Programme no. 235-OP
Professional Development
Cancer suspicion starting with abdominal symptoms in general practice
Professor Knut Holtedahl*1, Tonje Braaten2, Ranjan Parajuli3
1Institute of Community Medicine,UiT The Arctic University of Norway,Tromsø,Norway, 2Institute of Community Medicine,UiT The Arctic University of Norway,Tromsø,Norway, 3Institute of Community Medicine,UiT The Arctic University of Norway,Tromsø,Norway
* = Presenting author
Objectives:

A more detailed examination of abdominal and general symptoms and the degree of cancer suspicion they raise in general practice, and to what extent such suspicion of cancer in general practice is correct.

Background:

Early diagnosis of cancer is an important challenge in general practice. Persistent digestive problem is one of several common symptoms known to be alarm symptoms for cancer, and abdominal cancers are among the most frequent forms of cancer.

Results:

Between consultation and follow-up, 759 patients were diagnosed with cancer. At least one abdominal symptom was presented in 6,579 (10%) consultations, and at least one general symptom in 1,684 (26%) of those with abdominal symptoms during the consultations. For consultations with abdominal symptom(s), cancer suspicion from zero to strongly was noted in 94% of patients representing 6,225 consultations. Of these, 2,103 had a positive suspicion of cancer and zero suspicion was noted in 4122 consultations. Of all cancer patients, there was a positive suspicion in 114 (15%) patients. Where zero suspicion was reported, 87 (12%) got cancer. A positive cancer suspicion was correct in 7% of consultations where a suspicion was reported, while lack of cancer suspicion was erroneous in 2% of cases.

Material/Methods:

Retrospective cohort study with prospective registration of cancer. The study recruited 493 general practitioners (GPs) from six European countries (Norway, Sweden, Denmark, Belgium, Netherland and Scotland), organised through The Cancer and Primary Care Research International Network (Ca-PRI). In 2011, the GPs registered 70,358 consecutive patient consultations during ten working days, using one-sheet closed ended questionnaires. Sex and birth date were recorded for all patients, as well as symptoms if presented. If one or more abdominal symptoms were present, the GP was asked to answer all remaining questions for that particular patient. Whether the GP suspected cancer was answered for three dimensions: Based on symptoms, on clinical findings, on intuition. Cancer suspicion was graded for each dimension on a four-point scale: not at all, slightly, medium, strongly. All GPs were further asked to supply anonymous information about patients diagnosed with cancer during the follow-up period, whether or not they presented with symptoms in the initial survey. Around 75% of GPs took part in the second phase and reported from zero to seven patients with cancer.

Conclusion:

A correct cancer suspicion was 3.5 times more frequent than an erroneous lack of suspicion. A more detailed analysis of cancer suspicion across the three dimensions and its strength, for any symptom and for single symptoms, will be presented at the Congress.

Points for discussion: Apart from symptoms, what makes the thought of cancer appear in the head of a GP?