Exploring the diagnostic pathway of symptomatic cancer patients in the Netherlands

Abstract

Cancer is prevalent disease in the Netherlands with high morbidity and mortality. As prognosis of cancer is highly dependent on disease stage at diagnosis, timely detection is important and widely pursued. For Dutch cancer patients, the duration of the diagnostic pathway including all its different intervals and potential for improvement was not yet explored. With the DICKENS studies, we charted and explored the diagnostic pathway of Dutch cancer patients. Based on the results, we conclude that cancer is generally diagnosed within acceptable time limits; the median duration (half of the patients had a duration equal to or shorter than this value) of the diagnostic interval varied from 7 days for breast cancer to 78 days for kidney cancer and was comparable to or shorter than the median durations in other gatekeeper based health care systems. Because of the central role of the general practitioner (GP) in cancer detection in the Netherlands, we explored for which patients time to referral was relatively long and whether there were preventable delays. The majority of cancer patients (75-90%) was timely referred by the GP. Among patients for whom duration to referral was relatively long (10-25%), this was mainly because of a low cancer suspicion, for example because of a lack of alarm symptoms. Although GPs miss diagnostic opportunities once in a while, reduction of the primary care interval seems hardly possible for the majority of the patients. To reduce time to referral, new diagnostic tests and strategies are needed, enabling the GP to earlier recognize cancer patients despite a low suspicion.