Table 3 Results

  % getting a cancer diagnose

35

17

11

22

13

16

22

11

  Cancer stage

47% had solid tumors with potential to spread based on TNM-staging and 20% were referred to palliative care

Upper GI

Stage 1: 4%

Stage 2: 21%

Stage 3: 17%

Stage 4: 57%

Lung

Stage 1: 26%

Stage 2: 9%

Stage 3: 13%

Stage 4: 53%

Hematological

Stage 1: 20%

Stage 2: 13%

Stage 3: 40%

Stage 4: 27%

Lower GI

Stage 1: 0%

Stage 17%

Stage 3: 35%

Stage 4: 48%

  Mortality

Mortality 1-year rate at 44 and 3% for those with no cancer

The 1-year cumulative mortality is 28% compared to 3% for patients with another diagnose and 2% with no diagnose

Median survival time after cancer diagnosis was 1,4 years

  Median referral from referral to last visit day

Median time from first visitday at DC to last was 9 days

7

Duration of symptoms: 12 weeks

10

The median primary care interval for patients diagnosed with cancer was 15 days

From first contact in primary care to diagnosis at DC: Median time was 37 days

investigation at DC: 77% were investigated within 22 days

  Duration of symptoms before referred with NSSC

Median duration of symptoms was 12 weeks

Without cancer:

2 weeks or less 1%

1 month or less 6%

1-3 month 19%

3–6 months 17%

6-12 months 14%

With cancer:

2 weeks or less 1%

1 month or less 12%

1-3 month 33%

3–6 months 16%

6-12 months 15%

  Laboratory tests

44% patients had abnormal tests

Anemia, leukocytopenia, thrombocytopenia, elevated LDH and CRP was significant associated with cancer

A high-level lactate dehydrogenase had the strongest association with cancer

48% of patients had an abnormal blood sample at the GP, and 17% of patients that acquired a cancer diagnose had an abnormal cancer diagnose at the GP

59% of patients attaining a cancer diagnose were referred due to pathological lab values

61% of patients attaining a non-cancerous diagnose were referred due to pathological lab values

35% of patients attaining no diagnose were referred due to pathological lab values

(With cancer vs without cancer)

Increased levels:

Anaemia 43% vs 27%,

Thrombocytosis 18% vs 6%,

Raised CRP 68% vs 36%

Liver dysfunction 18% vs 8%

Conclusion from the study: “Hit rate for detecting malignancy, in patients with non-specific symptoms and signs of cancer, seems comparable to other fast-track workup plans for patients with disease-specific symptoms”

  Other paraclinical measures

44% underwent advanced diagnostic imaging

77% underwent advanced diagnostic imaging

47% of the patients went through advanced imaging.

28% had a cancer diagnose when taking a supplementary CT scan

15% of patients had an abnormal diagnostic imaging, and 17% of patients that acquired a cancer diagnose had an abnormal diagnostic imaging

   The 1. most prevalent cancer diagnoses

Hematological 30%

Breast cancer 18%

Lymphoma 14%

Hematological 25%

Lung 18%

Hematological

Upper GI 22%

  The 2. most prevalent cancer diagnoses

GI 23%

Hematopoietic/lymphoid tissue cancer 15%

Pulmonary cancer 13%

Colorectal 18%

Colorectal 13%

Lung

Lung 22%

  The 3. most prevalent cancer diagnoses

Lung 10%

MM 12%

Colorectal 10%

Kidney 10%

Hematopoietic tissue cancer 10%

Colorectal

Hematological/lower GI, urological 13%

  The 1. most prevalent non-cancer diagnoses

Rheumatological disease 12%

Cardiovascular disease 9%

Rheumatology 26%

Musculoskeletal diseases 20%

  The 2. most prevalent non- cancer diagnoses

GI 10%

Gastrointestinal disease 7%

Gastroenterology 18%

Gastrointestinal diseases 16%

  The 3. most prevalent non-cancer diagnoses

Hematological disease 9%

Musculoskeletal and connective tissue disease 5%

Endocrinology 15%

Hematological diseases 10%

  Symptom nr. 1

when referred with NSSC

Weight loss 24%

Weight loss 39% of patients attaining a cancer diagnose and 42% of patients did not attaining a cancer diagnose

Weight loss 35%

Weight loss 53%

Weight loss 53%

- Within patients with cancer 16%

Diagnosed with cancer:

Pathological lab values 59%

Diagnosed with other than cancer:

Pathological lab values 61%

No Diagnosis:

Weight loss 48%

Fatigue

Without cancer:

73%

With cancer:

74%

Weightloss 66%

  Symptom nr. 2 when referred with NSSC

Rare GP visits 22%

Fatigue 35% of patients attaining a cancer diagnose and 39% of patients did not attaining a cancer diagnose

Suspicion of major illness/cancer 15% and Pain 15%

Fatigue 50%

Fatigue 50%

- Within patients with cancer 16%

Diagnosed with cancer: Weight loss 45% Diagnosed with other than cancer: Weight loss 38%

No Diagnosis: Pathological lab values 35%

Pain Without cancer:

73%

With cancer:

74%

GP clinical suspicion: 36%

  Symptom nr. 3 when referred with NSSC

Duration of symptoms 19%

Loss of appetite 28% of patients attaining a cancer diagnose and 26% of patients did not attaining a cancer diagnose

Fatigue 13% and Abnormal blood tests 13%

Loss of appetite or nausea 36%

Pain 37%

Within patients with cancer 18%

Diagnosed with cancer:

Pain/joint pain 36%

Diagnosed with other than cancer:

Fatigue 35%

No Diagnosis:

Fatigue 33%

Weight loss

Without cancer:

47% With cancer::

37%

Pain 32%

  Comorbidity

46% had no comorbidity, 46% had 1–2 comorbidity and 7% had 3 or more comorbidities

78% had no comorbidity, 19% had 1 comorbidity and 3% had 2 or more comorbidities

47% had no comorbidity, 31% had 1 comorbidity and 22% had 2 or more comorbidities

51% had no comorbidity, 16% had 1 comorbidity, 16% had 2 and 17% had 3 or more comorbidities

25% had no comorbidity, 34% had 1 comorbidity, 24% had 2 and 18% had 3 or more comorbidities

Without cancer:

1–2: 32%

3–5: 42%

> 5: 14%

With cancer:

1–2: 31%

3–5: 42%

More than 5: 15%

31% had 0 comorbidities, 42% 1, 11% 2/3, 18% 3 and 9% comorbidity.

  The 1. most prevalent comorbidity in patients referred with NSSC

Cardiovascular diseases: 16% of patients referred with NSSC

Cardiovascular diseases: 6% of patients referred with NSSC

Hypertension 23% of patients referred with NSSC

Hypertension 28% of patients referred with NSSC

  The 2. most prevalent comorbidity in patients before referred with NSSC

Lung diseases 13% of patients referred with NSSC. (10% of patients that acquired a cancer diagnose.)

Shared 2. place: Diabetes, Cerebrovascular disease, previous cancer: each 3% of patients referred with NSSC

Osteoarthritis or inflammatory arthritis: 12% of patients referred with NSSC

Chronic lung disease: 17% of patients referred with NSSC

  The 3. most prevalent comorbidity in patients before referred with NSSC

Previous diagnosed cancer: 12% of patients referred with NSSC

COPD: 2% of patients referred with NSSC

Earlier cancer  or non melanoma skin cancer: 11,0% of patients referred with NSSC

Diabetes: 12% of patients referred with NSSC

  The 1. most prevalent comorbidity of patients when diagnosed with cancer

Previous diagnosed cancer: 22% of patients that acquired a cancer diagnose

Previous diagnosed cancer: 5% of patients that acquired a cancer diagnose

  The 2. most prevalent comorbidity of patients diagnosed with cancer

Cerebrovascular diseases: 12% of patients that acquired a cancer diagnose. (11% of patients referred with NSSC)

Cardiovascular diseases: 3% of patients that acquired a cancer diagnose

  The 3. most prevalent comorbidity of patients diagnosed with cancer

Cardiovascular diseases: 12% of patients that acquired a cancer diagnose.

Diabetes: 2% of patients that acquired a cancer diagnose

  Other comorbidities examined

Patients referred with NSSC:

-Inflammatory diseases 12%. 7% of patients diagnosed with cancer

-Diabetes 12%. 9% of patients diagnosed with cancer

-Cerebrovascular diseases 11%. 12% of patients diagnosed with cancer

-Renal failure 4%. 2% of patients diagnosed with cancer

-Peptic ulcer 3%. 4% of patients diagnosed with cancer

- Dementia 2%. 0% of patients diagnosed with cancer

-Cirrhosis 0,4%. 0,7% of patients diagnosed with cancer

Patients referred with NSSC:

-Connective tissue disease 1%. 0,5% of patients diagnosed with cancer

Patients referred with NSSC:

-COPD 11%

-Diabetes: 9%

-Ischemic heart disease: 8%

-Mental illness: 7%

-Stroke 6%

-Osteoporosis 6%

Patients referred with NSSC:

-Ischemic heart disease 11%

-Chronic joint or rheumatic disease 11%

-Osteoporosis 6%

-Apoplexy 5%

-Moderate to severe mental disorder 5%

  Mean age

Of patients referred with NSSC

67

65

64

70

66

69

Median age diagnosed with cancer: 70

Without: cancer: 62

With cancer: 69

Median age

Malignancy not suspected:

68

Malignancy possible:

72

Median: 69

Mean: 67

  Age

A year increase in age will increase the odds with a factor 1.02 for being diagnosed with cancer

Significantly associated to a cancer diagnose with an 34% increase in odds every ten-year

In 1 year increase in age, the odds will increase 4% for a cancer diagnose

The cancer patients had a statistically significantly higher age than those without cancer

  Gender

48% of referred patients were women and 52% men

47% of referred patients were women and 53% men

44% of patients diagnosed with cancer were women and 56% men

48% of patients diagnosed with a non-cancerous disease were women and 52% were men

Being woman was significant associated with being diagnosed with cancer

47% of referred patients were women and 53% men

58% of patients diagnosed with cancer were women and 42% men.

53% of patients diagnosed with a non-cancerous disease were women and 47% were men

53% of referred patients were women and 47% men

55% of referred patients were women and 45% men

53% of referred patients were women and 47% men

Cancer were more often found in men than in women

51% of referred patients were women and 49% men

Without cancer:

39% males, 61% females

With cancer:

60% males

40%females

This was statistical significant.

Malignancy not suspected:

Female 52%

Malignancy possible:

Female 55%

44% Male

and 56% Female were referred with non-specific symptoms of cancer

  Marital status

54% of the population was married patients. 56% of patients diagnosed with cancer were married

67% of the population was married, 12% separated, 11% widowed, 9% single

59% of the population of patients diagnosed with cancer was married

68% of patients referred with NSSC were married/living together and 31% were single

  Educational level*

50% of the study population had a medium academic education. 52% diagnosed with cancer had a medium education.

6% had a high academic education. 6% diagnosed with cancer had a high education.

41% had a short education/skilled worker. 39% diagnosed with cancer had a short education/skilled worker.

16% of the study population had a longer academic education and 28% a medium academic education. 34% had a short less than 15 years education/skilled worker

47% of patients diagnosed with cancer had a medium level education, 36% none education and 14% with a higher educational level.

46% with a low education level (</= 9 years) were referred with NSSC

36% with a medium education level (10-12 years) were referred with NSSC

18% with a higher education (> 12 years) were referred with NSSC

  Occupation

Patients referred with NSSC:

28% were employed. 68% were retired. 1% were out of workforce.

Patients diagnosed with cancer:

18% were employed. Diagnose. 80% were retired. 1% were out of workforce.

Patients referred with NSS

37% were employed, 59% retired and 7% unemployed

17% of patients with cancer was working patients and 83% were retired. 0% was out of workforce.

  Income

27% of patients that acquired a cancer diagnose were in the lowest income, 54% in the middle income and 19% in the highest income.

29% of patients that did not acquire a non-malignant disease were in the lowest income, 48% in the middle income and 23% in the highest income

  Smoking

36% of 11 smokers included in study 1 had a cancer diagnose

34% of patients never smoked and 66% was former/current smokers. 30% diagnosed with cancer never smoked and 70% was former/current smokers

70% of the patients included in the study were former/current smokers and 25% never smoked

29% are current smokers and 32% former/intermittent smoker and 38% never smoked

Without cancer

Current: 20%

Former: 11%

Never: 46%

With cancer:

Current: 26%

Former: 18%

Never: 56

  Alcohol

10% had a weekly consumption of alcohol above national guidelines. 13% diagnosed with cancer had a weekly consumption of alcohol above national guidelines

81% did not consume alcohol on daily basis

Without cancer

Within recommendation limits 21%

Excessive use: 10%

None: 54%

With cancer

Within recommendation limits 20%

Excessive use: 13%

None: 51%

  Ethnicity

54% of 204 patients with Dutch ethnicity had a cancer diagnose and 50% of 14 patients with another ethnicity

93% of the population from Denmark was referred with NSSC, 4% from another western country, 2% from Middle East/Asia an 1% from other countries

95% of the population from Denmark was diagnosed with cancer, 3% from another western country, 1% from Middle East/Asia an 1% from other countries

94% of patients referred with NSSC were born Sweden and 5% were not born in Sweden

Without cancer:

White: 42%

Mixed 1%

Asian: 6%

Black: 20%

Other 18%

Missing: 31%

With cancer

White: 56%

Mixed 0%

Asian: 4%

Black: 6%

Other 3%

Missing: 30%

  Mental diagnosis

2% of patients with NSSC had dementia and 0% acquired a cancer diagnose

1% was diagnosed after being referred to a Diagnostic Center with a mental or behavioral disorder

7% of referred patients had a mental illness

Moderate to severe mental disorder 5% of patients referred with NSSC

19 (≈7%) of patients referred with NSSC were diagnosed with a mental disorder

Without cancer:

18%

With cancer:

13%

  Mental health related scales

Health related Quality of life scale:

-No difference in physical and social functioning.

–Improved emotional function 30 days after referral.

-Being unemployed, having 2 or more comorbidities and receiving a cancer diagnosis had the greatest effect.

-Gender education and previous cancer did not have any effect on the quality of life.