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Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. Cross-sectional study using questionnaire and register data. General practice in Denmark. Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation. Box 1. Included survey items on the patients' experiences Items Response categories Combined in analysis Total respondents, n (%) Were you worried that you might have cancer when consulting a GP for the first time? Very much Very much/A great deal 1348 (44.6%)/909 (30.7%) A great deal A little A little/No 396 (13.1%)/334 (11.1%) No I do not know Omitted in analysis 36 (1.2%) Did you tell the GP about your concerns? No No 878 (44.6%) Yes Yes 1089 (55.4%) Did you feel taken seriously when consulting the GP for symptoms? No, not at all No, not at all/Not so much 135 (4.5%)/151 (5.0%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 354 (11.8%)/2258 (75.0%) Yes, very much Not relevant for me Omitted in analysis 111 (3.7%) Are you confident that the GP made the best possible effort before your cancer was diagnosed? No, not at all No, not at all/Not so much 142 (4.3%)/192 (5.8%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 376 (11.3%)/2,570 (77.3%) Yes, very much I was not in contact with [the GP] Omitted in analysis 45 (1.3%) How many times did you consult your GP before being referred to a medical specialist or hospital for diagnostic investigation? One time One time to three times 2212 (73.0%)/659 (21.7%) Two-three times Four times or more Four times or more 136 (4.5%) Was not referred Omitted in analysis 22 (0.7%) Was it clear to you what would happen after your visit(s) to your GP (e.g. whether you were to contact a medical specialist or would be contacted by the hospital staff)? Not at all Not at all/Not so much 164 (5.5)/118 (3.9%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 471 (15.7%)/2210 (73.6) Yes, very much Not relevant for me Omitted in analysis 39 (1.3%) How do you assess the time interval from your first contact to the GP (when you called or used the online system to book an appointment) until the first time you were seen/examined by the GP? The time interval was suitable The time interval was suitable 2210 (79.5%) It took too long It took too long 209 (7.5%) It was too short It was too short 232 (8.35%) Not relevant for me Omitted in analysis 128 (4.6%) How do you assess the time interval from the first time you were seen/examined by the GP until referred to a medical specialist or hospital for diagnostic investigation? The time interval was suitable The time interval was suitable 2163 (76.5%) It took too long It took too long 313 (11.1%) It was too short It was too short 282 (10.0%) Not relevant for me Omitted in analysis 68 (2.4%) A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders. It is unknown how patients with psychiatric disorders perceive the cancer diagnostic process in general practice. This study found an association between having a psychiatric disorder and more often perceiving the time interval as too short between the first booking of a consultation and the first GP consultation. An association was found between having a primary care treated psychiatric disorder and being worried about cancer and more often sharing these concerns with the GP. Experiences with the cancer diagnostic process in general practice did not differ between patients with a hospital treated psychiatric disorder and patients with no indication of psychiatric disorders. [ABSTRACT FROM AUTHOR]

Objective International differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia). Design Patients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients' primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression. Participants A total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses. Primary and secondary outcome measures Interval lengths in days (primary), reported patient symptoms (secondary). Results The main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was 'bleeding/blood in stool'. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results. Conclusion ICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions. [ABSTRACT FROM AUTHOR]