Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): a population-based nested case-control study in Australian Government Department of Veterans' Affairs clients

Vajdic, laire M., Schaffer, Andrea L., Dobbins, Timothy A., Ward, Robyn L., Er, Chuang C. and Pearson, Sallie-Anne (2015) Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): a population-based nested case-control study in Australian Government Department of Veterans' Affairs clients. Cancer Epidemiology, 39 4: 585-592. doi:10.1016/j.canep.2015.02.006


Author Vajdic, laire M.
Schaffer, Andrea L.
Dobbins, Timothy A.
Ward, Robyn L.
Er, Chuang C.
Pearson, Sallie-Anne
Title Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): a population-based nested case-control study in Australian Government Department of Veterans' Affairs clients
Journal name Cancer Epidemiology   Check publisher's open access policy
ISSN 1877-783X
1877-7821
Publication date 2015-08
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.canep.2015.02.006
Open Access Status Not Open Access
Volume 39
Issue 4
Start page 585
End page 592
Total pages 8
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Formatted abstract
Background: Population-based data on the use of health services and diagnostic investigations for patients with cancer of unknown primary (CUP) is scarce. It is uncertain whether the pathways to diagnosis are different for CUP compared to other cancers.

Methods: We performed a population-based nested matched case-control study using linked routinely collected records for Australian Government Department of Veterans' Affairs clients, 2004-2007. We compared health care consultations, hospitalisations, emergency department visits, and diagnostic procedures in the three months prior and the month of diagnosis for 281 clients registered with a diagnosis of CUP (C809) and 1102 controls randomly selected from clients registered with a first diagnosis of metastatic cancer of known primary.

Results: Overall, the median age at cancer diagnosis was 83 years. CUP patients were slightly older and had significantly more comorbidities prior to diagnosis than those with known primary. Compared to known primary, a diagnosis of CUP was significantly more likely after an emergency department visit, less specialist input, fewer invasive diagnostic procedures such as resection or endoscopy, and more non-invasive procedures such as magnetic resonance imaging. There were no differences in primary care or allied health consultations and hospitalisations.

Conclusions: This health care pathway suggests delayed recognition of cancer and scope for improvement in the medical management of high-risk individuals presenting to primary care. The pattern of diagnostic investigations reveals under-investigation in some CUP patients but this is likely to reflect recognition of limited treatment options and poor prognosis and is consistent with clinical guidelines.
Keyword Cancer of unknown primary
Cohort
Epidemiology
Health services
Diagnosis
Procedures
Consultations
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Office of the Vice-Chancellor
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 2 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 2 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Wed, 27 Jul 2016, 15:38:02 EST by Amelie Casgrain on behalf of School of Medicine