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Cited by 49Global Cancer Incidence and ScreeningLung Cancer Diagnosis and TreatmentCancer Diagnosis and Treatment

Cross-Sectional Study Using Primary Care and Cancer Registration Data to Investigate Patients with Cancer Presenting with Non-Specific Symptoms

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Pearson, Clare, Poirier, Veronique, Fitzgerald, Karen, Rubin, Greg, Hamilton, Willie·2020·BMJ Open
DOI 10.1136/bmjopen-2019-033008PMC PMC6955554
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Abstract

Introduction: Patients presenting to primary care with site-specific alarm symptoms can be referred onto urgent suspected cancer pathways, whereas those with non-specific symptoms currently have no dedicated referral routes leading to delays in cancer diagnosis and poorer outcomes. Pilot Multidisciplinary Diagnostic Centres (MDCs) provide a referral route for such patients in England. Objectives: This work aimed to use linked primary care and cancer registration data to describe diagnostic pathways for patients similar to those being referred into MDCs and compare them to patients presenting with more specific symptoms. Methods: This cross-sectional study linked primary care data from the National Cancer Diagnosis Audit (NCDA) to national cancer registration and Route to Diagnosis records. Patient symptoms recorded in the NCDA were used to allocate patients to one of two groups - those presenting with symptoms mirroring referral criteria of MDCs (non-specific but concerning symptoms (NSCS)) and those with at least one site-specific alarm symptom (non-NSCS). Descriptive analyses compared the two groups and regression analysis by group investigated associations with long primary care intervals (PCIs). Results: Patients with NSCS were more likely to be diagnosed at later stage (32% stage 4, compared with 21% in non-NSCS) and via an emergency presentation (34% vs 16%). These patients also had more multiple pre-referral general practitioner consultations (59% vs 43%) and primary care-led diagnostics (blood tests: 57% vs 35%). Patients with NSCS had higher odds of having longer PCIs (adjusted OR: 1.24 (1.11 to 1.36)). Patients with lung and urological cancers also had higher odds of longer PCIs overall and in both groups. Conclusions: Differences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.

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  • Patients presenting non-specific symptoms such as weight loss or fatigue are typically regarded as having non-serious conditions and are more likely to experience diagnostic delays than site-specific patients.

    “In contrast, patients presenting non-specific symptoms, such as weight loss or fatigue, are typically regarded as having non-serious conditions and are more likely to experience diagnostic delays than site-specific patients [136].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [136]

    The Introduction identifies weight loss and fatigue as non-specific but concerning symptoms, and the Results report longer pre-referral intervals for patients with cancer presenting with these symptoms than for the comparison group (pages not specified). The paper does not say such patients are typically regarded as having non-serious conditions; it describes difficulty choosing a referral pathway instead. Its findings concern patients subsequently diagnosed with cancer, not all patients presenting with these symptoms. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [1]National Institute for Health and Care Excellence Suspected cancer: recognition and referral. NICE guideline (NG12), 2015 Available: https://www.nice.org.uk/guidance/ng12 [Accessed 5 Nov 2018]. 32040285

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Authors
Pearson, C., Poirier, V., Fitzgerald, K., Rubin, G., & Hamilton, W.
Affiliations
  • Cancer Research UK (GB)
  • Royal Victoria Infirmary (GB)
Corresponding author
Pearson, Clare
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2020-01
Volume
10
Issue
1
Pages
e033008
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2019-033008
PMC
PMC6955554
OpenAlex
W3000051592
Cited by
49
References
29
Citations by year
2026: 9 · 2025: 10 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 12 · 2020: 3
FWCI
2.26
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by)
Funders
Cancer Research UK (C8640/A23385)
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Cancer Diagnosis and Treatment
Keywords
non-specific symptoms, cancer diagnosis, diagnostic pathway, cancer stage at diagnosis, emergency presentation, lung cancer, genitourinary cancer, primary care visits
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Cross-Sectional Studies, England, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Morbidity, Neoplasms, Primary Health Care, Surveys and Questionnaires, Registries, Early Detection of Cancer, Young Adult

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