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Schut MC, Luik TT, Vagliano I, Rios M, Helsper CW, van Asselt KM, de Wit N, Abu-Hanna A, van Weert HC. Artificial intelligence for early detection of lung cancer in GPs' clinical notes: a retrospective observational cohort study. Br J Gen Pract 2025; 75:e316-e322. [PMID: 40044183 PMCID: PMC12040367 DOI: 10.3399/bjgp.2023.0489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 01/17/2025] [Indexed: 04/24/2025] Open
Abstract
BACKGROUND The journey of >80% of patients diagnosed with lung cancer starts in general practice. About 75% of patients are diagnosed when it is at an advanced stage (3 or 4), leading to >80% mortality within 1 year at present. The long-term data in GP records might contain hidden information that could be used for earlier case finding of patients with cancer. AIM To develop new prediction tools that improve the risk assessment for lung cancer. DESIGN AND SETTING Text analysis of electronic patient data using natural language processing and machine learning in the general practice files of four networks in the Netherlands. METHOD Files of 525 526 patients were analysed, of whom 2386 were diagnosed with lung cancer. Diagnoses were validated by using the Dutch cancer registry, and both structured and free-text data were used to predict the diagnosis of lung cancer 5 months before diagnosis (4 months before referral). RESULTS The algorithm could facilitate earlier detection of lung cancer using routine general practice data. Discrimination, calibration, sensitivity, and specificity were established under various cut-off points of the prediction 5 months before diagnosis. Internal validation of the best model demonstrated an area under the curve of 0.88 (95% confidence interval [CI] = 0.86 to 0.89), which shrunk to 0.79 (95% CI = 0.78 to 0.80) during external validation. The desired sensitivity determines the number of patients to be referred to detect one patient with lung cancer. CONCLUSION Artificial intelligence-based support enables earlier detection of lung cancer in general practice using readily available text in the patient files of GPs, but needs additional prospective clinical evaluation.
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Affiliation(s)
- Martijn C Schut
- Department of Laboratory Medicine, Amsterdam University Medical Center (UMC) Vrije Universiteit Amsterdam, Amsterdam; Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Torec T Luik
- Department of Medical Informatics, Amsterdam UMC Academic Medical Center (AMC), Amsterdam; Amsterdam Public Health, Amsterdam UMC, Amsterdam; Department of Medical Biology, Amsterdam UMC AMC, Amsterdam, the Netherlands
| | - Iacopo Vagliano
- Department of Medical Informatics, Amsterdam UMC AMC, Amsterdam; Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Miguel Rios
- Department of Medical Informatics, Amsterdam UMC AMC, Amsterdam; Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands; Centre for Translation Studies, University of Vienna, Vienna, Austria
| | - Charles W Helsper
- Netherlands School of Public and Occupational Health, Utrecht, the Netherlands
| | - Kristel M van Asselt
- Amsterdam Public Health, Amsterdam UMC, Amsterdam; Department of General Practice, Amsterdam UMC AMC, Amsterdam, The Netherlands
| | - Niek de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC AMC, Amsterdam; Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Henk Cpm van Weert
- Amsterdam Public Health, Amsterdam UMC, Amsterdam; Department of General Practice, Amsterdam UMC AMC, Amsterdam, The Netherlands
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Simon Y, Helmer C, Delva F, Baldi I, Coureau G, Leguyader-Peyrou S, Amieva H, Mathoulin-Pelissier S, Pérès K, Galvin A. What are the determinants of functional decline in older adults with cancer? Results from the INCAPAC study. J Geriatr Oncol 2025; 16:102223. [PMID: 40121858 DOI: 10.1016/j.jgo.2025.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 11/14/2024] [Accepted: 03/06/2025] [Indexed: 03/25/2025]
Abstract
INTRODUCTION Older adults with cancer are exposed to greater difficulties in carrying out their daily activities due to cancer itself, its treatment, or both. The aim of this study was to describe functional decline after cancer diagnosis and to investigate the determinants of this decline among older individuals with cancer. MATERIALS AND METHODS Using the Gironde cancer registries, older subjects (≥65 years) with a diagnosis of cancer between 2005 and 2018 were identified in three prospective cohorts on aging. Functional decline was defined as an increase of 1 point for Activities of Daily Living (ADL), 2 points for Instrumental Activities of Daily Living (IADL), and 3 points for the overall score (ADL + IADL) between cancer pre- and post-diagnosis visits. Logistic regression models were used to identify determinants of functional decline among older subjects who underwent a post-diagnostic assessment. Additionally, multinomial logistic regression models were performed to account for individuals who had died prior to the post-diagnostic cancer visit. RESULTS A total of 306 individuals followed-up after the cancer diagnosis were included (median age at cancer diagnosis: 83; 44 % female). Older age at cancer, low educational level, impaired initial functional status, and poor five-year cancer-related prognosis were significantly associated with functional decline across all three scores. Multinomial logistic regression analyses (n = 489) yielded similar results, but only cancer-related factors, specifically unfavorable vital prognosis, were associated with higher risk of death. DISCUSSION Functional decline in older individuals with cancer is both multifactorial and multidimensional. Further studies are needed to disentangle the effects of cancer and aging.
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Affiliation(s)
- Yvanna Simon
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, ACTIVE team, UMR 1219, F-33000 Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, LEHA team, UMR 1219, F-33000 Bordeaux, France
| | - Fleur Delva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, EPICENE team, UMR 1219, F-33000 Bordeaux, France; Department of Public Health, Bordeaux University Hospital, F-3300 Bordeaux, France
| | - Isabelle Baldi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, EPICENE team, UMR 1219, F-33000 Bordeaux, France; Registre des tumeurs primitives du système nerveux central de la Gironde, Inserm U1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Gaëlle Coureau
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, EPICENE team, UMR 1219, F-33000 Bordeaux, France; Department of Public Health, Bordeaux University Hospital, F-3300 Bordeaux, France; Gironde General Cancer Registry, Univ Bordeaux, Bordeaux, France
| | - Sandra Leguyader-Peyrou
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, EPICENE team, UMR 1219, F-33000 Bordeaux, France; Registre des hémopathies malignes de la Gironde, Institut Bergonié, Bordeaux, France
| | - Hélène Amieva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, ACTIVE team, UMR 1219, F-33000 Bordeaux, France
| | - Simone Mathoulin-Pelissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, EPICENE team, UMR 1219, F-33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, ACTIVE team, UMR 1219, F-33000 Bordeaux, France.
| | - Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, EPICENE team, UMR 1219, F-33000 Bordeaux, France
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Hoveling LA, Schuurman M, Siesling S, van Asselt KM, Bode C. Diagnostic delay in women with cancer: What do we know and which factors contribute? Breast 2025; 80:104427. [PMID: 39987718 PMCID: PMC11904510 DOI: 10.1016/j.breast.2025.104427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 02/19/2025] [Indexed: 02/25/2025] Open
Abstract
Timely cancer diagnosis is important, but delays are common, also among women. This study reviews recent literature on diagnostic delays in women with breast cancer, focusing on individual-level factors and their interaction with micro, meso, exo, and macrosystem factors. Following PRISMA-ScR guidelines, we conducted a scoping review on diagnostic delays in cancer among women, including qualitative and quantitative studies with oncological patients or healthcare professionals. We searched PubMed/MEDLINE and Scopus for publications from 2018 to November 28, 2023, excluding studies not meeting the inclusion criteria, not in English or Dutch, or focused solely on cancer screening. Titles and full texts were screened, with disagreements resolved through discussion. Two reviewers independently extracted study details, population characteristics, study design, and factors contributing to diagnostic delays. Initially, 9699 records were retrieved, resulting in 129 relevant studies after exclusions. We focused on women's health and breast cancer, narrowing our scope to 22 studies in high-income countries. Studies explored diagnostic delays and factors at various levels: microsystem (demographics, health behaviours, psychology, healthcare interactions), mesosystem (schedules, peer and support networks), exosystem (social, cultural, environmental, accessibility factors), and macrosystem (broader cultural, societal contexts, healthcare policies). In high-income countries, diagnostic delays in breast cancer care involve factors across various systems, affecting individuals, peers, healthcare, and policies. Enhancing awareness, communication, and access is important, requiring targeted campaigns and infrastructure upgrades. The Bronfenbrenner's ecological model effectively addresses the multifaceted factors influencing diagnostic delays. Future research can benefit from applying this model to various cancers and income settings.
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Affiliation(s)
- Liza A Hoveling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
| | - Melinda Schuurman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Kristel M van Asselt
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands.
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Vagliano I, Rios M, Abukmeil M, Schut MC, Luik TT, van Asselt KM, van Weert HCPM, Abu-Hanna A. An Order-Sensitive Hierarchical Neural Model for Early Lung Cancer Detection Using Dutch Primary Care Notes and Structured Data. Cancers (Basel) 2025; 17:1151. [PMID: 40227640 PMCID: PMC11988128 DOI: 10.3390/cancers17071151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/25/2025] [Accepted: 03/27/2025] [Indexed: 04/15/2025] Open
Abstract
Background: Improving prediction models to timely detect lung cancer is paramount. Our aim is to develop and validate prediction models for early detection of lung cancer in primary care, based on free-text consultation notes, that exploit the order and context among words and sentences. Methods: Data of all patients enlisted in 49 general practices between 2002 and 2021 were assessed, and we included those older than 30 years with at least one free-text note. We developed two models using a hierarchical architecture that relies on attention and bidirectional long short-term memory networks. One model used only text, while the other combined text with clinical variables. The models were trained on data excluding the five months leading up to the diagnosis, using target replication and a tuning set, and were tested on a separate dataset for discrimination, PPV, and calibration. Results: A total of 250,021 patients were enlisted, with 1507 having a lung cancer diagnosis. Included in the analysis were 183,012 patients, of which 712 had the diagnosis. From the two models, the combined model showed slightly better performance, achieving an AUROC on the test set of 0.91, an AUPRC of 0.05, and a PPV of 0.034 (0.024, 0.043), and showed good calibration. To early detect one cancer patient, 29 high-risk patients would require additional diagnostic testing. Conclusions: Our models showed excellent discrimination by leveraging the word and sentence structure. Including clinical variables in addition to text slightly improved performance. The number needed to treat holds promise for clinical practice. Investigating external validation and model suitability in clinical practice is warranted.
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Affiliation(s)
- Iacopo Vagliano
- Department of Medical Informatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.R.); (M.A.); (M.C.S.); (T.T.L.); (A.A.-H.)
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
| | - Miguel Rios
- Department of Medical Informatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.R.); (M.A.); (M.C.S.); (T.T.L.); (A.A.-H.)
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
- Centre for Translation Studies, University of Vienna, Gymnasiumstraße 50, 1010 Vienna, Austria
| | - Mohanad Abukmeil
- Department of Medical Informatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.R.); (M.A.); (M.C.S.); (T.T.L.); (A.A.-H.)
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
| | - Martijn C. Schut
- Department of Medical Informatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.R.); (M.A.); (M.C.S.); (T.T.L.); (A.A.-H.)
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
- Department of Laboratory Medicine, Amsterdam University Medical Center, De Boelelaan 1117, 1105 AZ Amsterdam, The Netherlands
| | - Torec T. Luik
- Department of Medical Informatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.R.); (M.A.); (M.C.S.); (T.T.L.); (A.A.-H.)
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
- Department of Medical Biology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kristel M. van Asselt
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
- Department of General Practice & Nursing Science, Julius Center for Health Sciences, Primary Care University Medical Centre Utrecht, 3584 CG Utrecht, The Netherlands
| | - Henk C. P. M. van Weert
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
- Department of General Practice, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.R.); (M.A.); (M.C.S.); (T.T.L.); (A.A.-H.)
- Amsterdam Public Health, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands; (K.M.v.A.); (H.C.P.M.v.W.)
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Kokot MK, Mirosevic S, Bric N, Petek D. Analysis of early diagnostic pathway for prostate cancer in Slovenia. Radiol Oncol 2024; 58:544-555. [PMID: 39362037 PMCID: PMC11604256 DOI: 10.2478/raon-2024-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/25/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Prostate cancer (PCa) is a prevalent male malignancy globally. Prolonged diagnostic intervals are associated with poorer outcomes, emphasizing the need to optimize this process. This study aimed to evaluate the doctor and primary care interval, research their impact on patient survival and explore opportunities to improve PCa diagnostic pathway in primary care. PATIENTS AND METHODS A retrospective cohort study using cancer patients' anonymised primary care data and data of the Slovenian Cancer Registry. RESULTS The study found that the doctor interval had a median duration of 0 days (interquartile range ([IQR] 0-6) and primary care interval a median duration of 5 days (IQR 0-58). Longer intervals were observed in patients with more than two comorbidities, where general practitioners didn't have access to laboratory diagnostic tests within their primary health care centre and when patients first presented with symptoms (reported symptoms at first presentation: dysuria, lower urinary tract symptoms [LUTS], abdominal pain). The analysis also revealed a statistically significant association between lower 5-year survival rate and the accessibility of laboratory and ultrasound diagnostics in primary healthcare centres and a shorter 5-year survival of symptomatic patients in comparison to patients who were identified by elevated levels of prostate specific antigen (PSA). CONCLUSIONS This study shows that treating suspected PCa in primary care has a significant impact on 5-year survival. Several factors contribute to better survival, including easy access to laboratory and abdominal ultrasound in primary care centres. The study highlights the complex array of factors shaping PCa diagnosis, beyond individual clinicians' skills, encompassing test and service availability.
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Affiliation(s)
- Mateja Kokalj Kokot
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Primary Healthcare Centre Grosuplje, Grosuplje, Slovenia
| | - Spela Mirosevic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nika Bric
- Sector for Oncology Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Medical Centre Zdravje,Ljubljana, Slovenia
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Sharman Moser S, Yaari S, Apter L, Poellinger B, Rheenen M, Arunachalam A, Chodick G, Hoshen M, Gazit S, Siegelmann-Danieli N. Mapping the patient journey and treatment patterns in early-stage (stage I-III) non-small cell lung cancer. Cancer Epidemiol 2024; 93:102678. [PMID: 39357215 DOI: 10.1016/j.canep.2024.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/17/2024] [Accepted: 09/15/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION We map the patient journey from symptom onset to intervention and describe primary treatment in a retrospective population-based cohort study of patients in a large healthcare-provider. METHODS Newly diagnosed adult patients diagnosed with stages I-III non-small cell lung cancer (NSCLC) between 2016 and 2019 were identified from the Israel National Cancer Registry and chart review was performed to extract de-identified data. The following timelines were constructed: from symptom onset to imaging, imaging to biopsy, and biopsy to primary treatment initiation. Cutoff: 31st December 2021. The initial symptom was captured up to one year prior to biopsy. RESULTS Among 302 patients (41 % female, 70 % >=65 years, 79 % former or current smoking, 62 % adenocarcinoma), 34.1 % stage I, 10.3 % stage II, 42.1 % stage III and 13.6 % unknown (AJCC ver. 8). In the baseline year, 80.5 % of patients reported at least one symptom to their physician, and 12.3 % reported four or more symptoms. The most common symptoms reported were cough (29.8 %), pneumonia (24.2 %), chest pain (18.5 %), bronchitis (17.5 %) and wheezing (17.2 %). For patients with an initial symptom (n=243) median time from symptom onset to imaging was 5.5 months (95% CI:4.8-6.3), and time from imaging to primary treatment initiation was 2.6 (2.3-2.9) months in all patients. Total duration from symptom to intervention was 8.5 months (7.6-9.3). Over 93 % of stage I patients underwent surgery and 4.9 % received definitive radiation. Over 83 % of stage II patients underwent surgery; of these, 54.8 % received adjuvant/neoadjuvant chemotherapy. Of stage III patients, 68.5 % received definitive chemoradiation (half received durvalumab), and the remaining underwent surgery with adjuvant/neoadjuvant treatment. CONCLUSION A total of 80.5 % of patients were symptomatic and the median duration from symptom onset to treatment initiation was 8.5 month long. Improving patient and physician awareness to lung cancer symptoms, and the introduction of screening programs are essential for reducing those delays.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel.
| | - Shira Yaari
- MSD Israel, 34 Hacharash St. P.O.B 7340; Neve Neeman B; Hod Hasharon, 45240, Israel
| | - Lior Apter
- Health Division, Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Department of Health Systems, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | - Gabriel Chodick
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Faculty of Medicine, Tel Aviv University, Israel
| | - Moshe Hoshen
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel
| | - Sivan Gazit
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel
| | - Nava Siegelmann-Danieli
- Health Division, Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel; Faculty of Medicine, Tel Aviv University, Israel
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Mavor ME, Hanna TP, Asai Y, Langley H, Look Hong NJ, Wright FC, Nguyen P, Groome PA. Factors associated with the melanoma diagnostic interval in Ontario, Canada: a population-based study. Br J Cancer 2024; 130:483-495. [PMID: 38102225 PMCID: PMC10844321 DOI: 10.1038/s41416-023-02518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Protracted times to diagnosis of cancer can lead to increased patient anxiety, and in some cases, disease progression and worse outcomes. This study assessed the time to diagnosis for melanoma, and its variability, according to patient-, disease-, and system-level factors. METHODS This is a descriptive, cross-sectional study in Ontario, Canada from 2007-2019. We used administrative health data to measure the diagnostic interval (DI)-and its two subintervals-the primary care subinterval (PCI) and specialist care subinterval (SCI). Multivariable quantile regression was used. RESULTS There were 33,371 melanoma patients. The median DI was 36 days (interquartile range [IQR]: 8-85 days), median PCI 22 days (IQR: 6-54 days), and median SCI 6 days (IQR: 1-42 days). Increasing comorbidity was associated with increasing DI. Residents in the most deprived neighbourhoods and those in rural areas experienced shorter DIs and PCIs, but no differences in SCI. There was substantial variation in the DI and SCI across health regions, but limited differences in the PCI. Finally, patients with a history of non-melanoma skin cancer, and those previously established with a dermatologist experienced significantly longer DI, PCI, and SCI. DISCUSSION This study found variability in the melanoma DI, notably by system-level factors.
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Affiliation(s)
- Meaghan E Mavor
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada.
| | - Timothy P Hanna
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- ICES at Queen's University, Kingston, ON, Canada
| | - Yuka Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Hugh Langley
- Department of Oncology, Queen's University, Kingston, ON, Canada
- South East Regional Cancer Program, Kingston, ON, Canada
| | - Nicole J Look Hong
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Surgical Oncology Program, Cancer Care Ontario - Ontario Health, Toronto, ON, Canada
| | - Paul Nguyen
- ICES at Queen's University, Kingston, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
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Fernández-Antón E, Rodríguez-Miguel A, Gil M, Castellano-López A, de Abajo FJ. Development and Validation of Case-Finding Algorithms for Digestive Cancer in the Spanish Healthcare Database BIFAP. J Clin Med 2024; 13:361. [PMID: 38256495 PMCID: PMC10816118 DOI: 10.3390/jcm13020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND electronic health records (EHRs) are helpful tools in epidemiology despite not being primarily collected for research. In Spain, primary care physicians play a central role and manage patients even in specialized care. All of this introduces variability that may lead to diagnostic inconsistencies. Therefore, data validation studies are crucial, so we aimed to develop and validate case-finding algorithms for digestive cancer in the primary care database BIFAP. METHODS from 2001 to 2019, subjects aged 40-89 without a cancer history were included. Case-finding algorithms using diagnostic codes and text-mining were built. We randomly sampled, clustered, and manually reviewed 816 EHRs. Then, positive predictive values (PPVs) and 95% confidence intervals (95% CIs) for each cancer were computed. Age and sex standardized incidence rates (SIRs) were compared with those reported by the National Cancer Registry (REDECAN). RESULTS we identified 95,672 potential cases. After validation, the PPV (95% CI) for hepato-biliary cancer was 87.6% (81.8-93.4), for esophageal cancer, it was 96.2% (93.1-99.2), for pancreatic cancer, it was 89.4% (84.5-94.3), for gastric cancer, it was 92.5% (88.3-96.6), and for colorectal cancer, it was 95.2% (92.1-98.4). The SIRs were comparable to those reported by the REDECAN. CONCLUSIONS the case-finding algorithms demonstrated high performance, supporting BIFAP as a suitable source of information to conduct epidemiologic studies of digestive cancer.
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Affiliation(s)
- Encarnación Fernández-Antón
- Clinical Pharmacology Unit, University Hospital “Príncipe de Asturias”, 28805 Madrid, Spain
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Madrid, Spain
| | - Antonio Rodríguez-Miguel
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Madrid, Spain
| | - Miguel Gil
- BIFAP (Base de datos para la Investigación Farmacoepidemiológica en el Ámbito Público), Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), 28022 Madrid, Spain
| | - Amelia Castellano-López
- Department of Gastroenterology, University Hospital “Príncipe de Asturias”, 28805 Madrid, Spain
| | - Francisco J. de Abajo
- Clinical Pharmacology Unit, University Hospital “Príncipe de Asturias”, 28805 Madrid, Spain
- Department of Biomedical Sciences (Pharmacology), University of Alcalá (IRYCIS), 28805 Madrid, Spain
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Huang Y, Pfeiffer SM, Zhang Q. Primary tumor type prediction based on US nationwide genomic profiling data in 13,522 patients. Comput Struct Biotechnol J 2023; 21:3865-3874. [PMID: 37593720 PMCID: PMC10432138 DOI: 10.1016/j.csbj.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
Timely and accurate primary tumor diagnosis is critical, and misdiagnoses and delays may cause undue health and economic burden. To predict primary tumor types based on genomics data from a de-identified US nationwide clinico-genomic database (CGDB), the XGBoost-based Clinico-Genomic Machine Learning Model (XC-GeM) was developed to predict 13 primary tumor types based on data from 12,060 patients in the CGDB, derived from routine clinical comprehensive genomic profiling (CGP) testing and chart-confirmed electronic health records (EHRs). The SHapley Additive exPlanations method was used to interpret model predictions. XC-GeM reached an outstanding area under the curve (AUC) of 0.965 and Matthew's correlation coefficient (MCC) of 0.742 in the holdout validation dataset. In the independent validation cohort of 955 patients, XC-GeM reached 0.954 AUC and 0.733 MCC and made correct predictions in 77% of non-small cell lung cancer (NSCLC), 86% of colorectal cancer, and 84% of breast cancer patients. Top predictors for the overall model (e.g. tumor mutational burden (TMB), gender, and KRAS alteration), and for specific tumor types (e.g., TMB and EGFR alteration for NSCLC) were supported by published studies. XC-GeM also achieved an excellent AUC of 0.880 and positive MCC of 0.540 in 507 patients with missing primary diagnosis. XC-GeM is the first algorithm to predict primary tumor type using US nationwide data from routine CGP testing and chart-confirmed EHRs, showing promising performance. It may enhance the accuracy and efficiency of cancer diagnoses, enabling more timely treatment choices and potentially leading to better outcomes.
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Affiliation(s)
| | | | - Qing Zhang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, United States
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10
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Vaswani S, Kuhner C, Xu J, Dickman E, Becker K, Drapkin J, Turchiano M. Establishing a rapid assessment service for patients with suspected malignancies for expedited outpatient management. Am J Emerg Med 2023; 70:66-69. [PMID: 37210975 DOI: 10.1016/j.ajem.2023.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND 11% of new cancer diagnoses occur in the emergency department. Historically, these diagnoses disproportionately affect underserved patient populations and are associated with poor outcomes. This is an observational study of the Rapid Assessment Service (RAS) program, which aims to provide timely outpatient follow-up and facilitate a diagnosis for patients discharged from the emergency department with suspected malignancies. METHODS We performed a retrospective chart review of 176 patients who were discharged from the emergency department with RAS clinic follow up between February 2020 and March 2022. We manually chart reviewed 176 records in order to determine the average time to RAS clinic appointment, average time to diagnosis, and the final diagnosis based on biopsy. RESULTS 163 of 176 patients (93%) discharged to RAS received reliable follow-up care. 62 of the 176 patients (35%) followed up in the RAS clinic with a mean of 4.6 days. 46 of the 62 patients (74%) who followed up in the RAS clinic were ultimately diagnosed with a new cancer, with a mean time to diagnosis of 13.5 days. The leading new cancer diagnoses included: lung, ovarian, hematologic, head and neck, and renal cancers. CONCLUSIONS Creating a Rapid Assessment Service facilitated an expedited oncologic work-up and diagnosis in an outpatient setting.
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Affiliation(s)
- Sabena Vaswani
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Christopher Kuhner
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jason Xu
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Eitan Dickman
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kevin Becker
- Department of Oncology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Jefferson Drapkin
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Michael Turchiano
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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11
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Impact of the COVID-19 Outbreak-Delayed Referral of Colorectal and Lung Cancer in Primary Care: A National Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15051462. [PMID: 36900257 PMCID: PMC10000463 DOI: 10.3390/cancers15051462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) outbreak impacted health care. We investigated its impact on the time to referral and diagnosis for symptomatic cancer patients in The Netherlands. We performed a national retrospective cohort study utilizing primary care records linked to The Netherlands Cancer Registry. For patients with symptomatic colorectal, lung, breast, or melanoma cancer, we manually explored free and coded texts to determine the durations of the primary care (IPC) and secondary care (ISC) diagnostic intervals during the first COVID-19 wave and pre-COVID-19. We found that the median IPC duration increased for colorectal cancer from 5 days (Interquartile Range (IQR) 1-29 days) pre-COVID-19 to 44 days (IQR 6-230, p < 0.01) during the first COVID-19 wave, and for lung cancer, the duration increased from 15 days (IQR) 3-47) to 41 days (IQR 7-102, p < 0.01). For breast cancer and melanoma, the change in IPC duration was negligible. The median ISC duration only increased for breast cancer, from 3 (IQR 2-7) to 6 days (IQR 3-9, p < 0.01). For colorectal cancer, lung cancer, and melanoma, the median ISC durations were 17.5 (IQR (9-52), 18 (IQR 7-40), and 9 (IQR 3-44) days, respectively, similar to pre-COVID-19 results. In conclusion, for colorectal and lung cancer, the time to primary care referral was substantially prolonged during the first COVID-19 wave. In such crises, targeted primary care support is needed to maintain effective cancer diagnosis.
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12
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Paulino Pereira LJ, Heetman JG, van den Bergh RC, van Melick HH. Superfast Magnetic Resonance Imaging-based Diagnostic Pathway for Prostate Cancer. EUR UROL SUPPL 2022; 46:30-32. [PMID: 36310760 PMCID: PMC9615134 DOI: 10.1016/j.euros.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
We describe a <36-h superfast diagnostic pathway for men at risk of prostate cancer (PCa) that was initiated in our centre in March 2022. Patients are scheduled to undergo a repeat prostate-specific antigen blood test, magnetic resonance imaging, a urology consultation, and, if indicated, prostate biopsies in a single morning. The histopathology report is available the next day, after which the biopsy results and treatment options are discussed via a telephone consultation. The project has included 122 patients so far. With a reduction to only one hospital visit per patient and just five appointments (4%) cancelled so far, this timely pathway seems to be efficient from a patient perspective. In addition, reducing the waiting time until histopathology diagnosis could decrease the anxiety and depression that patients may experience during the diagnostic workup for PCa. Therefore, we believe that this fast-track diagnostic pathway could be incorporated in the future European standard of care, bringing PCa care in line with other malignancies such as breast cancer. Patient summary We describe a superfast diagnostic pathway for men at risk of prostate cancer. So far, this strategy seems to be an efficient and appropriate way to shorten time to diagnosis and to reduce the number of hospital visits for patients.
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Affiliation(s)
- Leonor Jane Paulino Pereira
- Corresponding author. Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands. Tel. +31 6 4712 6781.
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13
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Blackmore T, Chepulis L, Rawiri K, Kidd J, Stokes T, Firth M, Elwood M, Weller D, Emery J, Lawrenson R. Patient-reported diagnostic intervals to colorectal cancer diagnosis in the Midland region of New Zealand: a prospective cohort study. Fam Pract 2022; 39:639-647. [PMID: 34871389 PMCID: PMC9295611 DOI: 10.1093/fampra/cmab155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES New Zealand (NZ) has high rates of colorectal cancer (CRC) but low rates of early detection. The majority of CRC is diagnosed through general practice, where lengthy diagnostic intervals are common. We investigated factors contributing to diagnostic delay in a cohort of patients newly diagnosed with CRC. METHODS Patients were recruited from the Midland region and interviewed about their diagnostic experience using a questionnaire based on a modified Model of Pathways to Treatment framework and SYMPTOM questionnaire. Descriptive statistics were used to describe the population characteristics. Chi-square analysis and logistic regression were used to analyse factors influencing diagnostic intervals. RESULTS Data from 176 patients were analysed, of which 65 (36.9%) experienced a general practitioner (GP) diagnostic interval of >120 days and 96 (54.5%) experienced a total diagnostic interval (TDI) > 120 days. Patients reporting rectal bleeding were less likely to experience a long TDI (odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.14-0.78) and appraisal/help-seeking interval (OR, 0.19, 95% CI: 0.06-0.59). Patients <60 were more likely to report a longer appraisal/help-seeking interval (OR, 3.32, 95% CI: 1.17-9.46). Female (OR, 2.19, 95% CI: 1.08-4.44) and Māori patients (OR, 3.18, 95% CI: 1.04-9.78) were more likely to experience a long GP diagnostic interval. CONCLUSION NZ patients with CRC can experience long diagnostic intervals, attributed to patient and health system factors. Young patients, Māori, females, and patients experiencing change of bowel habit may be at particular risk. We need to increase symptom awareness of CRC for patients and GPs. Concentrated efforts are needed to ensure equity for Māori in access to screening, diagnostics, and treatment.
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Affiliation(s)
- Tania Blackmore
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Keenan Rawiri
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Melissa Firth
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Mark Elwood
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - David Weller
- Centre for Population Health Studies, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Jon Emery
- Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
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14
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Lorente R, Antonanzas F. Seeking efficiency gains outside drugs and diagnostics. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:759-761. [PMID: 35305177 DOI: 10.1007/s10198-022-01456-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
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15
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The effect of delayed treatment initiation on adverse events and recurrence in older head and neck cancer patients. Radiother Oncol 2022; 173:154-162. [DOI: 10.1016/j.radonc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
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16
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Bejan V, Pîslaru M, Scripcariu V. Diagnosis of Peritoneal Carcinomatosis of Colorectal Origin Based on an Innovative Fuzzy Logic Approach. Diagnostics (Basel) 2022; 12:1285. [PMID: 35626439 PMCID: PMC9140813 DOI: 10.3390/diagnostics12051285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer represents one of the most important causes worldwide of cancer related morbidity and mortality. One of the complications which can occur during cancer progression, is peritoneal carcinomatosis. In the majority of cases, it is diagnosed in late stages due to the lack of diagnostic tools capable of revealing the early-stage peritoneal burden. Therefore, still associates with poor prognosis and quality of life, despite recent therapeutic advances. The aim of the study was to develop a fuzzy logic approach to assess the probability of peritoneal carcinomatosis presence using routine blood test parameters as input data. The patient data was acquired retrospective from patients diagnosed between 2010-2021. The developed model focuses on the specific quantitative alteration of these parameters in the presence of peritoneal carcinomatosis, which is an innovative approach as regards the literature in the field and validates the feasibility of using a fuzzy logic approach in the noninvasive diagnosis of peritoneal carcinomatosis.
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Affiliation(s)
- Valentin Bejan
- Department of Surgery, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Farmacy of Iași, 700115 Iasi, Romania;
| | - Marius Pîslaru
- Department of Engineering and Management, Faculty of Industrial Design and Business Management, “Gheorghe Asachi” Technical University of Iași, 700050 Iasi, Romania;
| | - Viorel Scripcariu
- Department of Surgery, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Farmacy of Iași, 700115 Iasi, Romania;
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17
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Defining timeliness in care for patients with lung cancer: a scoping review. BMJ Open 2022; 12:e056895. [PMID: 35393318 PMCID: PMC8990712 DOI: 10.1136/bmjopen-2021-056895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/11/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer. METHODS This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles. RESULTS A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure. CONCLUSION This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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18
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Cañaveras León E, Cano Fuentes G, Dastis Bendala C, Terrón Dastis P, Almeida González CV. [Delay in the diagnosis and treatment of five types of cancer in two urban health centres]. Aten Primaria 2022; 54:102259. [PMID: 35144115 PMCID: PMC8841581 DOI: 10.1016/j.aprim.2021.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors. DESIGN Observational, retrospective, analytical cohort study. SITE: Primary care. Two urban health centres. PARTICIPANTS Three hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017. MAIN MEASURES The medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed. RESULTS Median ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder. CONCLUSIONS ID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.
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19
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Montiel Ishino FA, Odame EA, Villalobos K, Rowan C, Whiteside M, Mamudu H, Williams F. Sociodemographic and Geographic Disparities of Prostate Cancer Treatment Delay in Tennessee: A Population-Based Study. Am J Mens Health 2021; 15:15579883211057990. [PMID: 34836465 PMCID: PMC8646205 DOI: 10.1177/15579883211057990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The relationship of social determinants of health, Appalachian residence, and prostate cancer treatment delay among Tennessee adults is relatively unknown. We used multivariate logistic regression on 2005–2015 Tennessee Cancer Registry data of adults aged ≥18 diagnosed with prostate cancer. The outcome of treatment delay was more than 90 days without surgical or nonsurgical intervention from date of diagnosis. Social determinants in the population-based registry were race (White, Black, Other) and marital status (single, married, divorced/separated, widow/widower). Tennessee residence was classified as Appalachian versus non-Appalachian (urban/rural). Covariates include age at diagnosis (18–54, 54–69, ≥70), health insurance type (none, public, private), derived staging of cancer (localized, regional, distant), and treatment type (non-surgical/surgical). We found that Black and divorced/separated patients had 32% (95% confidence interval [CI]: 1.22–1.42) and 15% (95% CI: 1.01–1.31) increased odds to delay prostate cancer treatment. Patients were at decreased odds of treatment delay when living in an Appalachian county, both urban (odds ratio [OR] = 0.89, 95% CI: 0.82–0.95) and rural (OR = 0.83, 95% CI: 0.78–0.89), diagnosed at ≥70 (OR = 0.59, 95% CI: 0.53–0.66), and received surgical intervention (OR = 0.72, 95% CI: 0.68–0.76). Our study was among the first to comprehensively examine prostate cancer treatment delay in Tennessee, and while we do not make clinical recommendations, there is a critical need to further explore the unique factors that may propagate disparities. Prostate cancer treatment delay in Black patients may be indicative of ongoing health and access disparities in Tennessee, which may further affect quality of life and survivorship among this racial group. Divorced/separated patients may need tailored interventions to improve social support.
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Affiliation(s)
- Francisco A Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Emmanuel A Odame
- Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Villalobos
- Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claire Rowan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Martin Whiteside
- Tennessee Cancer Registry, Tennessee Department of Health, Nashville, TN, USA
| | - Hadii Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
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20
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Kuiper JG, van Herk-Sukel MPP, Lemmens VEPP, Kuipers EJ, Herings RMC. A population-based linked cohort of cancer and primary care data: A new source to study the management of cancer in primary care. Eur J Cancer Care (Engl) 2021; 31:e13529. [PMID: 34658095 PMCID: PMC9285474 DOI: 10.1111/ecc.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/25/2020] [Accepted: 10/04/2021] [Indexed: 01/04/2023]
Abstract
Objective Insight into the management of cancer in the primary care setting is pivotal to improve early recognition and survival of cancer patients. Therefore, the Netherlands Cancer Registry (NCR) was linked to the General Practitioner (GP) Database of the PHARMO Database Network to make this research possible. Methods The NCR collects tumour data on all newly diagnosed cancer patients, whereas the GP Database comprises data from electronic patient records registered by GPs. Databases were linked using a probabilistic record linkage technology. Results Through record linkage of the NCR and the GP Database, we have established a large population‐based cohort (NCR‐PHARMO GP cohort) of 135,868 cancer patients. Data are available on demographics, tumour characteristics, primary health care use before and after cancer diagnosis including medication use, medical conditions, laboratory tests, and referrals. Data can be used for a number of different studies, for example, to study the diagnostic pathway in the primary care setting in order to identify possibilities for early recognition. Conclusion The NCR‐PHARMO GP cohort provides rich data on the primary care management of cancer facilitating large‐scale observational cancer research in the primary care setting. The patient‐level linkage allows for long‐term follow‐up of cancer patients, with ongoing annual updates.
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Affiliation(s)
- Josephina G Kuiper
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron M C Herings
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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21
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Jessen NH, Jensen H, Helsper CW, Falborg AZ, Glerup H, Gronbaek H, Vedsted P. Cancer suspicion, referral to cancer patient pathway and primary care interval: a survey and register study exploring 10 different types of abdominal cancer. Fam Pract 2021; 38:589-597. [PMID: 33904928 DOI: 10.1093/fampra/cmab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Abdominal cancers represent 30% of all diagnosed cancers. Nevertheless, it is unknown if the general practitioner's (GP's) initial cancer suspicion varies for different abdominal cancer types and how this is associated with referrals to standardized cancer patient pathways (CPPs). OBJECTIVES To explore initial cancer suspicion in GPs and to investigate how this was associated with GP referrals to CPPs and the duration of the primary care interval (PCI) in 10 different abdominal cancer types. METHODS We conducted a cohort study on 1104 incident abdominal cancer patients diagnosed in Denmark in 2016 using a combination of survey and register-based data. Poisson regression was used to estimate associations between GP cancer suspicion, CPP referral and PCI duration. RESULTS The GPs initially suspected cancer or other serious disease in 46-78% of cases, lowest in kidney cancer, and referred 35-65% to a CPP, lowest in oesophageal cancer. The GP's suspicion at the first presentation was strongly associated with referral to a CPP. The median (0-11 days) and 75th percentile (3-32 days) PCIs varied between the abdominal cancer types. The likelihood of a long PCI was more than 3-fold higher when the GP did not initially suspect cancer. CONCLUSION In up to half of abdominal cancer patients, there is no initial suspicion of cancer or serious disease. CPPs were used in only one-third to two-thirds of patients, depending on cancer type. For kidney cancer, as well as several abdominal cancers, we need better diagnostic strategies to support GPs to enable effective and efficient referral.
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Affiliation(s)
- Nanna H Jessen
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus, Denmark
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alina Z Falborg
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus, Denmark
| | - Henning Glerup
- Diagnostic Center, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
| | - Henning Gronbaek
- Department of Clinical Medicine-Hepatology and Gastroenterology, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Aarhus, Denmark.,Diagnostic Center, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
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22
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Kuiper JG, van Herk-Sukel MPP, Lemmens VEPP, Kuipers EJ, Herings RMC. A steep increase in healthcare seeking behaviour in the last months before colorectal cancer diagnosis. BMC FAMILY PRACTICE 2021; 22:121. [PMID: 34154545 PMCID: PMC8218384 DOI: 10.1186/s12875-021-01482-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022]
Abstract
Background Timely recognition of colorectal cancer related symptoms is essential to reduce time to diagnosis. This study aims to investigate the primary healthcare use preceding a colorectal cancer diagnosis. Methods From a cohort of linked cancer and primary care data, patients diagnosed with primary colorectal cancer in the period 2007–2014 were selected and matched to cancer-free controls on gender, birth year, GP practice and follow-up period. Primary healthcare use among colorectal cancer cases before diagnosis was compared with matched cancer-free controls. Mean monthly number of GP consultations and newly prescribed medication was assessed in the year before index date (diagnosis date for cases). Results were stratified by colorectal cancer site: proximal colon cancer, distal colon cancer and rectal cancer. Results A total of 6,087 colorectal cancer cases could be matched to four cancer-free controls (N = 24,348). While mean monthly number of GP consultation were stable through the year among cancer-free controls, a statistical significant increase was seen among colorectal cancer cases in the last 4–8 months before diagnosis. Proximal colon cancer cases showed the longest time interval of increased mean monthly number of GP consultations. This increase was largely driven by a consultation for malignant neoplasm colon/rectum. The number patients receiving a newly prescribed medication was stable around 120 per 1,000 persons per month until 8 months before index date for proximal colon cancer cases, 4 months before index date for distal colon cancer cases and 3 months for rectal cancer cases. This increase was mainly driven by the prescription of laxatives drugs. Conclusion An increase in the healthcare seeking behaviour of colorectal cancer patients prior to diagnosis was seen. The longest period of increased GP consultations and newly prescribed medication was seen among patients diagnosed with proximal colon cancer. This can be explained by the difficultly to diagnose proximal colon cancer given the more subtle signs compared to distal colon cancer and rectal cancer. Therefore, faster diagnosis for this specific tumour subtype may only be possible when clear clinical signs and symptoms are present.
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Affiliation(s)
- Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands. .,Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands.,Department of Epidemiology & Data Science, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
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23
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Drabbe C, Grünhagen DJ, Van Houdt WJ, Braam PM, Soomers VLMN, Van der Hage JA, De Haan JJ, Keymeulen KBMI, Husson O, Van der Graaf WTA. Diagnosed with a Rare Cancer: Experiences of Adult Sarcoma Survivors with the Healthcare System-Results from the SURVSARC Study. Cancers (Basel) 2021; 13:cancers13040679. [PMID: 33567553 PMCID: PMC7914609 DOI: 10.3390/cancers13040679] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Patients with rare cancers face obstacles including delays in diagnosis, inadequate treatments and limited scientific evidence to guide decision making. These obstacles may have a unique impact on their experience with the healthcare system and might be different at various ages. Some aspects of care that shape the experience with the healthcare system include information needs, satisfaction with care and supportive care. Very little is known about these aspects of care, specifically for rare cancer patients. Sarcomas are prime examples of rare cancers and are diagnosed at all ages. In this study, we explored the experience of sarcoma patients (N = 1099) with the healthcare system and looked into detail at whether differences in experience existed between age groups. The results of this nationwide study showed that healthcare experiences differ per age group and we identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals. Abstract The aim of this study was to explore the experience of rare cancer patients with the healthcare system and examine differences between age groups (adolescents and young adults (AYA, 18–39 years), older adults (OA, 40–69 years) and elderly (≥70 years)). Dutch sarcoma patients, 2–10 years after diagnosis, completed a questionnaire on their experience with the healthcare system, satisfaction with care, information needs, patient and diagnostic intervals (first symptom to first doctor’s visit and first doctor’s visit to diagnosis, respectively) and received supportive care. In total, 1099 patients completed the questionnaire (response rate 58%): 186 AYAs, 748 OAs and 165 elderly. Many survivors experienced insufficient medical and non-medical guidance (32% and 38%), although satisfaction with care was rated good to excellent by 94%. Both patient and diagnostic intervals were >1 month for over half of the participants and information needs were largely met (97%). AYAs had the longest patient and diagnostic intervals, experienced the greatest lack of (non-)medical guidance, had more desire for patient support groups and used supportive care most often. This nationwide study among sarcoma survivors showed that healthcare experiences differ per age group and identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals.
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Affiliation(s)
- Cas Drabbe
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Winan J. Van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - Pètra M. Braam
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Vicky L. M. N. Soomers
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Jos A. Van der Hage
- Department of Surgical Oncology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands;
| | - Jacco J. De Haan
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Kristien B. M. I. Keymeulen
- Department of Surgical Oncology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, UK
- Correspondence:
| | - Winette T. A. Van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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24
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Schoonbeek RC, de Vries J, Bras L, Plaat BEC, van Dijk BAC, Halmos GB. Determinants of delay in the head and neck oncology care pathway: The next step in value-based health care. Eur J Cancer Care (Engl) 2021; 30:e13419. [PMID: 33555121 PMCID: PMC8365688 DOI: 10.1111/ecc.13419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/30/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
Objective Head and neck squamous cell carcinomas (HNSCC) are relatively fast‐growing tumours, and delay of treatment is associated with tumour progression and adverse outcomes. The aim of this study is to identify determinants of delay in a head and neck oncology centre. Methods This cohort study with prospectively collected data investigated associations between patient (including geriatric assessment at first consultation), tumour and treatment characteristics and treatment delay. Two quality indicator intervals assessing value‐based healthcare were studied: care pathway interval (CPI, interval between first visit in an HNOC and treatment initiation) and time‐to‐treatment initiation (TTI, interval between histopathological confirmation of HNSCC and treatment initiation), using regression analyses. Results Stage‐IV tumours and initial radiotherapy were independent predictors of delay in CPI. Initial radiotherapy was associated with delay in TTI. Overall, 37% of the patients started treatment within 30 days after first consultation (67% in case of initial surgical treatment and 11.5% if treated with (chemo)radiation, p < 0.001). Geriatric assessment outcomes were not associated with delay. Indicators for delay in initial surgery patients were stage‐IV tumours (CPI). Conclusion The majority of HNSCC patients encounter delay in treatment initiation, specifically in patients with advanced‐stage tumours or when radiotherapy is indicated.
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Affiliation(s)
- Rosanne C Schoonbeek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Julius de Vries
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Linda Bras
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL, Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rittitit A, Promthet S, Suwanrungruang K, Jenwitheesuk K, Santong C, Vatanasapt P. Factors Associated with Time Intervals for Diagnosis of Colorectal Cancer: A Hospital Based Study in Khon Kaen, Thailand. Asian Pac J Cancer Prev 2020; 21:1835-1840. [PMID: 32592385 PMCID: PMC7568870 DOI: 10.31557/apjcp.2020.21.6.1835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Colorectal cancer (CRC) is among the five-leading cancers in Thailand. Delayed diagnosis is crucial for undermining the prognosis of the patients. This study aims to evaluate the factors associated with the time interval for diagnosis (TID). Methods: A cross-sectional analytical study of 191 CRC patients with histological confirmation who were undergoing treatment in the tertiary hospital in Khon Kaen Province was conducted. The data were obtained by interview and retrieving from medical records. The time interval in each diagnostic process is reported in geometric mean. The geometric mean ratio (GMR) used to interpret the results from multiple linear regressions that analyze the relationship between factors and log-transformed TID. Results: Most patients were males (61.78%) with mean age of 61.28±10.2 years old. The geometric mean of TID was 263.48 days. Two factors were significantly associated with longer TID: first visit at a tertiary hospital (GMR=7.77 relative to secondary hospital; 95%CI=1.95 to 30.57) and distance to tertiary healthcare. Two factors were significantly associated with shorter TID: officer/ state enterprise (GMR=0.53 relative to agriculture; 95%CI=0.28 to 0.98) and cost of traveling to secondary healthcare. Conclusions: The results showed the occupation, first health care visit, distance and cost were factors associated with TID. Improving the facilities at the secondary healthcare units for diagnosing CRC would be likely to help to reduce the wasted time in the healthcare system.
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Affiliation(s)
- Attapong Rittitit
- Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Supannee Promthet
- ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Krittika Suwanrungruang
- ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chalongpon Santong
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patravoot Vatanasapt
- ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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26
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van Erp NF, Helsper CW, Slottje P, Brandenbarg D, Büchner FL, van Asselt KM, Muris JWM, Kortekaas MF, Peeters PHM, de Wit NJ. Time to diagnosis of symptomatic gastric and oesophageal cancer in the Netherlands: Where is the room for improvement? United European Gastroenterol J 2020; 8:607-620. [PMID: 32250202 PMCID: PMC7268938 DOI: 10.1177/2050640620917804] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An efficient diagnostic pathway and early stage diagnosis for cancer patients is widely pursued. This study aims to chart the duration of the diagnostic pathway for patients with symptomatic oesophageal and gastric cancer, to identify factors associated with long duration and to assess the association of duration with tumour stage at diagnosis. METHODS This was a retrospective cohort study, using electronic health records of six routine primary care databases covering about 640,000 patients, partly linked to the Netherlands Cancer Registry. Symptomatic patients with oesophageal and gastric cancer (2010-2015) that presented in primary care were included. Duration of four diagnostic intervals was determined: patient interval; first symptoms to primary care consultation, primary care interval; consultation to referral, secondary care interval; referral to diagnosis, and the diagnostic interval; consultation to diagnosis. Characteristics associated with 'long duration' (≥P75 duration) were assessed using log-binomial regression. Median durations were stratified for tumour stages. RESULTS Among 312 symptomatic patients with upper gastrointestinal cancer, median durations were: patient interval: 29 days (interquartile interval 15-73), primary care interval: 12 days (interquartile interval 1-43), secondary care interval: 13 days (interquartile interval 6-29) and diagnostic interval: 31 days (11-74). Patient interval duration was comparable for patients with and without alarm symptoms. Absence of cancer-specific alarm symptoms was associated with 'long duration' of primary care interval and secondary care interval: relative risk 5.0 (95% confidence interval 2.7-9.1) and 2.1 (95% confidence interval 1.3-3.7), respectively. Median diagnostic interval duration for local stage disease was 51 days (interquartile interval 13-135) versus 27 days (interquartile interval 11-71) for advanced stage (p = 0.07). CONCLUSION In the diagnostic pathway of upper gastrointestinal cancers, the longest interval is the patient interval. Reducing time to diagnosis may be achieved by improving patients' awareness of alarm symptoms and by diagnostic strategies which better identify cancer patients despite low suspicion.
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Affiliation(s)
- NF van Erp
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - CW Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - P Slottje
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | - D Brandenbarg
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, the Netherlands
| | - FL Büchner
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - KM van Asselt
- Department of General Practice, Amsterdam UMC, Amsterdam, the Netherlands
| | - JWM Muris
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - MF Kortekaas
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - PHM Peeters
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - NJ de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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27
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Dominiak A, Chełstowska B, Olejarz W, Nowicka G. Communication in the Cancer Microenvironment as a Target for Therapeutic Interventions. Cancers (Basel) 2020; 12:E1232. [PMID: 32422889 PMCID: PMC7281160 DOI: 10.3390/cancers12051232] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
The tumor microenvironment (TME) is a complex system composed of multiple cells, such as non-cancerous fibroblasts, adipocytes, immune and vascular cells, as well as signal molecules and mediators. Tumor cells recruit and reprogram other cells to produce factors that maintain tumor growth. Communication between cancerous and surrounding cells is a two-way process and engages a diverse range of mechanisms that, in consequence, can lead to rapid proliferation, metastasis, and drug resistance, or can serve as a tumors-suppressor, e.g., through tumor-immune cell interaction. Cross-talk within the cancer microenvironment can be direct by cell-to-cell contact via adhesion molecules, electrical coupling, and passage through gap junctions, or indirect through classical paracrine signaling by cytokines, growth factors, and extracellular vesicles. Therapeutic approaches for modulation of cell-cell communication may be a promising strategy to combat tumors. In particular, integrative approaches targeting tumor communication in combination with conventional chemotherapy seem reasonable. Currently, special attention is paid to suppressing the formation of open-ended channels as well as blocking exosome production or ablating their cargos. However, many aspects of cell-to-cell communication have yet to be clarified, and, in particular, more work is needed in regard to mechanisms of bidirectional signal transfer. Finally, it seems that some interactions in TEM can be not only cancer-specific, but also patient-specific, and their recognition would help to predict patient response to therapy.
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Affiliation(s)
- Agnieszka Dominiak
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland; (W.O.); (G.N.)
- Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Beata Chełstowska
- Department of Internal Medicine and Hematology, Laboratory of Hematology and Flow Cytometry, Military Institute of Medicine, 04-140 Warsaw, Poland;
| | - Wioletta Olejarz
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland; (W.O.); (G.N.)
- Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Grażyna Nowicka
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland; (W.O.); (G.N.)
- Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
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28
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Pattamatta M, Smeets BJJ, Evers SMAA, Peters EG, Luyer MDP, Hiligsmann M. Quality of life and costs of patients prior to colorectal surgery. Expert Rev Pharmacoecon Outcomes Res 2020; 20:193-198. [PMID: 31190575 DOI: 10.1080/14737167.2019.1628641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/04/2019] [Indexed: 11/12/2022]
Abstract
Objective: To assess the quality of life and societal costs of patients prior to colorectal surgery in the Netherlands.Methods: This study is embedded in a previous randomized controlled trial (SANICS II). The quality of life was measured using EQ-5D-5L questionnaires. The iMTA medical consumption questionnaire (iMCQ) and the iMTA productivity costs questionnaire (iPCQ) were used to identify and measure healthcare and productivity costs. Subgroup analyses were performed based on age and gender.Results: A total of 178 patients were included in the cost analysis and a total of 161 patients in the quality of life analysis. The three-month mean societal cost per patient amounted to €3,211 of which €1,459 was due to productivity losses. The mean utility was 0.88 per patient. Gender was an important predictor in quality of life with men scoring significantly higher than women (0.92 versus 0.82) at p < 0.0001.Conclusion: Colorectal cancer represents a high economic burden in the Netherlands. Further research with repeated cost and quality of life measurements would be needed to explore the change over time and the effects of surgery.
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Affiliation(s)
- M Pattamatta
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - B J J Smeets
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- GROW school of oncology and developmental biology, Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Center for Economic Evaluations, Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - E G Peters
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Tytgat Institute of Liver and Intestinal Research, University of Amsterdam, Amsterdam, The Netherlands
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Menon U, Vedsted P, Zalounina Falborg A, Jensen H, Harrison S, Reguilon I, Barisic A, Bergin RJ, Brewster DH, Butler J, Brustugun OT, Bucher O, Cairnduff V, Gavin A, Grunfeld E, Harland E, Kalsi J, Knudsen AK, Lambe M, Law RJ, Lin Y, Malmberg M, Turner D, Neal RD, White V, Weller D. Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP). BMJ Open 2019; 9:e025895. [PMID: 31776134 PMCID: PMC6886977 DOI: 10.1136/bmjopen-2018-025895] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Differences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer. DESIGN Newly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity. PARTICIPANTS Consecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS. PRIMARY AND SECONDARY OUTCOME MEASURES Interval lengths (days; primary), routes to diagnosis and symptoms (secondary). RESULTS With the exception of Denmark (-49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012-2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (-11 days) than Wales (20 days); Sweden had shorter (-20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (-13), Manitoba (-11), England (-9) and Northern Ireland (-4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%. CONCLUSION There are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.
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Affiliation(s)
- Usha Menon
- Institute for Women's Health, University College London, London, UK
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Henry Jensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | | | - Andriana Barisic
- Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Rebecca J Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - David H Brewster
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK
- Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | | | | | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Victoria Cairnduff
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Eva Grunfeld
- Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Elizabeth Harland
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mats Lambe
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Regional Oncologic Center, University Hospital, Uppsala, Sweden
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Yulan Lin
- European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Malmberg
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Donna Turner
- Population Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
- Academic Unit of Primary Care, University of Leeds, Leeds, UK
| | - Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - David Weller
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK
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30
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van Erp NF, Helsper CW, Olyhoek SM, Janssen RRT, Winsveen A, Peeters PHM, de Wit NJ. Potential for Reducing Time to Referral for Colorectal Cancer Patients in Primary Care. Ann Fam Med 2019; 17:419-427. [PMID: 31501203 PMCID: PMC7032917 DOI: 10.1370/afm.2446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE An optimal diagnostic process in primary care is pivotal for reducing cancer-related disease burden. This study aims to explore reasons for long times to referral for Dutch colorectal cancer (CRC) patients in primary care. METHODS A retrospective cohort study of anonymized free-text primary care records from the Julius General Practitioners' Network database, linked to the Netherlands Cancer Registry. Patients with a confirmed CRC diagnosis from 2007 through 2011 that symptomatically presented in primary care were included. Median time and interquartile ranges from presentation in primary care to referral were calculated for multiple patient and presentation characteristics. Associations of these characteristics with long time to referral (75th percentile was ≥59 days) were examined with log-binomial regression analyses. Routes to referral of patients with the longest times to referral were explored using thematic free-text analyses (90th percentile at ≥219 days). RESULTS Among the 309 people with CRC, patients who were female, did not have a registered family history, had a history of malignancy, lacked alarm symptoms at presentation, or had hemorrhoids at physical examination were at risk for longer time to referral in univariable analyses (longer median durations and/or univariable association with the 75th percentile). Only presentation without alarm symptoms showed a statistically significant association with long duration (75th percentile) in multivariable analysis (relative risk = 1.7; 95% CI, 1.1-2.6). Thematic exploration of the diagnostic routes to referral of patients with the longest durations (90th percentile) showed 2 dominating themes: "alternative working diagnosis" and "suboptimal diagnostic strategies," and included the sub-themes "omitting to reconsider an initial diagnosis" and "lacking follow-up." CONCLUSIONS Long time to referral for CRC in primary care is mainly related to low cancer suspicion. There is potential for reducing the longest times to referral for patients with CRC in primary care, with earlier reconsideration of the initial hypothesis and implementation of strict follow-up consultations.
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Affiliation(s)
- Nicole F van Erp
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Olyhoek
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ramon R T Janssen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Amber Winsveen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Tørring ML, Falborg AZ, Jensen H, Neal RD, Weller D, Reguilon I, Menon U, Vedsted P, Almberg SS, Anandan C, Barisic A, Boylan J, Cairnduff V, Donnelly C, Fourkala EO, Gavin A, Grunfeld E, Hammersley V, Hawryluk B, Kearney T, Kelly J, Knudsen AK, Lambe M, Law R, Lin Y, Malmberg M, Moore K, Turner D, White V. Advanced‐stage cancer and time to diagnosis: An International Cancer Benchmarking Partnership (ICBP) cross‐sectional study. Eur J Cancer Care (Engl) 2019; 28:e13100. [DOI: 10.1111/ecc.13100] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/17/2019] [Accepted: 05/01/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Marie L. Tørring
- Department of Anthropology, School of Culture and Society Aarhus University Højbjerg Denmark
| | - Alina Z. Falborg
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care Aarhus C Denmark
| | - Henry Jensen
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care Aarhus C Denmark
| | - Richard D. Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences University of Leeds Leeds UK
| | - David Weller
- Centre for Population Health Sciences University of Edinburgh Edinburgh UK
| | | | - Usha Menon
- Gynaecological Cancer Research Centre, Institute for Women's Health University College London London UK
| | - Peter Vedsted
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care Aarhus C Denmark
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Variation in the time to treatment for stage III and IV non-small cell lung cancer patients for hospitals in the Netherlands. Lung Cancer 2019; 134:34-41. [PMID: 31319992 DOI: 10.1016/j.lungcan.2019.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Increased emphasis on molecular diagnostics can lead to increased variation in time to treatment (TTT) for patients with stage III and IV non-small cell lung cancer. This article presents the variation in TTT for advanced NSCLC patients observed in Dutch hospitals before the widespread use of immunotherapy. The aim of this article was to explore the variation in TTT between patients, as well as between hospitals. MATERIAL AND METHODS Based on the Netherlands Cancer Registry, we used patient-level data (n = 4096) from all 78 hospitals that diagnosed stage III or IV NSCLC in the Netherlands in 2016. To investigate how patient characteristics and hospital-level effects are associated with TTT (from diagnosis until start treatment), we interpreted regression model results for five common patient profiles to analyze the influence of age, gender, tumor stage, performance status, histology, and referral status as well as hospital-level characteristics on the TTT. RESULTS AND CONCLUSIONS TTT varies substantially between and within hospitals. The median TTT was 28 days with an inter-quartile range of 22 days. The hospital-level median TTT ranges from 17 to 68 days. TTT correlates significantly with tumor stage, performance status, and histology. The hospital-level effect, unrelated to hospital volume and type, affected TTT by several weeks at most. For most patients, TTT is within range as recommended in current guidelines. Variation in TTT seems higher for patients receiving either radiotherapy or targeted therapy, or for patients referred to another hospital and we hypothesize this is related to the complexity of the diagnostic pathway. With further advances in molecular diagnostics and precision oncology we expect variation in TTT to increase and this needs to be considered in designing optimal cancer care delivery.
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Lung cancer patients' journey from first symptom to treatment: Results from a Greek registry. Cancer Epidemiol 2019; 60:193-200. [PMID: 31063908 DOI: 10.1016/j.canep.2019.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/19/2019] [Accepted: 04/26/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND To map the patients' journey from symptoms onset to treatment initiation for the most frequent histological types of lung cancer in Greece and describe the initial treatment that patients receive. METHODS The primary data source was a Greek hospital-based registry. Demographic, anthropometric, lifestyle, and diagnostic-related characteristics as well as treatment-related data were extracted from the registry for patients diagnosed with Adenocarcinoma, Squamous and Small Cell Lung Cancer (SCLC). The time intervals from symptoms onset to diagnosis (StD), diagnosis to treatment initiation (DtT), symptoms onset to treatment initiation (StT) and surgery to post-surgery treatment (SRGtT) were estimated. RESULTS 231, 120 and 122 patients were diagnosed with Adenocarcinoma, SCLC and Squamous, respectively. The percentage of patients diagnosed at stage III/IV ranged from 75% in Adenocarcinoma to 97.5% in SCLC (p < 0.001). The median (IQR) StD was 52 (28-104) days and no difference was detected across the three histological types (p = 0.301). Cough as first symptom was the only determinant of StD (p = 0.001). The median (IQR) DtT was 23 (13-36) days, with this time interval being shorter among patients with SCLC compared to patients with Adenocarcinoma and Squamous (p < 0.001). The median (IQR) StT was 81 (51-139) days. Almost one third of patients with Adenocarcinoma and Squamous were subjected first to surgery and the median (IQR) SRGtT was 42 (34-55) days. CONCLUSIONS Our results indicate that time interval from symptoms onset to treatment initiation in Greece is substantially prolonged, highlighting the need for strategies to expedite lung cancer diagnosis and access to evidence-based treatment.
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Chu G, Versteeg HH, Verschoor AJ, Trines SA, Hemels MEW, Ay C, Huisman MV, Klok FA. Atrial fibrillation and cancer - An unexplored field in cardiovascular oncology. Blood Rev 2019; 35:59-67. [PMID: 30928168 DOI: 10.1016/j.blre.2019.03.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 12/28/2022]
Abstract
An increasing body of evidence suggests an association between cancer and atrial fibrillation (AF). The exact magnitude and underlying mechanism of this association are however unclear. Cancer-related inflammation, anti-cancer treatment and other cancer-related comorbidities are proposed to affect atrial remodelling, increasing the susceptibility of cancer patients for developing AF. Moreover, cancer is assumed to modify the risk of thromboembolisms and bleeding. A thorough and adequate understanding of these risks is however lacking, as current literature is scarce and show ambiguous results in AF patients. The standardized risk-models that normally aid the clinician in the decision of initiating anticoagulant therapy do not take the presence of malignancy into account. Other factors that complicate risk assessment in AF patients with cancer include drug-drug interactions and other cancer-related comorbidities such as renal impairment. In this review, we highlight the available literature regarding epidemiological association, risk assessment and anticoagulation therapy in AF patients with cancer.
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Affiliation(s)
- Gordon Chu
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, the Netherlands.
| | - Henri H Versteeg
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, the Netherlands
| | - Arie J Verschoor
- Department of Medical Oncology, Leiden University Medical Centre, the Netherlands
| | - Serge A Trines
- Department of Cardiology, Heart-Lung Centre, Leiden University Medical Centre, the Netherlands
| | - Martin E W Hemels
- Department of Cardiology, Rijnstate, Arnhem, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Menno V Huisman
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, the Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, the Netherlands
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Li X, Shi L, Li L, Dong C, Li CZ, Shuang S. Recent Advances in Carbon Nanodots: Properties and Applications in Cancer Diagnosis and Treatment. JOURNAL OF ANALYSIS AND TESTING 2019. [DOI: 10.1007/s41664-019-00089-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Osowiecka K, Nawrocki S, Kurowicki M, Rucinska M. The Waiting Time of Prostate Cancer Patients in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030342. [PMID: 30691113 PMCID: PMC6388381 DOI: 10.3390/ijerph16030342] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 12/24/2022]
Abstract
Background: Prostate cancer is the second most common reason of mortality due to cancer among men in Poland. The study aimed to determine the waiting time for diagnosis and treatment of prostate cancer. Methods: The study was carried out on patients treated for prostate cancer from May 2014 to February 2015 at five oncological centres in Poland. The median waiting time was measured from the time cancer was suspected to the histopathological diagnosis (SDI), from the cancer suspicion to the start of treatment (STI) and from the diagnosis to the start of treatment (DTI). Results: 123 males treated for prostate cancer were included for analysis. The median time for SDI, STI and DTI was 7.7, 18.7 and 8.7 weeks, respectively. Place of residence was the only factor which influenced STI (p = 0.003). For patients, who started treatment with radiation therapy DTI was longer than for other patients (p < 0.001). Conclusions: Median times of STI, SDI and DTI for prostate cancer patients in Poland are similar to the intervals described in other countries. Patients, who lived further from an oncology centre waited longer for treatment. The impact of waiting time in the case of prostate cancer on improving the prognosis is still unclear.
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Affiliation(s)
- Karolina Osowiecka
- Department of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Al. Warszawska 30, Poland.
- Department of Public Health, Medical University of Warsaw, 02-097 Warszawa, Ul. Nielubowicza 5, Poland.
- Radiotherapy Center Nu-Med, 82-300 Elblag, Ul. Królewiecka 146, Poland.
| | - Sergiusz Nawrocki
- Radiotherapy Center Nu-Med, 82-300 Elblag, Ul. Królewiecka 146, Poland.
- Department of Oncology and Radiotherapy, Medical University of Silesia in Katowice, 40-515 Katowice, Ul. Ceglana 35, Poland.
| | - Marcin Kurowicki
- Radiotherapy Center Nu-Med, 82-300 Elblag, Ul. Królewiecka 146, Poland.
| | - Monika Rucinska
- Department of Oncology, Collegium Medicum, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-228 Olsztyn, Al. Wojska Polskiego 37, Poland.
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Szanto Z, Furak J, Falcoz PE, Brunelli A, Lang G. A country wide adaptation of the European Society of Thoracic Surgeons lung cancer core database: the Hungarian model. J Thorac Dis 2018; 10:S3467-S3471. [PMID: 30510781 DOI: 10.21037/jtd.2018.04.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Registering details of thoracic surgical activity has a long tradition in Hungary. Implemented first as a procedure based register, characteristics of the treatment, complications and outcomes has been noted for the last three decades. Although the limitations of the used database hindered the scientific analysis in the dataset and restricted the possibility of benchmarking. The European Society of Thoracic Surgeons (ESTS) database is offering a specialty-specific, procedure-specific, web-based electronic database for data contribution enabling international comparisons. Our aim was to accommodate and implement the ESTS database as the new Hungarian national thoracic surgical registry. Methods In 2014, cooperation of the ESTS Database Committee and the Hungarian Society of Thoracic Surgery evolved a new structure for contributing national thoracic surgical data, called the ESTS database "Hungarian model". The European dataset was translated into Hungarian, extended questionnaire and continuous data access helped the completion of the dataset. The "Hungarian model" was incorporated into the common practice of all the thoracic surgical centers in Hungary. Results In the first year of its implementation the "Hungarian model" of the ESTS dataset became the platform to use for contributing thoracic surgical data in Hungary. All the data included in the dataset were completed and periodically analyzed to form the annual Hungarian report ("the Hungarian Silver Book"). The dataset is permanently accessible for national scientific analysis and serves as a basis for quality improvement intentions. Conclusions The Hungarian model proved to be able to serve as a national database. The complete dataset of the thoracic activity has become eligible for scientific analysis and international benchmarking, highlighting the most important core messages of the ESTS database project of improving quality and patient safety thoracic surgeons. By creating a framework for a national registry the system is incorporating an alternative for other thoracic surgical societies.
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Affiliation(s)
- Zalan Szanto
- Department of Surgery, University of Pécs, Pécs, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | | | - Gyoergy Lang
- Department of Thoracic Surgery, Semmelweis University, Budapest, Hungary
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Dela R, Dubas-Jakóbczyk K, Kocot E, Sowada C. Improving oncological care organization in Poland-The 2015 reform evaluation in the context of European experiences. Int J Health Plann Manage 2018; 34:e100-e110. [PMID: 30187528 DOI: 10.1002/hpm.2635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
Cancer is one of the leading causes of morbidity and mortality worldwide with a significant economic impact which has been increasing in recent decades. Numerous expert groups and/or international organizations have developed guidelines on how to build effective cancer control mechanisms, while in the European Union the majority of countries have developed national programmes. In Poland, cancer is the second leading cause of death. Compared with other European countries, Poland is characterized by a relatively low cancer incidence ratio, yet in terms of mortality and survival ratios, the situation is much worse than the average. On 1 January 2015, an oncological therapy fast track was implemented in Poland, popularly known as the "oncological package." Its formal objectives were to improve access to and systemize the process of cancer diagnostics and treatment. The reform introduced some of the solutions existing in other European countries, including waiting time limits, patient pathways, multidisciplinary medical consultations, and a care coordinator position. The preliminary evaluation analyses suggest that after the reform implementation the average waiting time for diagnostics and treatment for patients covered by the new system was significantly shortened in comparison to those excluded. Further research evaluating the reform impact on quality and/or comprehensiveness of care are needed.
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Affiliation(s)
- Roksana Dela
- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Christoph Sowada
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Bergin RJ, Emery J, Bollard RC, Falborg AZ, Jensen H, Weller D, Menon U, Vedsted P, Thomas RJ, Whitfield K, White V. Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:1036-1046. [DOI: 10.1158/1055-9965.epi-18-0210] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/10/2018] [Accepted: 06/26/2018] [Indexed: 11/16/2022] Open
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