Factors associated with multiple general practitioner consultations before cancer diagnosis in adolescents and young adults: A cohort study in Australia

BackgroundAdolescent and young adults (AYA) with underlying cancer often experience multiple General Practitioner (GP) consultations before they are referred to a specialist. Certain patient groups may be at higher risk of such events, but evidence is lacking, particularly from Australia. We aimed to examine GP activity prior to cancer diagnosis in an Australian cohort of AYAs and factors associated with multiple GP consultations.MethodsWe conducted an Australian cohort study of patients aged 18–39 years with incident cancer recorded in the Victorian Cancer Registry between 2008-2022 and linkage to the Patron primary care dataset. We calculated the frequency of GP events in the year before cancer diagnosis (GP consultations, prescriptions, blood test and imaging) and the proportion of patients with multiple GP consultations (≥4) in this period. Using multivariable logistic regression models, we examined associations between multiple pre-diagnostic GP consultations and patient characteristics, including age, sex, socioeconomic status, regional or city location, culturally and linguistically diverse background and main spoken language.Results1,712 AYAs with cancer were identified: 276 aged 18–25 and 1,436 aged 26–39. AYAs had a mean of 3 GP consults in the six months pre-diagnosis (range 0-46), with 1,035 (60%) AYAs having a GP consultation in this period and 434 AYAs (25%) consulting a GP 4 or more times. AYAs living in regional Australia were more likely to have 4 or more consultations (adjusted odds ratio (AOR) 1.67, 95%CI 1.32-2.10, p<0.001) as were those diagnosed in more recent years, particularly between 2020-2022 (AOR 1.54, 95%CI 1.14-2.07, p=0.005). In AYAs aged 18-25 years, the most deprived patients were more likely to have multiple GP consults (AOR 3.46, 95%CI 1.55-7.72, p=0.002), with no evidence of an association was observed in AYAs aged 26-40.ConclusionsOur findings identify AYA patient groups at higher risk of multiple GP consultations before cancer diagnosis and at risk of having a prolonged diagnostic journey. These findings could help to inform policy and prioritise early diagnosis interventions focusing on these patient groups.Legal entity responsible for the studyUniversity of Melbourne Human Ethics team in the Office of Research Ethics and Integrity.FundingVictorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre.DisclosureAll authors have declared no conflicts of interest.