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Title: The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study
Authors: Goldsbury DE; O'Connell DL; Harris M; Pascoe S; Barton M; Olver I; Spigelman A; Beilby J; Veitch C; Weller D
Categories: Cancer Type - Bowel & Colorectal Cancer
Treatment - Resources and Infrastructure
Cancer Control, Survivorship, and Outcomes Research - Health Services, Economic and Health Policy Analyses
Keywords: analysis; radiotherapy; Registries; Research; surgery; Wales; Australia; cancer; cancer registry; Cohort Studies; colorectal cancer; Design; diagnosis; New South Wales
Year: 2013
Journal Title: BMJ Open
Volume: 3
Issue: 3
Abstract: OBJECTIVES: To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. DESIGN: A retrospective cohort analysis of linked data. SETTING: A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. PARTICIPANTS: 407 CRC patients who had a colonoscopy followed by surgery. PRIMARY OUTCOME MEASURES: Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. RESULTS: Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). CONCLUSIONS: Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management
Programme: Health Services Research
Division: Cancer Research Division
Funding Body: This work was supported by Cancer Australia (2007; a Priority-driven Collaborative Cancer Research Scheme (510348)).
DOI: 10.1136/bmjopen-2012-002325
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