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Research

Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study

Elka Humphrys, Fiona M Walter, Greg Rubin, Jon D Emery, Margaret Johnson, Anthony Richards, Rebecca C Fitzgerald, Yirupaiahgari KS Viswanath and Jenni Burt
BJGP Open 2020; 4 (1): bjgpopen20X101001. DOI: https://doi.org/10.3399/bjgpopen20X101001
Elka Humphrys
1 Research Associate, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
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  • ORCID record for Elka Humphrys
  • For correspondence: elka.humphrys@thisinstitute.cam.ac.uk
Fiona M Walter
2 Principal Researcher in Primary Care Cancer Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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  • ORCID record for Fiona M Walter
Greg Rubin
3 Emeritus Professor of General Practice and Primary Care, Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK
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Jon D Emery
4 Herman Professor of Primary Care Cancer Research, Department of General Practice and Primary Health Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
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Margaret Johnson
5 Lay Member, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Anthony Richards
6 Lay Member, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Rebecca C Fitzgerald
7 Professor of Cancer Prevention, MRC Cancer Unit, University of Cambridge, Cambridge, UK
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Yirupaiahgari KS Viswanath
8 Professor of Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Jenni Burt
9 Senior Social Scientist, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
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Article Figures & Data

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    Figure 1. Participant and clinical perspectives of heartburn, reflux, and indigestion.35–37
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    Figure 2. First symptom presented to the GP compared with symptom experience before diagnosis, stratified by cancer type.

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    Table 1. Participant, healthcare, and disease characteristics
    Survey participants(n = 127)aInterview participants(n = 26)a
    Age, years
    Median (range)71 (44–96)69.5 (55–88)
     <6012 (9.4b)3 (11.5)
     60–7478 (61.4b)12 (46.2)
     ≥7537 (29.1b)11 (42.3)
    Sex
     Male102 (80.3)18 (69.2)
    Female25 (19.7)8 (30.8)
    Cancer type
     Oesophagealc 102 (80.3)15 (57.7)
     Gastricd 25 (19.7)11 (42.3)
    Ethnic group
     White124 (97.6)26 (100.0)
    Other3 (2.4)0 (0.0)
    Region
     East77 (60.6)13 (50.0)
    North East50 (39.4)13 (50.0)
    Comorbidities
     Arthritis38 (29.9)13 (50.0)
     Cancer — other than O/G22 (17.3)5 (19.2)
     Heart disease17 (13.4)2 (7.7)
     Lung disease13 (10.2)2 (7.7)
     Anxiety or depression13 (10.2)2 (7.7)
     Barrett’s or reflux disease10 (7.9)1 (3.8)
     Any of the above72 (56.7)16 (61.5)
    OTC medication
     None79 (62.2)17 (65.4)
     Antacid or similar30 (23.6)7 (26.9)
     Other8 (6.3)1 (3.8)
    Reported GP consultations
     Nonee 13 (10.2)6 (23.1b)
     156 (44.1)10 (38.5b)
     235 (27.6)4 (15.4b)
     ≥321 (16.5)6 (23.1b)
    Referral route
     Urgentf 88 (69.3)16 (61.5)
     Routine19 (15.0)6 (23.1)
     Other9 (7.1)2 (7.7)
    Urgent referral based on GP consultations
     Nonee 8 (6.3)2 (7.7b)
     141 (32.3)8 (30.8b)
     224 (18.9)2 (7.7b)
     ≥315 (11.8)4 (15.4b)
    Cancer stage pre-treatment
     I/II59 (46.5)12 (46.2)
     III/IV64 (50.4)14 (53.8)
    • aValues are n (%) unless otherwise stated. Missing data not included bPercentages subject to rounding error. cTumours located in the upper or middle or lower oesophagus and gastro-oesophageal junction, including both adenocarcinomas and squamous cell carcinomas. dTumours located in the cardia, fundus, body, antrum, or pylorus. ePatient referred opportunistically, that is, having attended primary care for another reason. fUrgent referral is the 2-week wait suspected cancer pathway.

    • O/G = oesophageal or gastric. OTC = over the counter.

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Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study
Elka Humphrys, Fiona M Walter, Greg Rubin, Jon D Emery, Margaret Johnson, Anthony Richards, Rebecca C Fitzgerald, Yirupaiahgari KS Viswanath, Jenni Burt
BJGP Open 2020; 4 (1): bjgpopen20X101001. DOI: 10.3399/bjgpopen20X101001

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Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study
Elka Humphrys, Fiona M Walter, Greg Rubin, Jon D Emery, Margaret Johnson, Anthony Richards, Rebecca C Fitzgerald, Yirupaiahgari KS Viswanath, Jenni Burt
BJGP Open 2020; 4 (1): bjgpopen20X101001. DOI: 10.3399/bjgpopen20X101001
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Keywords

  • primary health care
  • gastrointestinal neoplasms
  • early diagnosis
  • interviews
  • Surveys and questionnaires
  • esophageal neoplasms
  • general practice

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