Presentations to general practice before a cancer diagnosis: do they differ between Australia and England?

Problem

The majority of patients diagnosed with cancer initially consult with a general practitioner (GP) about their symptoms. GPs are therefore pivotal in the timely diagnosis of cancer. There is a little evidence about GP consultations and factors associated with time preceding a cancer diagnosis in Australia. This study aimed to examine variation in number of GP visits preceding a cancer diagnosis and compare Australian data with those from England.

Approach

We analysed data from the Cancer Patient Experience Survey (CPES) from 1552 patients with one of 19 cancers (response rate 38%) treated in one of the five Victorian Comprehensive Cancer Centre hospitals. We also used comparative data from the 2010 CPES on 40,749 patients in England (response rate 67%).

Findings

Thirty-four per cent of Australian (426/1248) and 23%, (9550/40,749) of English patients had visited a GP at least three times before referral to a hospital doctor. There was large variation by cancer type in the proportion of patients who visited their GP at least three times before referral: in both populations myeloma and pancreatic cancer were most strongly associated with multiple GP visits; patients with melanoma, breast or endometrial cancer were less likely to have visited their GP at least three times before referral. Cancer type was also associated with the interval from symptom onset to seeing a hospital doctor: in the Australian sample it took at least three months for over a third of patients with prostate or colon cancer to see a hospital doctor (34.9 and 34.8% respectively; English data 24.1% and 28.9% respectively).

Consequences

Certain cancers are more often associated with multiple GP visits suggesting they are more challenging to recognise early. Greater access to investigations in Australian general practice could explain the higher proportion of patients having multiple GP visits before referral. In Australia, longer duration from first symptom to seeing a hospital doctor for colon or prostate cancer may also reflect poorer community symptom awareness or absence of fast track referral pathways to gastroenterology or urology services.