DIs were assessed using logistic regression.
Results:
The GPs interpreted symptoms as 'vague' in 25.4%, 'serious' in 50.0% and 'alarm' in 19.0% of cases. Symptom interpretation varied by cancer type (P<0.001) and was associated with the DI (P<0.001). Vomiting was associated with a shorter DI for central nervous system (CNS) tumours, and pain with a longer DI for leukaemia. Referral letter wording was associated with DI (P<0.001); the shortest DIs were observed when cancer suspicion was raised in the letter.
Conclusion:
The GPs play an important role in recognising early signs of childhood cancer as their symptom interpretation and referral wording have a profound impact on the diagnostic process.
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