media: 'Cinderella cancers' that doctors miss: Multiple visits to the GP needed for proper diagnosis (re: Lancet Oncology)

'Cinderella cancers' that doctors miss: Multiple visits to the GP needed for proper diagnosis | Mail Online


"...But the study, published in The Lancet Oncology journal, said there were ‘wide variations’ depending on the type of cancer and patient......
The study, which looked at 24 different cancers, comes amid concerns that some patients are not given the best chance of beating the disease because of delays in diagnosis.


The study shows patients with breast, melanoma, testicular and endometrial cancers were more likely to be referred to a specialist after just one or two consultations.


However, those with some less common cancers such as multiple myeloma, pancreatic, stomach and ovarian, as well as those with lung and colon cancers and lymphomas, were more likely to require three or more GP visits....."

Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England : The Lancet Oncology

Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians: a vignette-based study.

 Blogger's Note: in the absence of the full paper ($$$) conclusions should be viewed with caution (eg. detailed reasons, albeit summarized in the abstract...) because....the conclusion do not make sense. 

Please post a message IF this paper is available elsewhere in open text publishing format.

 BACKGROUND:

Genetic counseling and testing is recommended for women at high but not average risk of ovarian cancer. National estimates of physician adherence to genetic counseling and testing recommendations are lacking.

METHODS:

Using a vignette-based study, we surveyed 3200 United States family physicians, general internists, and obstetrician/gynecologists and received 1878 (62%) responses. The questionnaire included an annual examination vignette asking about genetic counseling and testing. The vignette varied patient age, race, insurance status, and ovarian cancer risk. Estimates of physician adherence to genetic counseling and testing recommendations were weighted to the United States primary care physician population.

 CONCLUSION:

Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed.

Fertility Preservation Practices Among Ontario Oncologists (study - male/female patients?)

Blogger's Note: in absence of the full text. it is not obvious if the study included male patients  

Abstract

This study explores the attitudes, knowledge, and referring behaviors in fertility preservation among Ontario physicians providing adult cancer care.. ...... Seventy-four percent of the physicians indicated that they rarely or never modified cancer treatment due to concern about future fertility........ About 45% did not know where to refer female patients, and 69.7% rarely ever made a fertility preservation consultation referral for their female patients..........

Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians - journal Cancer 2011 - abstract

CONCLUSION:

Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed.

full free access: - Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care - 2010 - BJOG

Implications of the findings

"The main finding is that only a minority of patients take the standard route of GP referral to a gynaecologist........"

(references SGO presentation) PCPs less likely to refer patients to gynecologic oncologists | HemOncToday

"..........Just 39.3% of family physicians and 51% of internists reported that they would refer the patient to the gynecologic oncologist. They were much more likely to refer their patients to obstetrician-gynecologists. Among obstetrician-gynecologists, however, two-thirds reported that they would refer a patient with abdominal pain and a suspicious ovarian mass to a gynecologic oncologist.........One-third of the obstetrician-gynecologists reported that they would operate on the patient themselves.........."

Goff B. #10. Presented at: the 42nd Annual Meeting of the Society of Gynecologic Oncologists; March 6-9, 2011, Orlando, Fla.

Diagnostic performance of urgent referrals for suspected gynaecological malignancies.

PURPOSE: The objective of this study was to investigate the outcome of the urgent referrals with suspected gynaecological malignancy.
CONCLUSION: The overall predictive value of two-week wait referrals for suspected gynaecological malignancies is low. Refinement of the current referral guidelines is required with particular emphasis in the premenopausal women where the diagnostic performance of the urgent referrals is significantly poorer.

full free access: eMJA: Pathways to the diagnosis of epithelial ovarian cancer in Australia

Note: excerpts below,  the tables included in the paper provide interesting information including patients with borderline tumours, 24% of patients in this study had a prior hysterectomy  etc...

Objective:

To describe the diagnostic pathways experienced by a large, representative group of Australian women with ovarian cancer, and to document the time between first presentation to a medical professional and clinical diagnosis.

Main outcome measures:

Number and type of doctors consulted, investigations performed, referral patterns and the time from first presentation to diagnosis.

Conclusions:

Despite anecdotal suggestions to the contrary, most women with ovarian cancer in Australia are investigated and diagnosed promptly. The diagnostic process is more protracted for a minority of women, and the factors we found to be associated with diagnostic delay warrant further investigation.

"........The numbers of symptoms reported, doctors seen and total doctor visits were all highly skewed. These variables were therefore summarised....."

National Guideline Clearinghouse | Initial evaluation and referral guidelines for management of pelvic/ovarian masses 2009

Guideline Title

Initial evaluation and referral guidelines for management of pelvic/ovarian masses.

Bibliographic Source(s)

Le T, Giede C, Society of Obstetricians and Gynaecologists of Canada (SOGC), Gynecologic Oncologists of Canada (GOC), Society of Canadian Colposcopists (SCC). Initial evaluation and referral guidelines for management of pelvic/ovarian masses. Practice guideline. J Obstet Gynaecol Can 2009 Jul 01;(230):668-73.

Guideline Status

This is the current release of the guideline.

Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malig.........

Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malignancy Index
Hypothesis

Higher risk of malignancy index (RMI) with multidisciplinary approach will reduce the number of referrals of ovarian masses, thus reducing the stress for patients and workload at the cancer center.
Conclusions: A higher RMI with multidisciplinary approach to refer patients with pelvic masses has the potential to reduce the numbers of benign cases, thus reducing stress for patients and reducing workload at centers.