title: Childhood cancer and factors related to prolonged diagnostic intervals: a Danish population-based study.
abstract: BACKGROUND
  Early diagnosis of childhood cancer provides hope for better prognoses. Shorter diagnostic intervals (DI) in primary care require better knowledge of the association between presenting symptoms, interpretation of symptoms and the wording of the referral letter.
  
  
  METHODS
  A Danish nationwide population-based study. Data on 550 children aged <15 years with an incident cancer diagnosis (January 2007-December 2010) were collected through questionnaires to parents (response rate=69%) and general practitioners (GPs) (response rate=87%). The DI from the first presentation in general practice until diagnosis was categorised as short or long based on quartiles. Associations between variables and long DIs were assessed using logistic regression.
  
  
  RESULTS
  The GPs interpreted symptoms as 'vague' in 25.4%, 'serious' in 50.0% and 'alarm' in 19.0% of cases. Symptom interpretation varied by cancer type (P<0.001) and was associated with the DI (P<0.001). Vomiting was associated with a shorter DI for central nervous system (CNS) tumours, and pain with a longer DI for leukaemia. Referral letter wording was associated with DI (P<0.001); the shortest DIs were observed when cancer suspicion was raised in the letter.
  
  
  CONCLUSIONS
  The GPs play an important role in recognising early signs of childhood cancer as their symptom interpretation and referral wording have a profound impact on the diagnostic process.
authors: Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark. jette.ahrensberg@alm.au.dk
authors: J M
authors: JM
authors: Ahrensberg
authors: F
authors: F
authors: Olesen
authors: R P
authors: RP
authors: Hansen
authors: H
authors: H
authors: Schrøder
authors: P
authors: P
authors: Vedsted
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors