Sarsha Yap1, Amy Vassallo2,3,4, Anna DeFazio5,6,7,8, Karen Canfell5, Julia Steinberg5, David Goldsbury5, Dianne L O'Connell5,9, Alison Brand6,10, Jon Emery11. 1. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia. sarsha.yap@sydney.edu.au. 2. Cancer Council NSW, Sydney, NSW, Australia. 3. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia. 4. Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 5. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia. 6. Department of Gynaecological Oncology, Westmead Hospital, Sydney, NSW, Australia. 7. School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 8. Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia. 9. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia. 10. Westmead Clinical School, University of Sydney, Sydney, NSW, Australia. 11. Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
Abstract
PURPOSE: To determine pathways to endometrial or ovarian cancer diagnosis by comparing health service utilization between cancer cases and matched cancer-free controls, using linked health records. METHODS: From cancer registry records, we identified 238 incident endometrial and 167 ovarian cancer cases diagnosed during 2006-2013 in the Australian 45 and Up Study cohort (142,973 female participants). Each case was matched to four cancer-free controls on birthdate, sex, place of residence, smoking status, and body mass index. The use of relevant health services during the 13-18-, 7-12-, 0-6-, and 0-1-months pre-diagnosis for cases and the corresponding dates for their matched controls was determined through linkage with subsidized medical services and hospital records. RESULTS: Healthcare utilization diverged between women with cancer and controls in the 0-6-months, particularly 0-1 months, pre-diagnosis. In the 0-1 months, 74.8% of endometrial and 50.3% of ovarian cases visited a gynecologist/gynecological oncologist, 11.3% and 59.3% had a CA125 test, 5.5% and 48.5% an abdominal pelvic CT scan, and 34.5% and 30.5% a transvaginal pelvic ultrasound, respectively (versus ≤ 1% of matched controls). Moreover, 25.1% of ovarian cancer cases visited an emergency department in the 0-1-months pre-diagnosis (versus 1.3% of matched controls), and GP visits were significantly more common for cases than controls in this period. CONCLUSION: Most women with endometrial or ovarian cancer accessed recommended specialists and tests in the 0-1-months pre-diagnosis, but a high proportion of women with ovarian cancer visited an emergency department. This reinforces the importance of timely specialist referral.
PURPOSE: To determine pathways to endometrial or ovarian cancer diagnosis by comparing health service utilization between cancer cases and matched cancer-free controls, using linked health records. METHODS: From cancer registry records, we identified 238 incident endometrial and 167 ovarian cancer cases diagnosed during 2006-2013 in the Australian 45 and Up Study cohort (142,973 female participants). Each case was matched to four cancer-free controls on birthdate, sex, place of residence, smoking status, and body mass index. The use of relevant health services during the 13-18-, 7-12-, 0-6-, and 0-1-months pre-diagnosis for cases and the corresponding dates for their matched controls was determined through linkage with subsidized medical services and hospital records. RESULTS: Healthcare utilization diverged between women with cancer and controls in the 0-6-months, particularly 0-1 months, pre-diagnosis. In the 0-1 months, 74.8% of endometrial and 50.3% of ovarian cases visited a gynecologist/gynecological oncologist, 11.3% and 59.3% had a CA125 test, 5.5% and 48.5% an abdominal pelvic CT scan, and 34.5% and 30.5% a transvaginal pelvic ultrasound, respectively (versus ≤ 1% of matched controls). Moreover, 25.1% of ovarian cancer cases visited an emergency department in the 0-1-months pre-diagnosis (versus 1.3% of matched controls), and GP visits were significantly more common for cases than controls in this period. CONCLUSION: Most women with endometrial or ovarian cancer accessed recommended specialists and tests in the 0-1-months pre-diagnosis, but a high proportion of women with ovarian cancer visited an emergency department. This reinforces the importance of timely specialist referral.
Authors: Usha Menon; David Weller; Alina Zalounina Falborg; Henry Jensen; John Butler; Andriana Barisic; Anne Kari Knudsen; Rebecca J Bergin; David H Brewster; Victoria Cairnduff; Evangelia Ourania Fourkala; Anna T Gavin; Eva Grunfeld; Elizabeth Harland; Jatinderpal Kalsi; Rebecca-Jane Law; Yulan Lin; Donna Turner; Richard D Neal; Victoria White; Samantha Harrison; Irene Reguilon; Charlotte Lynch; Peter Vedsted Journal: Br J Cancer Date: 2022-05-26 Impact factor: 9.075