The prediagnostic general practitioner care of sarcoma patients: A real-world data study.

BACKGROUND: Limited understanding exists regarding early sarcoma symptoms presented during general practitioner (GP) consultations. The study explores GP visit patterns and recorded diagnoses in the 12 months preceding sarcoma diagnosis. METHODS: Sarcoma cases diagnosed from 2010 to 2020 were identified through the Netherlands Cancer Registry alongside general practice data. Sarcoma cases were age and gender matched to cancer-free controls (2:1 or 1:1 ratio). RESULTS: A total of 787 individuals with soft-tissue sarcoma (STS) and 188 individuals with bone sarcoma (BS) were identified. There was a significant difference in monthly GP contacts from 4 months to the last month before STS diagnosis, and 2 months before BS diagnosis between cases and controls. Most prevalent diagnoses recorded by the GP for STS cases included musculoskeletal neoplasm (26.6%), uncomplicated hypertension (15.6%), and cystitis/other urinary infections (12.2%). For BS cases, musculoskeletal neoplasm (42.8%), knee symptoms/complaints (9.7%), and shoulder symptoms/complaints (9.7%) were most frequent. CONCLUSIONS AND DISCUSSION: A significant difference in GP contacts between cases and controls preceding sarcoma diagnosis. STS cases were predominantly diagnosed with nonspecific symptoms, whereas BS cases with diagnoses more suggestive of BS. Better understanding of the prediagnostic trajectory could aid GPs in early identification of sarcoma.

Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial.

BACKGROUND: Severe fatigue following coronavirus disease 2019 (COVID-19) is prevalent and debilitating. This study investigated the efficacy of cognitive-behavioral therapy (CBT) for severe fatigue following COVID-19. METHODS: A multicenter, 2-arm randomized controlled trial was conducted in the Netherlands with patients being severely fatigued 3-12 months following COVID-19. Patients (N = 114) were randomly assigned (1:1) to CBT or care as usual (CAU). CBT, targeting perpetuating factors of fatigue, was provided for 17 weeks. The primary outcome was the overall mean difference between CBT and CAU on the fatigue severity subscale of the Checklist Individual Strength, directly post-CBT or CAU (T1), and after 6 months (T2). Secondary outcomes were differences in proportions of patients meeting criteria for severe and/or chronic fatigue, differences in physical and social functioning, somatic symptoms, and problems concentrating between CBT and CAU. RESULTS: Patients were mainly nonhospitalized and self-referred. Patients who received CBT were significantly less severely fatigued across follow-up assessments than patients receiving CAU (-8.8 [95% confidence interval {CI}, -11.9 to -5.8]); P < .001), representing a medium Cohen's d effect size (0.69). The between-group difference in fatigue severity was present at T1 (-9.3 [95% CI, -13.3 to -5.3]) and T2 (-8.4 [95% CI, -13.1 to -3.7]). All secondary outcomes favored CBT. Eight adverse events were recorded during CBT, and 20 during CAU. No serious adverse events were recorded. CONCLUSIONS: Among patients, who were mainly nonhospitalized and self-referred, CBT was effective in reducing fatigue. The positive effect was sustained at 6-month follow-up. CLINICAL TRIALS REGISTRATION: Netherlands Trial Register NL8947.

Differences Between Women and Men Are Present in the Rate of Diagnosed Diseases After a Diagnostic Intervention is Conducted in Primary Care.

BACKGROUND: Recently it was shown that the relative lack of diagnostic interventions conducted in women mediated the negative association between female sex and diagnosed disease. However, it remains unknown whether women and men receive disease diagnoses in an equal frequency after diagnostic interventions have been performed in general practice. METHODS: We used generalized linear mixed-effect models to assess the association between diagnostic interventions and disease diagnoses when patients presented with common somatic symptoms and studied whether the association differed between female and male patients. RESULTS: In 34,268 episodes of care (61.4% female) physical examinations and specialist referrals were associated with more disease diagnoses (OR = 2.32; 95% CI = 2.17-2.49 and OR = 1.38; 95% CI = 1.27-1.49, respectively), whereas laboratory diagnostics were associated with fewer disease diagnoses (OR = 0.50; 95% CI = 0.47-0.54). Significant interaction terms showed that women presenting with back pain, tiredness, arm and/or leg symptoms and tingling extremities were provided with fewer disease diagnoses after diagnostic interventions were performed than men. We found no significant interaction term that indicated that men were provided with fewer disease diagnoses after a diagnostic intervention than women. CONCLUSION: Especially when patients present with the mentioned symptoms, general practitioners should be aware that diagnostic interventions yield fewer disease diagnoses in female patients than in men. Yet, performing fewer diagnostic interventions in women with these symptoms will further exacerbate sex differences in disease diagnoses.