PMID- 33955822
OWN - NLM
STAT- MEDLINE
DCOM- 20210818
LR  - 20220531
IS  - 1502-7724 (Electronic)
IS  - 0281-3432 (Print)
IS  - 0281-3432 (Linking)
VI  - 39
IP  - 2
DP  - 2021 Jun
TI  - Diagnostic center for primary care patients with nonspecific symptoms and 
      suspected cancer: compliance to workflow and accuracy of tests and examinations.
PG  - 148-156
LID - 10.1080/02813432.2021.1913892 [doi]
AB  - OBJECTIVE: To evaluate compliance to workflow and accuracy of tests in Sweden's 
      first fast-track referral pathway for patients with nonspecific symptoms and 
      suspected cancer (SCAN). DESIGN: Prospective cohort study with consecutive 
      inclusion of patients referred to the diagnostic center (DC). SETTING: Patients 
      with nonspecific symptoms were examined in primary care according to a protocol 
      including two test packages and diagnostic imaging. If symptoms were not 
      explained, patients were referred to the DC and a DC-test package was taken. At 
      the DC, further investigations resulted in diagnosis/no diagnosis. SUBJECTS: A 
      total of 290 patients, median age 69 years (interquartile range [IQR] 59-76), 48% 
      men, participated. A total of 64 (22%) were diagnosed with cancer, 186 (64%) with 
      non-malignant disease and 40 (14%) had no new disease. MAIN OUTCOME MEASURE: 
      Compliance was estimated by percentage of compulsory tests taken. Test accuracy 
      was assessed by likelihood ratios (LRs) regarding cancer. RESULTS: A total of 23 
      (8%) patients had taken both primary care packages, whereas 150 (52%) patients 
      went through entire diagnostic imaging. Abnormal pulmonary X-ray, peak expiratory 
      flow (PEF) and calcium had the highest LRs in primary care (3.5; 3.2; 2.7). A 
      total of 105 (36%) took the complete DC-package, of which bilirubin and 
      cytomegalovirus had the highest LRs (11.5; 10.9). The median number (IQR) of 
      abnormal primary care tests was 5 (3-6) for cancer, 3 (2-6) for other diagnoses 
      and 1 (0-3) for no diagnosis. CONCLUSIONS: Compliance to test packages in primary 
      care was low, which warrants review of the workflow. Few single tests had high 
      accuracy regarding cancer, but the number of abnormal tests can provide guidance 
      in complicated investigations of suspected malignancies.KEY POINTSFast-track 
      referral pathways for patients with nonspecific serious symptoms have been 
      implemented in several countries and are part of the national cancer strategy in 
      all of Scandinavia.Compliance with compulsory tests in primary care was modest in 
      this study; 8% of the patients had taken the entire compulsory test packages.Few 
      single compulsory tests had high accuracy regarding subsequent cancer, which 
      warrants a review of tests and examinations. However, patients diagnosed with 
      cancer had a higher number of abnormal test results compared to the other groups.
FAU - Stenman, Emelie
AU  - Stenman E
AD  - Center for Primary Health Care Research, Department of Clinical Sciences Malmo, 
      Lund University, Sweden.
FAU - Palmer, Karolina
AU  - Palmer K
AD  - Center for Primary Health Care Research, Department of Clinical Sciences Malmo, 
      Lund University, Sweden.
FAU - Ryden, Stefan
AU  - Ryden S
AD  - Regional Cancer Centre South, Skane Regional Council, Lund, Sweden.
FAU - Savblom, Charlotta
AU  - Savblom C
AD  - Regional Cancer Centre Stockholm Gotland, Stockholm Regional Council, Stockholm, 
      Sweden.
FAU - Ji, Jianguang
AU  - Ji J
AD  - Center for Primary Health Care Research, Department of Clinical Sciences Malmo, 
      Lund University, Sweden.
FAU - Sundquist, Jan
AU  - Sundquist J
AD  - Center for Primary Health Care Research, Department of Clinical Sciences Malmo, 
      Lund University, Sweden.
AD  - Department of Family Medicine and Community Health, Icahn School of Medicine at 
      Mount Sinai, New York, NY, USA.
AD  - Department of Population Health Science and Policy, Icahn School of Medicine at 
      Mount Sinai, New York, NY, USA.
AD  - Department of Functional Pathology, School of Medicine, Shimane University Japan, 
      Center for Community-based Healthcare Research and Education (CoHRE), Matsue, 
      Japan.
LA  - eng
PT  - Journal Article
DEP - 20210506
PL  - United States
TA  - Scand J Prim Health Care
JT  - Scandinavian journal of primary health care
JID - 8510679
SB  - IM
MH  - Female
MH  - Guideline Adherence
MH  - Humans
MH  - Infant, Newborn
MH  - Male
MH  - *Neoplasms/diagnosis
MH  - *Physical Examination
MH  - Primary Health Care
MH  - Prospective Studies
MH  - Workflow
PMC - PMC8293951
OTO - NOTNLM
OT  - Neoplasms
OT  - cancer
OT  - guideline adherence
OT  - nonspecific symptoms
OT  - test accuracy
COIS- No potential conflict of interest was reported by the author(s).
EDAT- 2021/05/07 06:00
MHDA- 2021/08/19 06:00
PMCR- 2021/05/06
CRDT- 2021/05/06 12:42
PHST- 2021/05/07 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
PHST- 2021/05/06 12:42 [entrez]
PHST- 2021/05/06 00:00 [pmc-release]
AID - 1913892 [pii]
AID - 10.1080/02813432.2021.1913892 [doi]
PST - ppublish
SO  - Scand J Prim Health Care. 2021 Jun;39(2):148-156. doi: 
      10.1080/02813432.2021.1913892. Epub 2021 May 6.