title: Patients with cancer and change of general practice: a Danish population-based cohort study.
abstract: BACKGROUND
  General practice plays an important role in the cancer care pathway. Patient dissatisfaction with the diagnostic process may be expressed by changing to another general practice.
  
  
  OBJECTIVE
  To compare the frequency of change of practice (COP) in patients with cancer (n = 150 216) with a matched cancer-free control cohort (n = 1 502 114) and to analyse associations with cancer type and patient characteristics.
  
  
  METHODS
  A population-based matched cohort study using historical and prospectively collected data from Danish nationwide registers.
  
  
  METHODS
  COP was defined as a change of practice list, unrelated to change of address or reorganisation of the practice. Data were analysed monthly in the year before and after a cancer diagnosis.
  
  
  RESULTS
  More patients with cancer than controls changed general practice (4.1% versus 2.6%) from 7 months before and until 12 months after diagnosis. The COP rate varied by cancer type (rectal cancer served as reference). Before the diagnosis, COP was most often seen among patients with ovarian cancer (risk ratio [RR] 1.51, 95% confidence interval [CI] = 1.10 to 2.08) and multiple myeloma (RR 1.89, 95% CI = 1.34 to 2.67). After the diagnosis, COP was most frequent among patients with brain cancer (RR 1.38, 95% CI = 1.05 to 1.82) and ovarian cancer (RR 1.51, 95% CI = 1.21 to 1.88).
  
  
  CONCLUSIONS
  Patients with cancer changed general practice more frequently than the cancer-free controls. COP variations between cancer types may be attributed to lack of diagnostic timeliness due to clinical complexity of the diagnosis and the role of the GP in the diagnostic process.
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Grooss
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hjertholm
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
authors.forename: Anders H
authors.initials: AH
authors.lastname: Carlsen
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D057210:Delayed Diagnosis; D003718:Denmark; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D058006:General Practice / Q000592:standards; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data*
keywords: Denmark; continuity of patient care; early detection of cancer; general practice; neoplasms; primary health care