{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:48:32Z","timestamp":1782730112815,"version":"3.54.5"},"reference-count":49,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,25]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate how patients with sarcoma present prior to diagnosis\u2014through a general practitioner (GP) or another healthcare professional (HCP)\u2014and describe presenting symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>International observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were obtained from the longitudinal \u2018QUality of life and Experiences of Sarcoma Trajectories\u2019 (QUEST) cohort study, conducted across the Netherlands, the United Kingdom (UK), Australia and New Zealand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 572 patients, 487 (85.1%) started their diagnostic trajectory at the GP (subcohort 1) and 85 (14.9%) with another HCP (subcohort 2)\u2014mainly medical specialists treating unrelated conditions (36\/85; 42.4%). Soft tissue sarcoma patients most often reported swelling, whereas bone sarcoma patients reported unexplained pain. Notably, 31\/85 (36.5%) of subcohort 2 were asymptomatic. Reasons for delaying GP visits included assuming symptoms were minor and expecting them to resolve. Patients sought care when, among others, symptoms persisted and worsened.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most patients first consulted a GP, underlining the role of primary care in sarcoma diagnosis internationally. Due to rarity and nonspecific symptoms, faster diagnosis remains challenging, requiring improvements in both primary and specialist care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03441906\">NCT03441906<\/jats:ext-link>\n                      Results.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114422","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:09:58Z","timestamp":1777921798000},"page":"e114422","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pre-diagnostic route reported by patients with sarcoma from the Netherlands, the UK, Australia and New Zealand: early detection challenges for general practitioners \u2013 an international observational cohort study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct03441906","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03441906","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2556-4553","authenticated-orcid":false,"given":"Emily I","family":"Holthuis","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"},{"name":"Medical Oncology Department, NKI-AVL - Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands"},{"name":"Department of Public Health, Erasmus MC Cancer Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-3968","authenticated-orcid":false,"given":"Vicky L M N","family":"Soomers","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Radboud Institute of Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meena","family":"Rafiq","sequence":"additional","affiliation":[{"name":"Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, UK"},{"name":"The University of Melbourne Department of General Practice and Primary Care, Carlton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4173-3844","authenticated-orcid":false,"given":"Robin L","family":"Jones","sequence":"additional","affiliation":[{"name":"Sarcoma Unit, Medical Oncology Department, Institute of Cancer Research, The Royal Marsden Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hayes","sequence":"additional","affiliation":[{"name":"Sarcoma Unit, Department of Surgery, Royal Marsden Hospital NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Van De Wal","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"},{"name":"Medical Oncology Department, NKI-AVL - Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cas","family":"Drabbe","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas B","family":"Been","sequence":"additional","affiliation":[{"name":"Surgery Oncology Department, University Medical Centre Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Bonenkamp","sequence":"additional","affiliation":[{"name":"Surgery Oncology Department, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos H","family":"van der Hage","sequence":"additional","affiliation":[{"name":"Surgery Oncology Department, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T J","family":"Lee","sequence":"additional","affiliation":[{"name":"Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis","family":"Verhoef","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winan J","family":"van Houdt","sequence":"additional","affiliation":[{"name":"Surgical Oncology Department, NKI-AVL - Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin J","family":"Young","sequence":"additional","affiliation":[{"name":"Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, St Andrews Place, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Andelkovic","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Chris O\u2019Brien Lifehouse, Camperdown, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Connor","sequence":"additional","affiliation":[{"name":"Te P\u016briri o Te Ora, Auckland City Hospital, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Koops","sequence":"additional","affiliation":[{"name":"Dutch Sarcoma Patient Platform, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winette T A","family":"van der Graaf","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands"},{"name":"Medical Oncology Department, NKI-AVL - 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Unique among cancers: a state of the nation review of sarcoma treatment and services across the UK. 2025. 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Suspected cancer. 2015."},{"key":"2026062608305580000_16.5.e114422.48","first-page":"277","article-title":"The diagnosis of soft tissue tumours","volume":"74","author":"Serpell","year":"1992","journal-title":"Ann R Coll Surg Engl"},{"key":"2026062608305580000_16.5.e114422.49","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-018-4320-y","article-title":"Working to improve the management of sarcoma patients across Europe: a policy checklist","volume":"18","author":"Kasper","year":"2018","journal-title":"BMC Cancer"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-114422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:28:18Z","timestamp":1782728898000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-114422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,4]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2025-114422"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-114422","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}