title: Why do patients with cancer access out-of-hours primary care? A retrospective study.
abstract: BACKGROUND
  Identifying why patients with cancer seek out-of-hours (OOH) primary medical care could highlight potential gaps in anticipatory cancer care.
  
  
  OBJECTIVE
  To explore the reasons for contact and the range and prevalence of presenting symptoms in patients with established cancer who presented to a primary care OOH department.
  
  
  METHODS
  A retrospective review of 950 anonymous case records for patients with cancer who contacted the OOH general practice service in Grampian, Scotland between 1 January 2010 and 31 December 2011.
  
  
  METHODS
  Subjects were identified by filtering the OOH computer database using the Read Codes 'neoplasm', 'terminal care', and 'terminal illness'. Consultations by patients without cancer and repeated consultations by the same patient were excluded. Data were anonymised. Case records were read independently by two authors who determined the presenting symptom(s).
  
  
  RESULTS
  Anonymous case records were reviewed for 950 individuals. Eight hundred and fifty-two patients made contact because of a symptom. The remaining 97 were mostly administrative and data were missing for one patient. The most frequent symptoms were pain (n = 262/852, 30.8%); nausea/vomiting (n = 102/852, 12.0%); agitation (n = 53/852, 6.2%); breathlessness (n = 51/852, 6.0%); and fatigue (n = 48/852, 5.6%). Of the 262 patients who presented with pain, at least 127 (48.5%) had metastatic disease and 141 (53.8%) were already prescribed strong opiate medication.
  
  
  CONCLUSIONS
  Almost one-third of patients with cancer seeking OOH primary medical care did so because of poorly controlled pain. Pain management should specifically be addressed during routine anticipatory care planning.
authors.affiliation: Centre for Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Adam
authors.forename: Patrick
authors.initials: P
authors.lastname: Wassell
authors.forename: Peter
authors.initials: P
authors.lastname: Murchie
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018450:Disease Progression; D004417:Dyspnea / Q000188:drug therapy / Q000453:epidemiology; D005221:Fatigue / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009325:Nausea / Q000188:drug therapy / Q000453:epidemiology; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D010166:Palliative Care; D015995:Prevalence; D011320:Primary Health Care; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000453:epidemiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D018434:Sickness Impact Profile; D014839:Vomiting / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D000970:Antineoplastic Agents
keywords: cancer; pain; palliative care; primary health care; signs and symptoms; symptom management