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背景部分癌症患者在初级医疗中经历多次诊断前问诊,导致专科医生调查和诊断延后。罕见癌症患者更有可能面临这种情况,但是缺乏具体证据。目的探讨罕见癌症患者接受全科医生重复问诊的频率和预测因子。设计和场所从3个英国国家癌症患者调查(2010年、2013年和2014年)中搜集转诊前问诊的患者报告数据,将数据合并得到尽可能大的罕见癌症患者样本量。方法计算转诊前问诊数量≥3次的频率和大致调整优势比(与1~2次相比),调整因素包括年龄、性别、民族、剥夺程度和癌症诊断(共38个诊断组,其中包括12个此前无相关证据的罕见癌症)。结果共纳入7 838例患者,发现12种罕见癌症。在患有小肠癌、骨肉瘤、肝癌、胆囊癌及原发性软组织肉瘤和输尿管癌的患者中,转诊前问诊数量≥3次的患者比例>30.0%~60.0%,而在患有口咽癌、肛门癌、腮腺癌、阴茎癌和口腔癌的患者中,这一比例为15.0%~30.0%。转诊前问诊数量≥3次的所有癌症患者的比例为23.4%。多因素Logistic回归分析显示一致规律,充分证明不同罕见癌症情况不同。结论罕见癌症患者的转诊前问诊频率显示了中度到高度的诊断难度,这一发现能够引导新型诊断干预的发展和罕见癌症患者症状的安全筛查方法。
Background Some cancer patients have undergone multiple pre-diagnosis visits in primary care, leading to delayed investigations and diagnosis by specialists. Rare cancer patients are more likely to face this situation, but the lack of specific evidence. Objective To investigate the frequency and predictors of repeat medical consultations in patients with rare cancers. DESIGN AND SETTINGS Patient reporting data prior to referral were collected from 3 UK National Cancer Surveys (2010, 2013 and 2014) and combined to obtain as large a sample of rare cancer patients as possible. Methods The frequency of pre-referral visits ≥ 3 times and the adjusted odds ratio (compared with 1 or 2 times) were calculated and adjusted for age, gender, ethnicity, degree of deprivation, and cancer diagnosis (38 in total Including 12 rare cancers that were previously unrelated to evidence). Results A total of 7 838 patients were enrolled and 12 rare cancers were found. In patients with small bowel cancer, osteosarcoma, liver cancer, gallbladder cancer and primary soft-tissue sarcoma and ureteral cancer, the number of pre-referral visits ≥ 3 times the proportion of patients> 30.0% to 60.0%, while in patients with mouth In patients with pharyngeal, anal, parotid, penile and oral cancers, the proportion was 15.0% to 30.0%. The proportion of all cancer patients who had ≥3 visits before referral was 23.4%. Multivariate logistic regression analysis showed a consistent pattern that fully demonstrated the different conditions of different rare cancers. Conclusions The frequency of pre-referral consultations in rare cancer patients shows a moderate to high degree of difficulty in diagnosis, a finding that can lead to the development of new diagnostic interventions and the safety screening of patients with rare cancer symptoms.