A study of electronic patient records, funded by the Wellcome Trust, suggests that older women with suspected ovarian cancer may be referred by their GPs for investigation later than younger women.
Researchers at the Brighton and Sussex Medical School studied records from the General Practice Research Database (GPRD) and compared recorded diagnoses of ovarian cancer against rates in the UK cancer registries to see whether there was a difference in how older patients are managed by their GP. The results are published in the British Journal of Cancer.
The researchers found that during the period 2002-06, GPs were less likely to refer patients for gynaecological investigation when they were older. 82% of women under the age of fifty-five years had received at least one relevant investigation in the year before their diagnosis; this figure fell to 75% for women aged between fifty-five and sixty-nine years, and 66% for women aged over seventy years.
GPs were also found to be slower to refer elderly patients than their middle-aged counterparts. Women aged between forty-five and sixty-nine years tended to be referred for gynaecological investigation within ten weeks of presenting to their GP with their first symptom. This figure steadily increases, peaking at twenty weeks for women aged seventy-five to seventy-nine years.
"Ovarian cancer is a relatively rare disease but, as with all cancers, early diagnosis is important for improving the chances of successful treatment," says Dr Rosemary Tate, lead author of the study. "Our research suggests that age plays a role in how quickly diagnosis and referral occurs -- the older the patient, the later this appears to happen.
"As we only looked at one type of cancer, we don't know if our results will generalise to other cancers. However, if this is the case, then such delays could be an important cause of avoidable illness and mortality, and could contribute to the lower survival rates and higher mortality rates experienced in the UK compared with other European countries."
Survival rates for cancer in the UK are amongst the lowest in Europe, particularly for older people (see note 1). Despite significant advances in cancer treatment, these developments seem not to be benefiting older people as much as they could. A comparison of data from the World Health Organization registry database suggests that there has been little or no improvement in cancer mortality rates for the UK elderly during the last decade (see note 2).
The researchers also found that the rates of recorded diagnoses of ovarian cancer in the GPRD were lower than those recorded in UK cancer registries for all age groups. However, these differences were much larger for patients over sixty; for example, for women aged forty-five to fifty, the difference was only 5% as compared with 22% for those between seventy-five and eighty.
The researchers stress that the reasons for the discrepancy between the GP database and the UK cancer registry are not clear, but may be explained in part by how and when data is recorded. Similarly, it may be possible that GPs are less motivated to record cancer diagnoses in older people if they have other serious illnesses, or to investigate them for other problems first.
"Electronic patient records provide a valuable opportunity for disease surveillance and for monitoring and improving," explains Professor Jackie Cassell. "It is important that we understand why there is a discrepancy between rates in the GP databases compared to cancer registries. This will help ensure that the information available to our health services is accurate and fit for purpose."
Sara Hiom, director of health information at Cancer Research UK, which owns the British Journal of Cancer, said: "Ovarian cancer symptoms can be vague and suggestive of other, less serious conditions. But it's important that the disease is diagnosed at the earliest possible stage, whether the patient is young or old, as it is then easier to treat and there is a better chance of survival. Ovarian cancer is more common in older women, with four out of five cases in women over 50, so it's concerning if these older women are indeed less likely to be investigated.
"All too often cancer is found at a late stage, which is why we're working with the Department of Health, NHS and others on the National Awareness and Early Diagnosis Initiative (NAEDI) to address this problem. These results reinforce the importance of NAEDI's work, which includes raising public awareness of cancer, promoting earlier presentation and supporting doctors with the most up-to-date evidence and decision support."
- A R Tate, A Nicholson and J A Cassell. Are GPs under-investigating older patients presenting with symptoms of ovarian cancer? Observational study using General Practice Research Database. British Journal of Cancer, 2010; DOI: 10.1038/sj.bjc.6605593
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