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European differences in cancer survival: report of an international symposium of general practitioners from three countries exploring primary and secondary care delay

Peter Murchie, Lennart Johansson, Elizabeth K Delaney, Geert-Jan Dinant, Piotr Rollano, Mark Spigt, Lucy Wisely

BackgroundThere are several potential delays in the cancer diagnostic pathway: patient delay, primary care delay and secondary care delay. People in the UK have poorer five-year survival from many cancers compared with people in European countries with similar healthcare systems. The reasons for this are not clear, although it has been postulated that UK patients may present with cancer at a later stage. We are conducting a study to investigate the feasibility of comparing diagnostic delays in different European countries. Methods (conduct of the symposium) A half-day, round-table symposium was convened with seven general practitioners (GPs) and single primary care researchers fromSweden (Malmo¨), theNetherlands (Maastricht) and Scotland (Aberdeen). In Session People with cancer in the three countries following a broadly similar cancer diagnostic pathway. In Sweden and the Netherlands GPs have direct unscreened access to a greater range of investigations than in Scotland. In Scotland there is a greater reliance on specialist guidelines than in the Netherlands or Sweden. One the group had a broad-ranging discussion comparing and contrasting their different working contexts and how these might impact on the cancer diagnostic pathway. In Session Two the group considered two case studies from Scotland, applying their own local experience and the insights generated in Session One to identify common and divergent issues. When it had finished the facilitator drafted a detailed report of the symposium which was supported by reference to the individual participants’ notes which had been collected at the end of the symposium. Results (consensus views reached) Sweden, the Netherlands and Scotland have strong traditions of primary care acting in a gate-keeping role. Future research in the UK could explore the potential contribution of increased GP access to investigations and revised referral guidelines.