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Seeing same doctor 'delays' cancer diagnosis, study claims

Cancer may be spotted earlier in patients who see more than one GP in the period leading up to their diagnosis, a new study has suggested.

The research, which seemed to contradict traditional assumptions on the benefits of continuity of care, indicated that seeing an unknown GP may slightly speed up the process of spotting symptoms of cancer.

However the the University of Bristol researchers said following up with the same doctor seemed to result in a quicker confirmed diagnosis.

The study, published in the British Journal of General Practice today, looked at data drawn from the General Practice Research Database across a 10-year period, including around 18,500 patients aged 40 years or older.

Relevant cancer symptoms or signs were identified up to one year before diagnosis and this was compared to how often patients saw the same doctor up to two years before their diagnosis.

The Cancer Research UK-sponsored study concluded that for bowel cancer, seeing the same doctor over the two years before diagnosis was linked to a longer time to diagnosis, although with a maximum delay of around seven days.

However continuing to see that same doctor after worrying symptoms were spotted tended to get a diagnosis around 14 days sooner than not doing so.

For lung cancer patients, this was around 18 days, while seeing the same doctor didn’t seem to affect the speed of diagnosis of breast cancer.

Study leader Dr Matthew Ridd, a GP and senior lecturer in primary care at the University of Bristol, said: ‘These findings provide some evidence that GPs should follow up patients who present with potential cancer symptoms to make sure they receive a timely diagnosis.

‘Interestingly, we also found that your regular doctor might not be the best person to spot those symptoms in the first place. So in some cases getting a second opinion from a different doctor could speed up the time to diagnosis.’

Dr Richard Roope, Cancer Research UK’s GP expert, pointed out that most GPs will only see around eight new cancer cases per year, despite thousands of patients arriving with potential symptoms.

Dr Roope said that while many people prefer to have a single family doctor, ‘these intriguing findings suggest that in some cases a fresh pair of eyes could be better at spotting early signs of cancer’. He added that anything which could be done to support GPs with early cancer diagnosis was ‘worth pursuing’.

Readers' comments (4)

  • Nice research.
    Let's get the salaried 30 doctor surgery model up and running, sue GPs who delay a diagnosis, place no responsibility on the patient to report red flag features well explained and publicised and see how many 2ww referrals and other mindless tests are created.

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  • Not surprising as there is still a large variation in the ability of individual Gps in whom which appraisal and re validation has completely failed to address.

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  • And the clinical significance of an 8 day delay is....?

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  • Samuel Lewis

    look up http://bjgp.org/content/65/634/e305 to see what the paper actually said:-

    "Patient–doctor continuity in the 24 months before diagnosis was associated with a slightly later diagnosis of colorectal (time ratio [TR] 1.01, 95% confidence interval [CI] =1.01 to 1.02) but NOT breast (TR = 1.00, 0.99 to 1.01) or lung cancer (TR = 1.00, 0.99 to 1.00). Secondary analyses suggested that for colorectal and lung cancer, continuity of doctor before the index consultation was associated with a later diagnosis but continuity after the index consultation was associated with an earlier diagnosis, with no such effects for breast cancer. For all three cancers, most of the delay to diagnosis occurred after referral.

    Conclusion:
    Any effect for patient–doctor continuity appears to be small. Future studies should compare investigations, referrals, and diagnoses in patients with and without cancer who present with possible cancer symptoms or signs; and focus on ‘difficult to diagnose’ types of cancer."

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