Patient-doctor continuity and diagnosis of cancer: electronic medical records study in general practice.
BACKGROUND
Continuity of care may affect the diagnostic process in cancer but there is little research.


OBJECTIVE
To estimate associations between patient-doctor continuity and time to diagnosis and referral of three common cancers.


METHODS
Retrospective cohort study in general practices in England.


METHODS
This study used data from the General Practice Research Database for patients aged ≥40 years with a diagnosis of breast, colorectal, or lung cancer. Relevant cancer symptoms or signs were identified up to 12 months before diagnosis. Patient-doctor continuity (fraction-of-care index adjusted for number of consultations) was calculated up to 24 months before diagnosis. Time ratios (TRs) were estimated using accelerated failure time regression models.


RESULTS
Patient-doctor continuity in the 24 months before diagnosis was associated with a slightly later diagnosis of colorectal (time ratio [TR] 1.01, 95% confidence interval [CI] =1.01 to 1.02) but not breast (TR = 1.00, 0.99 to 1.01) or lung cancer (TR = 1.00, 0.99 to 1.00). Secondary analyses suggested that for colorectal and lung cancer, continuity of doctor before the index consultation was associated with a later diagnosis but continuity after the index consultation was associated with an earlier diagnosis, with no such effects for breast cancer. For all three cancers, most of the delay to diagnosis occurred after referral.


CONCLUSIONS
Any effect for patient-doctor continuity appears to be small. Future studies should compare investigations, referrals, and diagnoses in patients with and without cancer who present with possible cancer symptoms or signs; and focus on 'difficult to diagnose' types of cancer.
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
Matthew J
MJ
Ridd
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
Diana L Santos
DL
Ferreira
Nottingham Clinical Trials Unit, University of Nottingham, Nottingham.
Alan A
AA
Montgomery
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
Chris
C
Salisbury
University of Exeter, Exeter.
William
W
Hamilton
D000368:Aged; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D057210:Delayed Diagnosis; D057286:Electronic Health Records; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice / Q000379:methods*; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D012189:Retrospective Studies
cancer; continuity of care; diagnosis; general practice; patient-doctor continuity; symptoms