Patterns of Diagnostic Testing for Oesophagogastric Cancer-Related Symptoms in Australian General Practice.

Abstract

Background: Oesophagogastric (OG) cancer-associated symptoms are common in primary care, but most research has focused on patients with a confirmed OG cancer diagnosis, rather than those presenting with symptoms for the first time.

Aim: To examine diagnostic testing patterns for upper gastrointestinal symptoms linked to OG cancer.

Design and setting: Retrospective cohort study used a linked primary care database. It included de-identified patients aged 55 and older who presented with symptoms suggestive of OG cancer between 2008 and 2022. We analysed the proportion of patients who underwent pathology, imaging, referral, endoscopy, or a test of treatment. Differences across socioeconomic groups were also examined, along with the proportion of patients diagnosed with OG cancer.

Results: The study cohort consisted of 44,402 patients, of whom 126 (0.28%) were diagnosed with OG cancer within 12 months of presentation. Reflux was the most common symptom (57%), followed by nausea (11%). Patients over 75 were less likely to be investigated or referred (OR = 0.59, 95% CI: 0.56-0.62, p < 0.001). Those from less disadvantaged areas were 1.4 times more likely to be investigated (OR = 1.44, 95% CI: 1.36-1.53, p < 0.001). Patients on 'test of treatment' medications were less likely to receive further investigation (OR = 0.66, 95% CI: 0.63-0.69, p < 0.001). Multiple symptoms and visits increased the likelihood of investigation (OR = 2.77, 95% CI: 2.55-3.00, p < 0.001).

Conclusion: Significant variations in diagnostic testing could contribute to disparities in OG cancer outcomes.