Contacts to general practice in the 12 months preceding a diagnosis of an abdominal cancer: a national register-based cohort study

Abstract

Objective

To compare the number of contacts to general practice across 11 types of abdominal cancer in the 12 months preceding a diagnosis.

Design

Nationwide register study.

Setting

Danish general practice.

Subjects

Forty-seven thousand eight hundred and ninety-eight patients diagnosed with oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney or bladder cancer in 2014–2018.

Main outcome measures

Monthly contact rates and incidence rate ratios (IRRs) of daytime face-to-face, email and telephone consultations in general practice across different abdominal cancers. The analyses were conducted for each sex and adjusted for age, comorbidity, marital status and education.

Results

Compared to women with colon cancer, women with rectal cancer had the lowest number of contacts to general practice (IRR 12 months pre-diagnostic (IRR_–12)=0.86 (95% CI: 0.80–0.92); IRR 1 month pre-diagnostic (IRR_–1)=0.85 (95% CI: 0.81–0.89)), whereas women with liver (IRR_–12=1.23 (95% CI: 1.09–1.38); IRR_–1=1.11 (95% CI: 1.02–1.20)), pancreatic (IRR_–12=1.08 (95% CI: 1.01–1.16); IRR₁=1.52 (95% CI: 1.45–1.58)) and kidney cancer (IRR_–12=1.14 (95% CI: 1.05–1.23); IRR_–1=1.18 (95% CI: 1.12–1.24)) had the highest number of contacts. Men showed similar patterns. From seven months pre-diagnostic, an increase in contacts to general practice was seen in bladder cancer patients, particularly women, compared to colon cancer.

Conclusions

Using pre-diagnostic contact rates unveiled that liver, pancreatic, kidney and bladder cancers had a higher and more prolonged use of general practice. This may suggest missed opportunities of diagnosing cancer. Thus, pre-diagnostic contact rates may indicate symptoms and signs for cancer that need further research to ensure early cancer diagnosis.

Key points

• The majority of cancer patients attend their general practitioner (GP) before diagnosis; however, little is known about the use of general practice across different abdominal cancers.

• This study suggests that a potential exists to detect some abdominal cancers at an earlier point in time.

• The contact patterns in general practice seem to be shaped by the degree of diagnostic difficulty.

• GPs may need additional diagnostic opportunities to identify abdominal cancer in symptomatic patients.

Keywords:

• Abdomen
• Denmark
• general practice
• neoplasms
• population
• primary health care
• referral and consultation

Acknowledgements

We would like to thank data manager Kaare Rud Flarup for helping with the initial data management, Statistics Denmark for facilitating linkage between registers, and Lone Niedziella for linguistic revision.

Ethical considerations: The study was approved and registered in the Record of Processing Activities at the Research Unit for General Practice in Aarhus in accordance with the provisions of the General Data Protection Regulation (GDPR) of the European Union. According to Danish law, the study required no approval from the Committee on Health Research Ethics of the Central Denmark Region as no biomedical intervention was performed. The study was conducted in accordance with the STROBE statement.

Authorship contributions

NHJ provided the basic idea and contributed to the preparation of the study, performed the statistical analyses, and drafted the manuscript. HJ participated in the design, the data interpretation, and the revision of the manuscript. AZF assisted with the statistical analyses. HGL provided critical input to revisions of the manuscript, and HGR participated in the planning of the study and made crucial revisions to the drafts. PV interpreted the results and provided critical revisions to the manuscript.

All authors read and approved the final version of the manuscript.

Disclosure statement

Henning Gronbaek is a member of the advisory board of the Ipsen Biopharmaceutical Group and has received research grants from Abbvie, Intercept, ARLA, ADS AIPHIA Development Services AG, and the NOVO Nordisk Foundation. The funders had no role in the design or reporting of the study. All other authors declare to have no conflict of interests.

Data availability statement

The datasets included in this study are not publicly available as they contain information that might impair the privacy of the study population. The datasets are stored electronically at Statistics Denmark and can only be accessed by approved collaborators.

Additional information

Funding

The work was funded by the Louis-Hansen Foundation, the Danish General Practice Fund, the Central Denmark Region and the Danish Cancer Society. The research is linked to the CanTest Collaborative, which is funded by Cancer Research UK [C8640/A23385], of which Peter Vedsted is Associate Director.