[Symptom Presentation in Cancer Patients in General Practice]

Introduction: For the majority of cancer patients, the diagnostic investigations begin in general practice. The aim of the study was to investigate for which symptoms cancer patients consulted their general practitioner (GP).

Material And Methods: All newly diagnosed cancer patients and their GPs in the County of Aarhus, Denmark, participated in a 1-year questionnaire survey. The GPs answered questions about the patients' first presentation of cancer symptoms and the GPs' interpretation of these symptoms.

Results: A total of 2,212 (83%) questionnaires were answered. The total number of reported symptoms was 3,208 corresponding to 1.7 reported symptoms per patient. The majority (57.6%) of patients presented only one symptom. Symptoms varied with the type of cancer. Patients with breast cancer and malignant melanoma mainly presented with diagnosis-specific symptoms. Patients with colorectal, lung and prostate cancer presented diagnosis-specific symptoms (change in bowel habits, cough and bladder dysfunction) as well as more non-specific symptoms (pain, weight loss and fatigue). The GPs interpreted the symptoms as alarm symptoms in 49%, as general symptoms in 24% and as non-cancer specific symptoms in 27% of the patients.

Conclusions: In general practice, incident cancer patients often present with few and non-cancer specific symptoms. The fact that only half of the patients presented with alarm symptoms complicates the GPs' diagnostic work-up and the use of fast track for suspected cancer. Therefore, there is a need for alternative referral pathways for cancer patients with non-cancer specific symptoms.