Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care.
BJOG: An International Journal of Obstetrics and Gynaecology
This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.
OBJECTIVE: To identify the routes patients with ovarian cancer take between first symptom presentation and diagnosis. DESIGN: Cohort study. SETTING: The study took place in 39 general practices in Devon, UK. POPULATION: All ovarian cancer patients identified in the practices, with a diagnosis between 2000 and 2007 inclusive. METHODS: All patients had their cancer symptoms, referrals, and diagnoses identified and dated using their doctors' records. MAIN OUTCOME MEASURES: Numbers of patients taking specific routes to diagnosis, together with the time taken to diagnosis. RESULTS: Three main routes to diagnosis emerged. The first was the expected route of outpatient referral: 195 (92% of the total) had at least one of the seven ovarian cancer symptoms or an abdominal mass. A total of 123 (58%) were referred to a specialist, although only 65 (31%) were referred to a gynaecologist. Thirty-five (17%) were initially investigated within primary care by ultrasound scanning, and a further 35 (17%) were admitted as emergencies. The interval from first symptom to referral was similar across the different pathways, with a median (interquartile range) time between the first symptom presenting to primary care and first investigation or referral being 2.5 (0, 27.5) days. The median interval from first symptom reported in primary care to diagnosis was 74.5 (32, 159) days. CONCLUSIONS: Only a minority of ovarian cancer patients follow the expected route to diagnosis, of urgent referral to a gynaecologist. In most women, GPs rapidly identified the need to investigate. Avoidable delays generally occurred after the decision to investigate was made.
This work was undertaken by the authors who received funding from the Department of Health’s NIHR School for Primary Care Research. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health. Additionally, WH is funded through an NCCRCD post-doctoral fellowship, and his research practice in Exeter received funding from the Department of Health’s Research Practices scheme. The study sponsor was the University of Bristol. The authors were independent from the funder and sponsor, who had no role in conduct, analysis or the decision to publish.
Research Support, Non-U.S. Gov't
Vol. 117, Iss. 5, pp. 610 - 614
Place of publication