Patterns of diagnostic testing for oesophagogastric cancer-related symptoms in Australian primary care: a retrospective cohort study.

Abstract

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. To examine diagnostic testing patterns for upper gastrointestinal (GI) symptoms linked to OG cancer. A retrospective cohort study was undertaken, which used a linked primary care database. It included de-identified patients aged >55 years who presented with symptoms suggestive of OG cancer between 2008 and 2022. The study analysed the proportion of patients who underwent pathology, imaging, referral, upper GI endoscopy, or a test of treatment. Differences across socioeconomic groups were also examined, along with the proportion of patients diagnosed with OG cancer. The study cohort consisted of 44 402 patients, of whom 126 (0.3%) were diagnosed with OG cancer within 12 months of presentation. Reflux was the most common symptom (57%), followed by nausea (11%). Patients aged ≥75 years were less likely to be investigated or referred than those aged 56-64 years (odds ratio [OR] 0.59, 95% confidence interval [CI] = 0.56 to 0.62, <i>P</i><0.001). Those from less disadvantaged areas were 1.4 times more likely to be investigated than people from the most disadvantaged areas (OR 1.44, 95% CI = 1.36 to 1.53, <i>P</i><0.001). Patients on test-of-treatment medications were less likely to receive further investigation (OR 0.66, 95% CI = 0.63 to 0.69, <i>P</i><0.001). Multiple symptoms and visits increased the likelihood of investigation (OR 2.77, 95% CI = 2.55 to 3.00, <i>P</i><0.001). Significant variations in diagnostic testing could contribute to disparities in OG cancer outcomes.