The development of an abdominal ‘yes-no’ pathway for primary care patients with vague and non-specific abdominal symptoms (PhD)

Start Date May 2017

Code A4-Aff, PhD

Status Ongoing

Project Lead
Senior Lead
Institution
Others
Supervisors: Henning Gronbaek (Aarhus University Hospital), Henry Jensen, Henning Glerup (both Aarhus),
Charles Helsper (Utrecht)

Introduction

Earlier cancer diagnosis is a pivotal step to improve the prognosis, and there seems to be opportunity for improvement in abdominal cancers. In Denmark, 31% of all newly diagnosed cancers are abdominal cancers.

The majority (75-85%) of cancer patients initially present symptoms to their GP, but only half of them present alarm symptoms, while 20% present serious non-specific symptoms, and 30% present vague non-specific symptoms. Site-specific cancer patient pathways (CPPs) for alarm symptoms were implemented in Denmark in 2008/2009. In 2012, a new Danish CPP was implemented to target patients with serious non-specific symptoms (NSSC-CPP). Still, no pathway exists for patients with vague abdominal symptoms.

Funding

Louis-Hansen Foundation: 100,000 DKK = 11,859.65 GBP
Danish General Practice Fund: 100,000 DKK = 11,859.65 GBP
Danish Cancer Society: 1,070,000 DKK = 127,622.45 GBP
Rational and Early Diagnosis, Central Denmark Region: 163,000 DKK = 19,441.55 GBP
Committee of Multipractice Studies in General Practice: 40,431 DKK = 4,794.97 GBP

Aims & objectives

To explore the frequency and timing of specific abdominal related investigations and CPPs in the year prior to a diagnosis of an abdominal cancer.

To describe GPs´ involvement in the diagnosis, suspicion of cancer and the primary care interval among abdominal cancer patients.

To develop a rapid, stepped abdominal `yes-no’ pathway for patients in primary care with vague abdominal symptoms, and to set-up the pathway and assess the feasibility.

Methodology

This PhD project is composed of three parts.

Study 1 is a register-based national cohort study of first-time abdominal cancer (including gynaecological and urological cancer) patients, who are registered in the Danish Cancer Registry (DCR) with an abdominal cancer in the period from 1 January 2014 to 31 December 2017.

In study 2 we use individual data for each patient, collected on the basis of medical records through a questionnaire send to the GP of each patient.

Study 3 consists of both a developmental part and a feasibility part. The first part comprised of focus group interviews with 16 selected specialist. Second part consisted of a feasibility study, recently conducted (1 April to 30 September 2019) at Silkeborg Regional Hospital. Inclusion criteria were both men and women ≥30 years old presenting with vague and non-specific abdominal symptoms (considered by the GP as being ‘vague’), lasting for at least 3-4 weeks. The abdominal ´yes-no´ pathway consisted of: 1) Medical and objective examination, 2) Selected blood samples and a Fecal Immunochemical test (FIT), and 3) Abdominal ultrasound (US) and transvaginal US (TVUS) (for women).

Outputs & impact

Overall, the project will provide new important knowledge of the clinical examinations conducted in the year prior to an abdominal cancer diagnosis, and the GPs’ symptom interpretation and referral practice for patients with abdominal cancer.

Further, this project will contribute with novel knowledge of providing direct access in primary care to a newly developed abdominal ‘yes-no’-pathway, which may help improve the diagnostics of abdominal cancers or other serious abdominal disease in the future.

Next steps

Data from study 1 and 2 are being analysed. An evaluation of the recently tested abdominal ‘yes-no’ pathway is currently being planned through a focus group meeting with both GPs who have used the abdominal ‘yes-no’ pathway and GPs who have not used the offer of direct access to the abdominal ‘yes-no’ pathway.

 

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