Clinical activity in general practice before sarcoma diagnosis: an Australian cohort study

Rafiq, M; de Boer, J; Mar, J; Desai, J; Bae, S; Gyorki, DE; Di Bella, C; Lyratzopoulos, G; Lewin, JH; Emery, J

Author(s): Rafiq, M; de Boer, J; Mar, J; Desai, J; Bae, S; Gyorki, DE; Di Bella, C; Lyratzopoulos, G; Lewin, JH; Emery, J;
Details: Publication Year 2024-08,Volume 74,Issue #745,Page e508-e516
Journal Title: British Journal of General Practice
Publication Type: Research article
Abstract: BACKGROUND: Increased time to diagnosis in sarcoma is associated with poor prognosis and patient outcomes. Research is needed to identify whether opportunities to expedite the diagnosis of sarcoma in general practice exist. AIM: To examine pre-diagnostic GP clinical activity before sarcoma diagnosis. DESIGN AND SETTING: An Australian retrospective cohort study using hospital registry data (Australian Comprehensive Cancer Outcomes and Research Database [ACCORD]) linked to two primary care datasets (Patron and MedicineInsight). METHOD: The frequency of general practice healthcare utilisation events (general practice attendances, prescriptions, blood test, and imaging requests) were compared in 377 patients with soft tissue sarcoma (STS) and 64 patients with bone sarcoma (BS) in the year pre-diagnosis. Poisson regression models were used to calculate monthly incidence rate ratios (IRR) for the 24 months pre-diagnosis and estimate inflection points for when healthcare use started to increase from baseline. RESULTS: In the 6 months pre-diagnosis, patients with sarcoma had a median of 3-4 general practice attendances, around one-third had a GP imaging request (33% [n = 21] BS and 36% [n = 134] STS), and approximately one in five had multiple imaging requests (19% [n = 12] BS and 21% [n = 80] STS). GP imaging requests progressively increased up to eight-fold from 6 months before sarcoma diagnosis (IRR 8.43, 95% confidence interval [CI] = 3.92 to 18.15, P<0.001) and general practice attendances increased from 3 months pre-diagnosis. CONCLUSION: Patients with sarcoma have increased GP clinical activity from 6 months pre-diagnosis, indicating a diagnostic window where potential opportunities exist for earlier diagnosis. Interventions to help identify patients and promote appropriate use of imaging and direct specialist centre referrals could improve earlier diagnosis and patient outcomes.
Keywords: Humans; *Sarcoma/diagnosis/epidemiology; *General Practice/statistics & numerical data; Retrospective Studies; Australia/epidemiology; Female; Male; Middle Aged; Soft Tissue Neoplasms/diagnosis/epidemiology; Adult; Bone Neoplasms/diagnosis/epidemiology; Referral and Consultation/statistics & numerical data; Aged; Registries; Practice Patterns, Physicians'/statistics & numerical data; Early Detection of Cancer/statistics & numerical data; diagnostic activity; diagnostic time window; general practice; imaging; referral and consultation; sarcoma
Department(s): Office of Cancer Research; Medical Oncology; AYA Cancer Service
Publisher's Version: https://doi.org/10.3399/bjgp.2023.0610
Open Access at Publisher's Site: https://doi.org/10.3399/bjgp.2023.0610
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-09-03 05:24:46

Last Modified: 2024-09-03 05:24:56