title: Tumour stage and implementation of standardised cancer patient pathways: a comparative cohort study.
abstract: BACKGROUND
  Some European countries have introduced standardised cancer patient pathways (CPPs), including urgent referrals, with the aim of diagnosing cancer at an earlier stage. This is despite a lack of evidence, particularly in patients with symptomatic cancer diagnosed via general practice.
  
  
  OBJECTIVE
  To compare tumour stages in patients with incident cancer diagnosed via general practice before, during, and after CPP implementation in Denmark in 2008-2009.
  
  
  METHODS
  A comparative cohort study of data from GPs and registries on patients with incident cancer listed with a GP before (n = 1420), during (n = 5272), and after (n = 2988) CPP implementation.
  
  
  METHODS
  χ(2) test was used to compare stage distributions and logistic regression to estimate odds ratios (OR) of having local cancer after versus before CPP implementation.
  
  
  RESULTS
  Distribution of tumour stages did not differ statistically significantly across time (P = 0.494) or between CPP use (P = 0.202). For all cancers combined, the OR of having local cancer after CPP implementation was 0.88 (95% confidence interval [CI] = 0.73 to 1.06) compared with before. For CPP-referred patients, the OR of having local cancer was 0.77 (95% CI = 0.62 to 0.94) compared with all patients before CPP implementation; the corresponding OR for non-CPP-referred patients was 0.96 (95% CI = 0.80 to 1.14).
  
  
  CONCLUSIONS
  No clear tendencies were observed confirming earlier detection of cancer after rather than before CPP implementation. CPP-referred patients had lower odds of having local cancer after CPP implementation than all patients before CPP implementation; this could be because the GPs refer patients who are 'more ill' as urgent referrals.
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice and Section for General Medical Practice, Department of Public Health;
authors.forename: Henry
authors.initials: H
authors.lastname: Jensen
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health; Department of Anthropology, School of Culture and Society;
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Tørring
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Fenger-Grøn
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Overgaard
authors.affiliation: Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D058006:General Practice / Q000379:methods* / Q000592:standards; D006801:Humans; D009367:Neoplasm Staging / Q000379:methods*; D009369:Neoplasms / Q000175:diagnosis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation; D012042:Registries; D061665:Time-to-Treatment
keywords: Denmark; cancer; early diagnosis; general practice; tumour stage; urgent referral