title: Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey.
abstract: OBJECTIVE
  To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist.
  
  
  METHODS
  Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 2012 - 30 April 2013.
  
  
  METHODS
  The primary outcome was the proportion of patients who had had three or more GP consultations about cancer-related health problems before being referred to hospital. The secondary outcome was the interval between the patient first suspecting a problem and their seeing a hospital specialist.
  
  
  RESULTS
  34% of the patients included in the final analyses (426 of 1248) had visited a GP at least three times before referral to a hospital doctor. The odds ratios (reference: rectal cancer; adjusted for age, sex, language spoken at home, and socio-economic disadvantage index score) varied according to cancer type, being highest for pancreatic cancer (3.2; 95% CI, 1.02-9.9), thyroid cancer (2.5; 95% CI, 0.9-6.6), vulval cancer (2.5; 95% CI, 0.7-8.7) and multiple myeloma (2.4; 95% CI, 1.1-5.5), and lowest for patients with breast cancer (0.4; 95% CI, 0.2-0.8), cervical cancer (0.5; 95% CI, 0.1-2.1), endometrial cancer (0.5; 95% CI, 0.2-1.4) or melanoma (0.7; 95% CI, 0.3-1.5). Cancer type also affected the duration of the interval from symptom onset to seeing a hospital doctor; it took at least 3 months for more than one-third of patients with prostate or colon cancer to see a hospital doctor.
  
  
  CONCLUSIONS
  Certain cancer types were more frequently associated with multiple GP visits, suggesting they are more challenging to recognise early. In Victoria, longer intervals from the first symptoms to seeing a hospital doctor for colon or prostate cancer may reflect poorer community symptom awareness, later GP referral, or limited access to gastroenterology and urology services.
authors.affiliation: Victorian Comprehensive Cancer Centre, Melbourne, VIC hannah.cross@unimelb.edu.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Lacey
authors.affiliation: Victorian Comprehensive Cancer Centre, Melbourne, VIC.
authors.forename: James F
authors.initials: JF
authors.lastname: Bishop
authors.affiliation: Victorian Comprehensive Cancer Centre, Melbourne, VIC.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Cross
authors.affiliation: University of Melbourne, Melbourne, VIC.
authors.forename: Patty
authors.initials: P
authors.lastname: Chondros
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.affiliation: University of Melbourne, Melbourne, VIC.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014739:Victoria; D055815:Young Adult