Studies often show that cancer patients diagnosed more rapidly have higher mortality rates than patients with longer waits in the primary and secondary health care sector. Our aim was to examine whether this paradox is manifest in the Danish health care system. The study was based on data on hospital discharge diagnoses for the 2004-2005 period, extracted from population-based healthcare databases in the former County of Aarhus, Denmark, and subsequently validated in the National Danish Cancer Registry. All patients with a first-time diagnosis of colon, rectal, lung, skin, breast, or prostate cancer were identified and confirmed by each patient’s general practitioner (GP), who provided a detailed description of the diagnostic pathway. Diagnostic interval was defined as time duration from first presentation of symptom to GP until date of diagnosis. Patients were followed up to three years after diagnosis, and we used Cox regression to estimate mortality rate ratios as a function of diagnostic delay using restricted cubic splines, and adjusting for gender, age, and co-morbidity. We identified 1080 cancer patients. For all cancers, except breast cancer, mortality after diagnosis decreased with longer diagnostic interval until the reference point of 30 days. For colon, rectal, skin, and breast cancer mortality seemed to increase with diagnostic interval longer than 30 days. The waiting list paradox is manifest in Denmark. We speculate that medical professionals organise the diagnostic pathway according to severity of symptoms and disease. Too simple analyses may block our knowledge of the effect of longer waits for non-emergency cancer patients.
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19th Wonca World Conference of Family Doctors, 2010