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Department of General Practice Research Unit for General Practice
U N I V E R S I T Y O F A A R H U Swww.alm.au.dk
Do cancer patients’ symptoms influence the pattern of delay?
Rikke Pilegaard HansenMD, PhD
Delay - definition The interval between a patient’s
first symptoms and initiation of treatment
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 delayDoctor delayPatient delay
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
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
Total delay
25% percentile:57 days
Median:98 days
75% percentile:168 days
010
020
030
040
0
De
lay
in d
ays
0 200 400 600 800 1000
Patients
System delay
25% percentile:32 days
Median:55 days
75% percentile:93 days
010
020
030
040
0
De
lay
in d
ays
0 500 1000 1500
Patients
Doctor delay
25% percentile:0 days
Median:0 days
75% percentile:2 days
010
020
030
040
0
De
lay
in d
ays
0 500 1000 1500 2000
Patients
Patient delay
25% percentile:7 days
Median:21 days
75% percentile:56 days
010
020
030
040
0
De
lay
in d
ays
0 500 1000 1500
Patients
Symptoms Symptom interpretation by GPs:
Alarm symptoms: 49% General symptoms: 24% Non-cancer-specific symptoms: 27%
All delay types
0
20
40
60
80
100
120
Patient delay Doctor delay System delay Total delay
Days
Alarm symptoms
General symptoms
Non-cancer-specific symptoms
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 delayDoctor delayPatient delay
System delay
0
5
10
15
20
25
30
35
40
"Investigation start" to "referral" "Referral" to "diagnosis" "Diagnosis" to "treatment start"
Days
Alarm symptoms
General symptoms
Non-cancer-specific symptoms
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
Department of General Practice Research Unit for General Practice
U N I V E R S I T Y O F A A R H U Swww.alm.au.dk
Thank you for your attention
Delay
Patient delay Doctor delay System delay Total delay
Median (IQI*) 21 days (7-56) 0 days (0-2) 55 days (32-93) 98 days(57-168)
*Interquartile interval
