PT  - JOURNAL ARTICLE
AU  - Silvia C Mendonca
AU  - Gary A Abel
AU  - Georgios Lyratzopoulos
TI  - Pre-referral GP consultations in patients subsequently diagnosed with rarer cancers: a study of patient-reported data
AID  - 10.3399/bjgp16X683977
DP  - 2016 Mar 01
TA  - British Journal of General Practice
PG  - e171--e181
VI  - 66
IP  - 644
4099  - http://bjgp.org/content/66/644/e171.short
4100  - http://bjgp.org/content/66/644/e171.full
SO  - Br J Gen Pract2016 Mar 01; 66
AB  - Background Some patients with cancer experience multiple pre-diagnostic consultations in primary care, leading to longer time intervals to specialist investigations and diagnosis. Patients with rarer cancers are thought to be at higher risk of such events, but concrete evidence of this is lacking.Aim To examine the frequency and predictors of repeat consultations with GPs in patients with rarer cancers.Design and setting Patient-reported data on pre-referral consultations from three English national surveys of patients with cancer (2010, 2013, and 2014), pooled to maximise the sample size of rarer cancers.Method The authors examined the frequency and crude and adjusted odds ratios for ≥3 (versus 1–2) pre-referral consultations by age, sex, ethnicity, level of deprivation, and cancer diagnosis (38 diagnosis groups, including 12 rarer cancers without prior relevant evidence).Results Among 7838 patients with 12 rarer cancers, crude proportions of patients with ≥3 pre-referral consultations ranged from >30.0% to 60.0% for patients with small intestine, bone sarcoma, liver, gallbladder, cancer of unknown primary, soft-tissue sarcoma, and ureteric cancer. The range was 15.0–30.0% for patients with oropharyngeal, anal, parotid, penile, and oral cancer. The overall proportion of responders with any cancer who had ≥3 consultations was 23.4%. Multivariable logistic regression indicated concordant patterns, with strong evidence for variation between rarer cancers (P <0.001).Conclusion Patients with rarer cancers experience pre-referral consultations at frequencies suggestive of middle-to-high diagnostic difficulty. The findings can guide the development of new diagnostic interventions and ‘safety-netting’ approaches for symptomatic presentations encountered in patients with rarer cancers.