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Wording of GP referral letters speeds up cancer diagnoses

Use of key words means faster diagnosis, finds study

Adrian O'Dowd

Thursday, 04 April 2013

How a GP words their referral letter to a consultant can have a significant impact on the speed of diagnosis of cancer in children, according to a news study published in the British Journal of Cancer.

Danish researchers found that use of key words by GPs in referral letters made a difference in speed of diagnosis.

For the study, a team of researchers from Aarhus University in Denmark studied data on 550 children aged under 15 with diagnosed cancer between January 2007 and December 2010.

Researchers sent questionnaires to parents of children with cancer to see if there was a link between what GPs put on their referral letters to hospitals and the time it took children to be diagnosed with cancer.

A separate questionnaire was sent to GPs for descriptions of the first symptoms, the diagnostic process and the wording of the referral letter sent.

Questionnaires were completed by 377 parents and 315 GPs.

They found that for the most common childhood cancer leukaemia, reference in the GP notes to fatigue, anaemia or bruising was associated with a shorter time to diagnosis.

For children with brain tumours, there was also a faster diagnosis if the GP noted the patient had been vomiting.

In addition to specific symptoms such as tiredness or bruising, when GPs interpreted a symptom as indicating "alarm" or "serious disease" this was linked to speedier diagnoses than if symptoms were interpreted as “vague”.

If the referral letter from the GP explicitly suggested cancer then the length of time from referral to diagnosis was much shorter than when "serious illness" or "something wrong" was used.

Jette Ahrensberg, lead researcher on the project, said: “We found that there were many things that GPs included in their referral letters to hospitals that meant children were seeing specialists quicker. These included how the symptoms were flagged by GPs and also which symptoms the GP put on the letter.

“We also found that the length of time before a diagnosis was reached was at times longer for leukaemia when pain was reported. Although bone pains are common in leukaemia patients, other explanations are much more plausible, such as minor traumas.

“Diagnosing childhood cancer early provides the best chance of long-term survival and recognising early signs is vitally important. Thankfully, childhood cancer is relatively rare, but this study is an important reminder of the crucial role GPs play in early diagnosis of these diseases.”

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “This study provides evidence that when GPs suspect cancer and say so explicitly in referral letters their concerns can contribute to a faster diagnosis.

“Importantly, this research identifies key symptoms, which, when mentioned, speed up the crucial specialist investigations needed for a diagnosis of childhood cancer. The challenge is to accelerate diagnosis when the symptoms are less specific.”

DOI:10.1038/bjc.2013.88

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