Presenting symptoms of children with cancer: a primary-care population-based study.
BACKGROUND
Knowledge of how children with cancer present in general practice is sparse. Timely referral from general practice is important to ensure early diagnosis.


OBJECTIVE
To investigate the presenting symptoms and GPs' interpretations of symptoms  of children with cancer.


METHODS
A Danish nationwide population-based study including children (<15 years) with an incident cancer diagnosis (January 2007 to December 2010).


METHODS
A questionnaire on symptoms and their interpretation was  mailed to GPs (n=363). Symptoms were classified according to the International Classification of Primary Care (ICPC)-2 classification.


RESULTS
GPs' response rate was 87% (315/363) and GPs were involved in the diagnostic process of 253 (80.3%) children. Symptoms  were few (2.4 per child) and most fell into the category 'general and unspecified' (71.9%), apart from patients with tumours of the central nervous system (CNS), whose symptoms fell mostly in the category 'neurological' (for example, headache). Symptoms like pain, swelling/lump,  or fatigue were reported in 25% of the patients and they were the most commonly reported symptoms. GPs interpreted children's symptoms as alarm symptoms in 20.2%, as serious (that is, not alarm) symptoms in 52.9%, and as vague symptoms in 26.9%. GPs' interpretation varied significantly  by diagnosis (P<0.001).


CONCLUSIONS
Children with cancer presented with few symptoms in general practice, of which most were 'general and unspecified' symptoms. Only 20% presented alarm symptoms, while 27% presented vague and non-specific symptoms.  This low level of alarm symptoms may influence the time from symptom presentation in general practice to final diagnosis.
Section for General Practice, Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Denmark. jette.ahrensberg@alm.au.dk
Jette Møller
JM
Ahrensberg
Rikke Pilegaard
RP
Hansen
Frede
F
Olesen
Henrik
H
Schrøder
Peter
P
Vedsted
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003718:Denmark; D055088:Early Detection of Cancer; D058006:General Practice; D006801:Humans; D007223:Infant; D009369:Neoplasms / Q000175:diagnosis*; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012042:Registries; D011795:Surveys and Questionnaires