Objective Childhood cancer is rare and symptoms tend to be unspecific and vague. Using the utilization of health care services as a proxy for symptoms, the present study seeks to determine when early symptoms of childhood cancer are seen in general practice. Methods A population-based matched comparative study was conducted using nationwide registry data. As cases, all children in Denmark below 16 years of age (N = 1,278) diagnosed with cancer (Jan 2002-Dec 2008) were included. As controls, 10 children per case matched on gender and date of birth (N = 12,780) were randomly selected. The utilization of primary health care services (daytime contacts, out-of-hours contacts and diagnostic procedures) during the year preceding diagnosis/index date was measured for cases and controls. Results During the six months before diagnosis, children with cancer used primary care more than the control cohort. This excess use grew consistently and steadily towards the time of diagnosis with an IRR = 3.19 (95%CI: 2.99–3.39) (p<0.0001) during the last three months before diagnosis. Children with Central Nervous System (CNS) tumours had more contacts than other children during the entire study period. The use of practice-based diagnostic tests and the number of out-of-hours contacts began to increase four to five months before cancer diagnosis. Conclusions The study shows that excess health care use, a proxy for symptoms of childhood cancer, occurs months before the diagnosis is established. Children with lymphoma, bone tumour or other solid tumours had higher consultation rates than the controls in the last five months before diagnosis, whereas children with CNS tumour had higher consultation rates in all twelve months before diagnosis. More knowledge about early symptoms and the diagnostic pathway for childhood cancer would be clinically relevant.
References
[1]
Kaatsch P (2010) Epidemiology of childhood cancer. Cancer Treat Rev 36: 277–285.
[2]
Dang-Tan T, Franco EL (2007) Diagnosis delays in childhood cancer: a review. Cancer 110: 703–713.
[3]
Thulesius H, Pola J, Hakansson A (2000) Diagnostic delay in pediatric malignancies–a population-based study. Acta Oncol 39: 873–876.
[4]
Dixon-Woods M, Findlay M, Young B, Cox H, Heney D (2001) Parents' accounts of obtaining a diagnosis of childhood cancer. Lancet 357: 670–674.
[5]
Goyal S, Roscoe J, Ryder WD, Gattamaneni HR, Eden TO (2004) Symptom interval in young people with bone cancer. Eur J Cancer 40: 2280–2286.
[6]
Dommett RM, Redaniel MT, Stevens MC, Hamilton W, Martin RM (2012) Features of childhood cancer in primary care: a population-based nested case-control study. Br J Cancer 106: 982–987.
[7]
Buntinx F, Mant D, Van den Bruel A, Donner-Banzhof N, Dinant GJ (2011) Dealing with low-incidence serious diseases in general practice. Br J Gen Pract 61: 43–46.
[8]
Ahrensberg JM, Schroder H, Hansen RP, Olesen F, Vedsted P (2012) The initial cancer pathway for children - one-fourth wait more than 3 months. Acta Paediatr 101: 655–662.
[9]
Vedsted P, Olesen F (2009) Early diagnosis of cancer–the role of general practice. Scand J Prim Health Care 27: 193–194.
[10]
Hansen RP, Olesen F, Sorensen HT, Sokolowski I, Sondergaard J (2008) Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study. BMC Health Serv Res 8: 49.
[11]
Jones R, Latinovic R, Charlton J, Gulliford MC (2007) Alarm symptoms in early diagnosis of cancer in primary care: cohort study using General Practice Research Database. BMJ 334: 1040.
[12]
Olesen F, Hansen RP, Vedsted P (2009) Delay in diagnosis: the experience in Denmark. Br J Cancer 101 Suppl 2S5–S8.
[13]
Ansell P, Johnston T, Simpson J, Crouch S, Roman E, et al. (2010) Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS. Pediatrics 125: 112–119.
[14]
Storm HH, Michelsen EV, Clemmensen IH, Pihl J (1997) The Danish Cancer Registry–history, content, quality and use. Dan Med Bull 44: 535–539.
[15]
Pedersen CB, Gotzsche H, Moller JO, Mortensen PB (2006) The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull 53: 441–449.
[16]
Olivarius NF, Hollnagel H, Krasnik A, Pedersen PA, Thorsen H (1997) The Danish National Health Service Register. A tool for primary health care research. Dan Med Bull 44: 449–453.
[17]
Frank L Epidemiology (2000) When an entire country is a cohort. Science 287: 2398–2399.
[18]
World Health Organization. International Classification of Diseases (ICD). http://www.who.int/classifications/icd/e？n/. Accessed 15 June 2012.
[19]
Robins JM, Gail MH, Lubin JH (1986) More on “Biased selection of controls for case-control analyses of cohort studies”. Biometrics 42: 293–299.
[20]
Thomsen JL, Parner ET (2006) Methods for analysing recurrent events in health care data. Examples from admissions in Ebeltoft Health Promotion Project. Fam Pract 23: 407–413.
[21]
Gjerstorff ML (2011) The Danish Cancer Registry. Scand J Public Health 39 (Suppl): 42–45.
[22]
Schmiegelow K (2006) [Cancer in childhood and inheritance]. Ugeskr Laeger 168: 2373–2376.
[23]
de Nully BP, Hertz H, Olsen JH, Yssing M, Scheibel E, et al. (1989) Incidence of childhood cancer in Denmark 1943–1984. Int J Epidemiol 18: 546–555.
[24]
Edgeworth J, Bullock P, Bailey A, Gallagher A, Crouchman M (1996) Why are brain tumours still being missed? Arch Dis Child 74: 148–151.
[25]
Dobrovoljac M, Hengartner H, Boltshauser E, Grotzer MA (2002) Delay in the diagnosis of paediatric brain tumours. Eur J Pediatr 161: 663–667.
[26]
Flores LE, Williams DL, Bell BA, O'Brien M, Ragab AH (1986) Delay in the diagnosis of pediatric brain tumors. Am J Dis Child 140: 684–686.
[27]
Haimi M, Perez-Nahum M, Stein N, Ben Arush MW (2011) The role of the doctor and the medical system in the diagnostic delay in pediatric malignancies. Cancer Epidemiol 35: 83–89.
[28]
Dang-Tan T, Trottier H, Mery LS, Morrison HI, Barr RD, et al. (2008) Delays in diagnosis and treatment among children and adolescents with cancer in Canada. Pediatr Blood Cancer 51: 468–474.
[29]
Pollock BH, Krischer JP, Vietti TJ (1991) Interval between symptom onset and diagnosis of pediatric solid tumors. J Pediatr 119: 725–732.
