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Cancer-related gut feelings among general practitioners in the Netherlands.

Donker, G.A., Dorsman, S., Jabaaij, L. Cancer-related gut feelings among general practitioners in the Netherlands.: , 2011. 61 p. Abstract. The Cancer and Primary Care Research International Network (Ca-PRI) 4th international Annual Meeting 'New pathways in cancer care: Substitution from Secondary to Primary Care?', 26-27 mei 2011, Noordwijkerhout. In: Abstractbook Ca-PRI 2011. Noordwijkerhout: The Cancer and Primary Care Research International Network, 2011.
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Introduction: Gut feelings; the uncomfortable feeling that something is wrong while specific indications are lacking, are a common feature among general practitioners (GPs) and are often related to a suspicion of cancer. Although there is little evidence of the prognostic value of these feelings, it is known that such sense of alarm can activate the GPs’ diagnostic behaviour. Studies show that early recognition of symptoms may contribute to early detection of cancer and is an important factor for prognosis and survival. In this way, one might expect that gut feelings can help predict and prevent serious disease and it will be of great value to assess the evidence of these feelings. Objective: To examine the causes of cancer-related gut feelings amongst GPs in the Netherlands, to describe the therapeutic actions that were driven by these feelings and to investigate whether the symptoms that caused the gut feelings have ultimately lead to a cancer diagnosis. Methods: Data were collected via the Dutch Sentinel General Practice Network; a network of 42 general practices, nationally representative by age, gender, regional distribution and population density. From January 2010, all GPs were asked to fill in questionnaires for each patient causing a gutfeeling that he/she may have cancer. After three months, the GPs were asked to complete a second questionnaire, evaluating patient’s final diagnosis. Results: A total of 124 questionnaires were completed in 2010. The GPs indicated that the gut feelings were caused by: unexplained weight loss, consultation of a patient who rarely visits the GP, smoking, a palpable tumor (especially in the breast), icterus, an irregular hematogram or extension of symptoms. Preliminary results show that the gut feelings lead to a diagnosis in 63% of the cases and in 60% of the cases this was a diagnosis of cancer. However in the majority of cases (56%) it was not the diagnosis anticipated initially. Conclusions: The study confirms that gut feelings may be a useful although not a precise instrument in the early diagnosis of cancer in general practice. Further studies in triggers of gut feelings are recommended. (aut. ref.)