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Aglietta M, Rossana B, Biasco G, Bossi P, Gentili M, Giacomelli L, Lanzetta G, Marinangeli F, Tonini G, Vellucci R. Are we doing enough to treat cancer pain? The urgent need for action in oncology practice. Future Oncol 2025:1-3. [PMID: 40333362 DOI: 10.1080/14796694.2025.2501522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 04/30/2025] [Indexed: 05/09/2025] Open
Affiliation(s)
| | - Berardi Rossana
- Department of Medical Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Guido Biasco
- Medical Oncology, Alma Mater University of Bologna, Bologna, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Gentili
- Research Biology Private Practice, Milan, Milan, Italy
| | | | - Gaetano Lanzetta
- Department of Medical Oncology and Palliative Care, Casa di Cura INI, Grottaferrata, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Pain Treatment & Palliative Care, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Tonini
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Renato Vellucci
- Pain and Palliative Care Clinic, University of Florence, Florence, Italy
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Klein EA, Church TR, Clarke CA, Hubbell E. Modeled Benefit of Individual Cancer Signal Origin Prediction for Multi-Cancer Early Detection. CANCER RESEARCH COMMUNICATIONS 2025; 5:814-824. [PMID: 40323021 PMCID: PMC12087281 DOI: 10.1158/2767-9764.crc-24-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 02/14/2025] [Accepted: 04/30/2025] [Indexed: 05/20/2025]
Abstract
Multi-cancer early detection (MCED) tests may detect a broad spectrum of cancer types, including uncommon types that lack recommended screening. After a cancer signal is detected by an MCED test, some diagnostic process must definitively confirm the patient's cancer status. A commercially available blood-based MCED test detects a cancer signal and then predicts an anatomic location, a cancer signal origin (CSO), to guide the diagnostic process. We extended a preexisting model for MCED cancer screening, adding predicted CSO categories and a simple model of the diagnostic chain. We then predicted outcomes of the diagnostic chain for each predicted CSO and in populations with differing clinical risk factors. Typical positive predictive values were>40%, and using a minimal sufficient level of positive predictive value (>7%), (i) diagnostic workup based on any CSO was generally warranted, and (ii) continued workup for cancers in locations other than the CSO was justifiable. The benefit of prediction-directed workups was also observed via estimated clinical utility metrics, such as lives saved per diagnostic test, and remained applicable in populations with varying cancer risk, such as lung cancer prediction-directed workups in never-smokers. CSO predictions may enable most true-positive cases to be resolved by short and efficient diagnostic processes. The model predicted a large enough conditional benefit to warrant diagnostic workup based on any CSO prediction from an MCED test, assuming late-stage reduction by MCED leads to mortality reduction, which remains to be demonstrated. SIGNIFICANCE MCED tests may detect a signal from many cancers. Predicting an anatomic location from which the cancer signal may originate allows effective, usual diagnostic workup. In this study, we show that these predictions are beneficial to physicians choosing a diagnostic path, even for uncommon cancer types and among populations with differing cancer risks.
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Affiliation(s)
| | - Timothy R. Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Chima S, Martinez-Gutierrez J, Hunter B, Laughlin A, Chondros P, Lumsden N, Boyle D, Nelson C, Amores P, Tran-Duy A, Manski-Nankervis JA, Emery J. Future Health Today and patients at risk of undiagnosed cancer: a pragmatic cluster randomised trial of quality- improvement activities in general practice. Br J Gen Pract 2025; 75:e306-e315. [PMID: 39567181 PMCID: PMC12010534 DOI: 10.3399/bjgp.2024.0491] [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: 08/05/2024] [Accepted: 11/04/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses. AIM This trial aimed to evaluate the effectiveness of Future Health Today (FHT) - a technology that provides clinical decision support, auditing, and quality-improvement monitoring - on the appropriate follow-up of patients at risk of undiagnosed cancer. DESIGN AND SETTING Pragmatic, cluster randomised trial undertaken in general practices in Victoria and Tasmania, Australia. METHOD Practices were randomly assigned to receive recommendations for follow-up investigations for cancer (FHT cancer module) or the active control. Algorithms were applied to the electronic medical record, and used demographic information and abnormal test results that are associated with a risk of undiagnosed cancer (that is, anaemia/iron deficiency, thrombocytosis, and raised prostate-specific antigen) to identify patients requiring further investigation and provide recommendations for care. The intervention consisted of the FHT cancer module, a case-based learning series, and ongoing practice support. Using the intention-to-treat approach, the between-arm difference in the proportion of patients with abnormal test results who were followed up according to guidelines was determined at 12 months. RESULTS In total, 7555 patients were identified as at risk of undiagnosed cancer. At 12 months post-randomisation, 76.0% of patients in the intervention arm had received recommended follow-up (21 practices, n = 2820/3709), compared with 70.0% in the control arm (19 practices, n = 2693/3846; estimated between-arm difference = 2.6% [95% confidence interval (CI)] = -2.8% to 7.9%; odds ratio = 1.15 [95% CI = 0.87 to 1.53]; P = 0.332). CONCLUSION The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended follow-up was high, suggesting a possible ceiling effect for the intervention.
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Affiliation(s)
- Sophie Chima
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Javiera Martinez-Gutierrez
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia; Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Barbara Hunter
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Adrian Laughlin
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Natalie Lumsden
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia; Western Health Chronic Disease Alliance, Western Health, Sunshine, Australia
| | - Douglas Boyle
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia; Centre for Research Excellence in Interactive Digital Technology to Transform Australia's Chronic Disease Outcomes, Melbourne, Australia
| | - Craig Nelson
- Department of Medicine, Western Health, University of Melbourne, Sunshine, Australia; Department of Nephrology, Western Health, Sunshine, Australia
| | - Paul Amores
- Centre for Health Policy, University of Melbourne, Melbourne, Australia; Methods and Implementation Support for Clinical Health Research Hub, University of Melbourne, Melbourne, Australia
| | - An Tran-Duy
- Centre for Health Policy, University of Melbourne, Melbourne, Australia; Methods and Implementation Support for Clinical Health Research Hub, University of Melbourne, Melbourne, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia; Primary Care and Family Medicine, LKC Medicine, Nanyang Technological University, Singapore
| | - Jon Emery
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia, and Western Health, Sunshine, Australia
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Marcu A, Ream E, Poole K, Armes J, Gibson F, Whittaker L, Harris J. Symptom appraisal and help- seeking before a cancer diagnosis during pregnancy: a qualitative study. Br J Gen Pract 2025; 75:e341-e348. [PMID: 39824622 PMCID: PMC12010531 DOI: 10.3399/bjgp.2024.0208] [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: 04/08/2024] [Accepted: 01/10/2025] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND The estimated incidence of a cancer diagnosis during or shortly after pregnancy is 1 in 1000 pregnancies in England. Pregnancy can have an impact on symptom appraisal and help-seeking for symptoms subsequently diagnosed as cancer. Little is known about the pathway to cancer diagnosis in pregnancy or delays that women can encounter. AIM To explore symptom appraisal, help-seeking decisions, and experience of receiving a cancer diagnosis during pregnancy. DESIGN AND SETTING Semi-structured interviews were conducted with women diagnosed with cancer during or shortly after pregnancy in the previous 4 years in the UK, recruited between January and May 2022 via the charity Mummy's Star. METHOD This study used reflexive thematic analysis of 20 interviews. Analysis was largely inductive and the themes generated were mapped onto the intervals of the Model of Pathways to Treatment. RESULTS Symptoms were often interpreted through the lens of pregnancy by both participants and most of the healthcare professionals from whom they sought help. Participants who found breast lumps were likely to suspect cancer and be referred promptly for tests in secondary care. Although most participants sought timely help for their symptoms, some subsequently encountered health system delays, partly owing to both the vague nature of their symptoms and the COVID-19 pandemic. CONCLUSION Health services need to better support women presenting with possible cancer symptoms during pregnancy to ensure timely diagnosis. Recommendations include prioritising symptoms over attributing them solely to pregnancy, ensuring timely referrals to rule out serious conditions, and emphasising clear communication alongside robust safety-netting practices. A full assessment is essential before dismissing symptoms as pregnancy related.
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Affiliation(s)
- Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford
| | - Karen Poole
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford; director of research, Nursing and Allied Health, Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London
| | | | - Jenny Harris
- School of Health Sciences, University of Surrey, Guildford
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Reincke SM, Espinosa C, Chung P, James T, Berson E, Aghaeepour N. Mitigation of outcome conflation in predicting patient outcomes using electronic health records. J Am Med Inform Assoc 2025; 32:920-927. [PMID: 40056434 PMCID: PMC12012356 DOI: 10.1093/jamia/ocaf033] [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: 10/17/2024] [Revised: 02/04/2025] [Accepted: 02/18/2025] [Indexed: 03/10/2025] Open
Abstract
OBJECTIVES Artificial intelligence (AI) models utilizing electronic health record data for disease prediction can enhance risk stratification but may lack specificity, which is crucial for reducing the economic and psychological burdens associated with false positives. This study aims to evaluate the impact of confounders on the specificity of single-outcome prediction models and assess the effectiveness of a multi-class architecture in mitigating outcome conflation. MATERIALS AND METHODS We evaluated a state-of-the-art model predicting pancreatic cancer from disease code sequences in an independent cohort of 2.3 million patients and compared this single-outcome model with a multi-class model designed to predict multiple cancer types simultaneously. Additionally, we conducted a clinical simulation experiment to investigate the impact of confounders on the specificity of single-outcome prediction models. RESULTS While we were able to independently validate the pancreatic cancer prediction model, we found that its prediction scores were also correlated with ovarian cancer, suggesting conflation of outcomes due to underlying confounders. Building on this observation, we demonstrate that the specificity of single-outcome prediction models is impaired by confounders using a clinical simulation experiment. Introducing a multi-class architecture improves specificity in predicting cancer types compared to the single-outcome model while preserving performance, mitigating the conflation of outcomes in both the real-world and simulated contexts. DISCUSSION Our results highlight the risk of outcome conflation in single-outcome AI prediction models and demonstrate the effectiveness of a multi-class approach in mitigating this issue. CONCLUSION The number of predicted outcomes needs to be carefully considered when employing AI disease risk prediction models.
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Affiliation(s)
- S Momsen Reincke
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, United States
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, United States
| | - Philip Chung
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
| | - Tomin James
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, United States
| | - Eloïse Berson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, United States
- Department of Pathology, Stanford University, Stanford, CA 94305, United States
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, United States
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Roberts K, Cooper N, Webster L, Sharpless B, Round T, Gildea C, Nicholson BD. Characterising the volume and variation of multiple urgent suspected cancer referrals in England, April 2013-March 2018: a national cohort study. BMJ Open 2025; 15:e097180. [PMID: 40204315 PMCID: PMC11979496 DOI: 10.1136/bmjopen-2024-097180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/27/2025] [Indexed: 04/11/2025] Open
Abstract
OBJECTIVES To establish a methodology to categorise urgent suspected cancer (USC) referrals in England and use these categories to understand individual patient referral patterns by demographic characteristics, financial year and referral pathway. DESIGN Cross-sectional population-based cohort study. SETTING From Cancer Waiting Times data, linked to demographic information held by the National Disease Registration Service, referral-level data on all USC referrals in England between 1 April 2013 and 31 March 2018. PARTICIPANTS After restricting records to those with an English postcode at referral and with complete demographic information, 9 524 435 referrals were identified for 7 542 592 patients. PRIMARY AND SECONDARY OUTCOME MEASURES USC referrals were categorised into first and subsequent USC referrals, based primarily on intervals between referral dates. Our primary outcome was to describe the distribution of referral categories by financial year, suspected cancer referral type and four demographic variables. Our secondary aim was to understand which suspected cancer referral types were found in combination within the first 4 months. RESULTS During the study period, 7.5 million people had an USC referral, with one in five having more than one referral, with 9.5 million referrals in total. Referrals were categorised as first (91.1%) and subsequent (8.9%) USC referrals. The relative increase in the number of referrals across the study period was largest (78.2%) for subsequent USC referrals.Subsequent referrals were most common in the gynaecological (10%), lung (10%) and haematological cancer pathways (12%).Suspected lower gastrointestinal referrals were most frequently included in a pair of USC referrals; it was one of the five most common pairings for 14 out of 16 referral type pathways, contributing to 30% of upper gastrointestinal USC referral pairings. CONCLUSION Multiple USC referrals increased in the study period, particularly within a year of the first referral. Common referral pairings suggest opportunities for pathway reorganisation where common non-specific symptoms result in multiple USC referrals.
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Affiliation(s)
- Kirstin Roberts
- National Disease Registration Service, NHS England, Leeds, UK
- Cancer Research UK, London, UK
| | - Nicola Cooper
- National Disease Registration Service, NHS England, Leeds, UK
| | - Laura Webster
- National Disease Registration Service, NHS England, Leeds, UK
| | - Ben Sharpless
- National Disease Registration Service, NHS England, Leeds, UK
- Cancer Research UK, London, UK
| | - Thomas Round
- National Disease Registration Service, NHS England, Leeds, UK
- Population Health Sciences, King's College London, London, UK
| | - Carolynn Gildea
- National Disease Registration Service, NHS England, Leeds, UK
| | - Brian D Nicholson
- Department of Primary Care Health Sciences, University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
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Bautista-González E, Muñoz Rocha TV, Soto-Perez-de-Celis E, Vindrola-Padros C, Peasey A, Pikhart H. Treatment delays in patients with lung cancer: a retrospective study conducted at the National Cancer Institute of Mexico between 2004 and 2021. Oncologist 2025; 30:oyae358. [PMID: 40202013 PMCID: PMC11979458 DOI: 10.1093/oncolo/oyae358] [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: 04/18/2024] [Accepted: 11/14/2024] [Indexed: 04/10/2025] Open
Abstract
IMPORTANCE Lung cancer management involves navigating a complex pathway from symptom onset to treatment initiation, where delays can compromise outcomes. OBJECTIVE To identify the length of treatment intervals among Mexican lung cancer patients, compare treatment intervals to results from other countries, and identify determinants of delays. DESIGN Retrospective study collecting patient records and exploring the treatment interval in lung cancer. SETTING The study was conducted at Mexico's National Cancer Institute. PARTICIPANTS 2645 lung cancer patients with a confirmed diagnosis between 2004 and 2021 were included in the analysis. EXPOSURE Social determinants of health. MAIN OUTCOME Treatment interval (from diagnosis to treatment). RESULTS Logistic regression models revealed significant associations between delays and various factors, including marital status, education, region, first symptom at presentation, treatment type, and political period. A comparison with international guidelines highlighted substantial delays in patients diagnosed at the Instituto Nacional de Cancerología and diagnosed externally. CONCLUSIONS Targeted interventions should consider patient characteristics to enhance care efficiency. Concerns should be raised about the observed increase in treatment intervals from 2014 and the associated impact on survival rates. There is an urgency for timely interventions, continuous research, and collaborative efforts to optimize care delivery and outcomes for lung cancer patients in Mexico.
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Affiliation(s)
- Elysse Bautista-González
- Institute of Epidemiology and Health Care, Research Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, United Kingdom
| | - Teresa Verenice Muñoz Rocha
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Morelos, 62100, Mexico
| | - Enrique Soto-Perez-de-Celis
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Anschutz Cancer Pavilion, 1665 Aurora Ct, Aurora, CO 80045, Estados Unidos
| | - Cecilia Vindrola-Padros
- Division of Surgery & Interventional Science, Department of Targeted Intervention, University College London, London, W1W 7TY, United Kingdom
| | - Anne Peasey
- Institute of Epidemiology and Health Care, Research Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, United Kingdom
| | - Hynek Pikhart
- Institute of Epidemiology and Health Care, Research Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, United Kingdom
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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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Tarburn EL, Iversen L, Robertson C, McShane C, Duncombe A, McMullin MF, Harrison C, Mesa R, Anderson LA. Pathways to myeloproliferative neoplasm presentation and time to diagnosis: results from a cross-sectional study. BJGP Open 2025; 9:BJGPO.2024.0068. [PMID: 39079744 DOI: 10.3399/bjgpo.2024.0068] [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: 03/14/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Early cancer recognition is key to improving patient outcomes. Diagnosis is often delayed in patients with myeloproliferative neoplasms (MPNs), putting them at risk of thromboembolic events and other complications pre-diagnosis. A clear understanding of the barriers to presentation and diagnosis is required. AIM To explore barriers and factors influencing delayed presentation and diagnosis of MPNs. DESIGN & SETTING A cross-sectional study of patients with MPN within the UK and the Republic of Ireland. METHOD An online cross-sectional survey of patients with MPN was undertaken. Symptoms and factors influencing patient and GP delay were examined. Adjusted odds ratios (aORs) were calculated to explore the relationship between these factors and patient and GP delay. RESULTS Most (80.2%) of the 620 patients completing the survey reported symptomatic presentation. The most common symptoms associated with patient delay were pruritus (aOR 1.89, 95% confidence interval [CI] = 1.19 to 3.01), headaches (aOR 1.86, 95% CI = 1.13 to 2.82), and concentration difficulties (aOR 1.75, 95% CI = 1.12 to 2.76). Attributing symptoms to ageing (aOR 1.92, 95% CI = 1.19 to 3.11) and not wanting to burden the GP (2.04, 95% CI = 1.24 to 3.39) were significantly associated with patient delay. Those reporting >3 blood cancer warning signs were more likely to experience GP delay than those experiencing fewer (aOR 3.26, 95% CI = 1.75 to 6.29), and lack of relational continuity of GP care was significantly associated with GP delay (aOR 3.41, 95% CI = 1.65 to 7.28). CONCLUSION Debunking misconceptions around ageing, encouraging timely communication with GPs, and improving relational continuity of GP care could assist in reducing diagnostic delays, prevent potentially fatal disease complications, and ultimately improve outcomes for patients with MPN.
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Affiliation(s)
- Emma-Louise Tarburn
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Lisa Iversen
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Charlene McShane
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Andrew Duncombe
- Haematology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary-Frances McMullin
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Claire Harrison
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruben Mesa
- Atrium Health Levine Cancer Institute, Charlotte, NC, US
| | - Lesley A Anderson
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Elattabi C, Lamchabbek N, Boutayeb S, Belyamani L, Huybrechts I, Faure E, Khalis M. The Impact of Travel Distance on Cancer Stage at Diagnosis for Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:518. [PMID: 40283744 PMCID: PMC12027156 DOI: 10.3390/ijerph22040518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 03/16/2025] [Accepted: 03/17/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Geographic access to healthcare services can impact cancer outcomes. This paper reviews and updates the current evidence and gaps in the literature on the associations between travel distance and cancer stage. METHODS A search of electronic databases (PubMed, SpringerLink, and Science Direct) was conducted to identify studies published between 2015 and 2025. Studies examining the association between travel distance and cancer stage at diagnosis were included in this article. RESULTS From 19,197 studies, 11 articles met the inclusion criteria. In summary, four articles reported significant associations between travel distance/time and cancer stage, while six other articles did not report any association. Significant associations were observed in sub-Saharan Africa. In contrast, studies from Scotland, Canada, and the United States did not show significant relationships, while results from Japan varied, with papers showing either no significant impact of travel distance or indicating a correlation with advanced stages. CONCLUSIONS This study suggests that longer travel distance is associated with advanced cancer stage in countries with healthcare access challenges and highlights the importance of healthcare accessibility in improving early cancer detection.
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Affiliation(s)
- Chaimaa Elattabi
- Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat 10112, Morocco; (N.L.); (S.B.); (L.B.); (M.K.)
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
| | - Najoua Lamchabbek
- Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat 10112, Morocco; (N.L.); (S.B.); (L.B.); (M.K.)
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
| | - Saber Boutayeb
- Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat 10112, Morocco; (N.L.); (S.B.); (L.B.); (M.K.)
| | - Lahcen Belyamani
- Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat 10112, Morocco; (N.L.); (S.B.); (L.B.); (M.K.)
- Faculty of Medicine, Mohammed VI University of Sciences and Health, Casablanca 43150, Morocco
| | - Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, 69366 Lyon, France;
- French Network for Nutrition and Cancer Research (Nacre Network), 78350 Jouy-en-Josas, France
| | - Elodie Faure
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805 Villejuif, France;
| | - Mohamed Khalis
- Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat 10112, Morocco; (N.L.); (S.B.); (L.B.); (M.K.)
- Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
- Higher Institute of Nursing Professions and Health Techniques, Rabat, Ministry of Health and Social Protection, Rabat 10000, Morocco
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11
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Drosdowsky A, Lamb KE, Te Marvelde L, Gibbs P, Dunn C, Faragher I, Jones I, IJzerman MJ, Emery JD. Factors associated with diagnostic and treatment intervals in colorectal cancer: A linked data study. Int J Cancer 2025. [PMID: 40079691 DOI: 10.1002/ijc.35414] [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: 08/20/2024] [Revised: 02/03/2025] [Accepted: 02/18/2025] [Indexed: 03/15/2025]
Abstract
This research aimed to assess the length of intervals before diagnosis and treatment for colorectal cancer in Australia using linked datasets, and to determine any factors associated with interval length. A colorectal cancer clinical registry was linked to general practice electronic medical record data and routinely collected hospital referral datasets to determine the length of four key intervals in the time before first treatment. Cox proportional hazards regression was used to assess associations between individual characteristics (sociodemographic variables such as age and sex, and disease characteristics such as cancer subtype and treatment approach) and the length of each interval. Sample sizes available for analysis varied by interval, ranging from 99 to 9359. The median interval length ranged from 21 (IQR 5-38) days for the time between diagnosis and treatment to 63 (IQR 24-218) days for the time between first presentation and diagnosis. Overall, few measured characteristics were associated with the lengths of any of the intervals. Of note, shorter diagnostic intervals were associated with presenting to the general practitioner with alarm symptoms, and people proceeding to surgery as initial treatment had shorter times to treatment than any other treatment modality. Given disease and medical system factors were associated with interval length, broad improvements to the overall efficient functioning of the healthcare system are likely to improve timeliness. More targeted interventions could focus on processes at the transitions between different levels of the healthcare system and implementing recommended maximum lengths of intervals along the diagnostic and treatment pathway.
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Affiliation(s)
- Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia
| | - Karen E Lamb
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | | | - Peter Gibbs
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Catherine Dunn
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Ian Jones
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Maarten J IJzerman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, Australia
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12
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Zaremba A, Zaremba P, Zahorodnia S. In silico development of HASDI-G2 as a novel agent for selective recognition of the DNA sequence. Sci Rep 2025; 15:8577. [PMID: 40075113 PMCID: PMC11904238 DOI: 10.1038/s41598-025-89967-1] [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: 08/19/2024] [Accepted: 02/10/2025] [Indexed: 03/14/2025] Open
Abstract
Genetic information, which is mostly encoded in the form of DNA sequence, is the basis of life. Its deviations are often the cause of the most deadly diseases such as cancer. Accordingly, the development of methods to control the transcription of certain DNA parts is an important direction of modern pharmacological and biological research. Within the scope of this work, we are investigating the second generation of a polyintercalating agent that we developed earlier, potentially capable of recognizing 16-bp DNA sequences. In order to confirm its ability for advanced selective DNA recognition a series of simulation experiments was conducted. We differentially investigated the stability of HASDI-G2 complexes with mutated targeting sequences and their native variants. Firstly, we confirmed the ability of HASDI-G2 to clearly discriminate the target sequence (EBNA1) from a random site in the human genome (KCNH2). That repeated the experiment of the polyintercalator's previous version and additionally showed better results of the next-generation structure. Next, we examined HASDI-G2 under conditions where the target sequence differed from the random one increasingly slightly. And we found that even a one-nucleotide mismatch leads to a similar complex destabilization as a mismatch of 3 or 4 nucleotides. Such complexes showed significant conformational rearrangements, accompanied by a sharp decrease in the hydrogen bonds quantity, a drop in the binding free energy, and local melting of the DNA duplex. Moreover, the latter applied not only to sites of direct incompatibility, but also to parts where HASDI-G2 fully corresponded to the sequence of intercalation.
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Affiliation(s)
- Andrii Zaremba
- Zabolotny Institute of Microbiology and Virology of NASU, 154 Acad. Zabolotny Str., Kyiv, 03143, Ukraine.
| | - Polina Zaremba
- Zabolotny Institute of Microbiology and Virology of NASU, 154 Acad. Zabolotny Str., Kyiv, 03143, Ukraine
| | - Svіtlana Zahorodnia
- Zabolotny Institute of Microbiology and Virology of NASU, 154 Acad. Zabolotny Str., Kyiv, 03143, Ukraine
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13
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Rafiq M, White B, Barclay M, Abel G, Renzi C, Lyratzopoulos G. A UK population-based case-control study of blood tests before cancer diagnosis in patients with non-specific abdominal symptoms. Br J Cancer 2025; 132:450-461. [PMID: 39799273 PMCID: PMC11876449 DOI: 10.1038/s41416-024-02936-9] [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: 03/14/2024] [Revised: 12/02/2024] [Accepted: 12/27/2024] [Indexed: 01/15/2025] Open
Abstract
BACKGROUND Abnormal results in commonly used primary care blood tests could be early markers of cancer in patients presenting with non-specific abdominal symptoms. METHODS Using linked data from the UK Clinical Practice Research Datalink (CPRD) and national cancer registry we compared blood test use and abnormal results from the 24-months pre-diagnosis in 10,575 cancer patients (any site), and 52,875 matched-controls aged ≥30 presenting, with abdominal pain or bloating to primary care. RESULTS Cancer patients had two-fold increased odds of having a blood test (odds ratio(OR):1.51-2.29) and 2-3-fold increased odds of having an abnormal blood test result (OR:2.42-3.30) in the year pre-diagnosis compared to controls. Raised inflammatory markers were the most common abnormality (74-79% of tested cases). Rates of blood test use and abnormal results progressively increased from 7 months pre-diagnosis in cancer patients, with relatively small corresponding increases in symptomatic controls. In cancer patients, the largest increases from baseline were raised platelets in males with abdominal pain (increased 33-fold), raised white blood cell count in males with abdominal bloating (increased 37-fold) and low albumin in females with either symptom (increased 22-41 fold). CONCLUSIONS Common blood test abnormalities are early signals of cancer in some individuals with non-specific abdominal symptoms and could support expedited cancer diagnosis.
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Affiliation(s)
- Meena Rafiq
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, UK.
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
| | - Becky White
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, UK
| | - Matthew Barclay
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, UK
| | - Gary Abel
- University of Exeter Medical School, Exeter, UK
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, UK
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, UK
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14
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Putnin T, Chanarsa S, Yaiwong P, Ngamaroonchote A, Aroonyadet N, Jakmunee J, Bamrungsap S, Laocharoensuk R, Ounnunkad K. Unraveling the Impact of Polyethylenimine-Coated Gold Nanoparticle Size on the Efficiency of Sandwich-Style Electrochemical Immunosensors. ACS MEASUREMENT SCIENCE AU 2025; 5:96-108. [PMID: 39991027 PMCID: PMC11843508 DOI: 10.1021/acsmeasuresciau.4c00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 01/10/2025] [Accepted: 01/14/2025] [Indexed: 02/25/2025]
Abstract
Sometimes, smaller size is not always better, and looking for nanomaterials that offer better device performance requires consideration of their properties at the first stage. In this study, the effects of the size of polyethylenimine-capped AuNPs (PEI-AuNPs) and proteins on the immunosensor performances, namely, sensitivity and limit of detection, are examined. The size-effect investigation of PEI-AuNPs involves their modification on the surface of disposable screen-printed carbon electrodes to support primary antibodies and their ability to load secondary antibodies and redox probes to perform amplification in the immunosensor. The correlation of the average size, electrochemical activities, protein size, and device property of PEI-AuNPs is investigated. The synthesized PEI-AuNPs with different average diameters ranging from 4.7 to 44.9 nm are employed for the investigation. When the sensor surface forms a sandwich architecture, the detection employs the current response of Ag+ ions on the PEI-AuNPs bioconjugate, which greatly increases by increasing the protein concentration. In addition, the best electrochemical signal of PEI-AuNPs or their antibody complexes with a unique AuNPs' average size allows superior signal amplification. The effect of using different sizes of target proteins on their devices is not significantly observed. Although in general small-sized nanomaterials offer high active surface areas, which can improve the electrode surface, reactivity, and device performance, we observe that the medium size of PEI-AuNPs (16.3 nm) gives the best sensitivity and detection limit of this sensor type. Therefore, the finding is useful for considering and optimizing their sizes for tunable voltammetric properties and acquiring a superior sensor.
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Affiliation(s)
- Thitirat Putnin
- Department
of Chemistry, Faculty of Science, Chiang
Mai University, Chiang
Mai 50200, Thailand
- National
Nanotechnology Center (NANOTEC), National Science and Technology Development
Agency (NSTDA), Pathum
Thani 12120, Thailand
| | - Supakeit Chanarsa
- Department
of Chemistry, Faculty of Science, Chiang
Mai University, Chiang
Mai 50200, Thailand
- Center
of Excellence for Innovation in Chemistry, Chiang Mai University, Chiang
Mai 50200, Thailand
| | - Patrawadee Yaiwong
- Department
of Chemistry, Faculty of Science, Chiang
Mai University, Chiang
Mai 50200, Thailand
- Center
of Excellence for Innovation in Chemistry, Chiang Mai University, Chiang
Mai 50200, Thailand
| | - Aroonsri Ngamaroonchote
- National
Nanotechnology Center (NANOTEC), National Science and Technology Development
Agency (NSTDA), Pathum
Thani 12120, Thailand
| | - Noppadol Aroonyadet
- National
Nanotechnology Center (NANOTEC), National Science and Technology Development
Agency (NSTDA), Pathum
Thani 12120, Thailand
| | - Jaroon Jakmunee
- Department
of Chemistry, Faculty of Science, Chiang
Mai University, Chiang
Mai 50200, Thailand
- Center
of Excellence for Innovation in Chemistry, Chiang Mai University, Chiang
Mai 50200, Thailand
| | - Suwussa Bamrungsap
- National
Nanotechnology Center (NANOTEC), National Science and Technology Development
Agency (NSTDA), Pathum
Thani 12120, Thailand
| | - Rawiwan Laocharoensuk
- National
Nanotechnology Center (NANOTEC), National Science and Technology Development
Agency (NSTDA), Pathum
Thani 12120, Thailand
| | - Kontad Ounnunkad
- Department
of Chemistry, Faculty of Science, Chiang
Mai University, Chiang
Mai 50200, Thailand
- Center
of Excellence for Innovation in Chemistry, Chiang Mai University, Chiang
Mai 50200, Thailand
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15
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Ahmed HS, Nair SV, Sache MS, Das R, Gupta A, Choradia SC, Prakash L, Praveen PB, Gowda P, Gupta S, Bharath CHS, Shivananda DB, Thrishulamurthy CJ. Clinical profile, histopathology, and management of caruncular lesions; a systematic review. Eye (Lond) 2025; 39:424-435. [PMID: 39715858 PMCID: PMC11794479 DOI: 10.1038/s41433-024-03560-w] [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: 08/07/2024] [Revised: 12/04/2024] [Accepted: 12/12/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND The lacrimal caruncle, a nodular structure located at the inner canthus, contains a variety of tissue types, leading to diverse clinical manifestations of its lesions. Caruncular lesions, though rare, may be benign or malignant, complicating diagnosis and treatment. This systematic review aims to provide a comprehensive overview of the clinical profiles, histopathological features, and management strategies for caruncular lesions. METHODS This was a PROSPERO-registered (CRD42024529956), PRISMA guideline-adherent systematic review. Databases searched include PubMed, Scopus, and CINAHL Ultimate from inception to June 29, 2024. Grey literature was also searched. Studies involving patients diagnosed with caruncular lesions were included. A novel classification strategy has been developed and proposed. RESULTS From an initial 1602 articles, 16 studies were included, representing a range of demographics and clinical features. Histopathological diagnosis varied widely, with benign lesions more common than malignant ones. Common benign lesions included nevi, papillomas, and pyogenic granulomas, while malignant lesions included basal cell carcinomas, sebaceous cell carcinomas, and melanomas. Medical management often combined topical therapies with surgical excision. Surgical management primarily involved excision, with some cases necessitating more radical procedures, which were typically reserved for extensive or malignant lesions. Recurrence was noted in several studies, with melanomas being at the highest risk of recurrence. CONCLUSION Caruncular lesions exhibit diverse histopathological profiles, necessitating a combination of clinical and histopathological examination for accurate diagnosis and management. Early detection and appropriate management are crucial for improving patient outcomes. Despite the rarity of these lesions, their potential malignancy and systemic metastasis create a need for prospective studies.
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Affiliation(s)
- H Shafeeq Ahmed
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India.
| | - Samyuktha Vinu Nair
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Mohammed Sulaiman Sache
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Rishika Das
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Aryan Gupta
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Sakshi C Choradia
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Likitha Prakash
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | | | - Prajwal Gowda
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Sneha Gupta
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - C H Sai Bharath
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
| | - Deepak B Shivananda
- Department of Ophthalmology, Bangalore Medical College and Research Institute, Bengaluru, India
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16
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Sætre LMS, Balasubramaniam K, Søndergaard J, Jarbøl DE. Smoking status, symptom significance and healthcare seeking with lung cancer symptoms in the Danish general population. NPJ Prim Care Respir Med 2025; 35:3. [PMID: 39794355 PMCID: PMC11724040 DOI: 10.1038/s41533-025-00412-2] [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: 02/09/2024] [Accepted: 01/02/2025] [Indexed: 01/13/2025] Open
Abstract
This study analyses the associations between smoking status and perceived symptom significance (concern and influence on daily activity) among individuals with possible lung cancer symptoms and investigate the influence of symptom significance on healthcare seeking among individuals with different smoking status. A nationwide survey with 21,920 randomly selected individuals aged ≥40 years included questions about lung cancer symptoms, symptom concern and influence on daily activities, GP contact, and smoking status. Descriptive statistics and multivariable regression models were applied. Overall, individuals who currently smoked were more likely to perceive their lung cancer symptoms as significant, and individuals who reported high symptom significance were more likely to seek healthcare with both specific and non-specific symptoms. The significance of symptoms appeared to have less pronounced effect on prompting healthcare seeking among individuals with a history of current smoking. This implies that they may benefit from support and encouragement to seek care.
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Affiliation(s)
- Lisa Maria Sele Sætre
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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17
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Romero JMS, Mallah N, Varela‐Centelles PI, Warnakulasuriya S, Takkouche B. Primary Care Referral Delays in Oral Cancer Diagnosis: A Meta‐Analysis. Oral Dis 2024. [DOI: 10.1111/odi.15218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 11/27/2024] [Indexed: 01/03/2025]
Abstract
ABSTRACTObjectiveTo measure the primary care interval (PCI) in the diagnostic delay of oral cancer and to assess the relation of the referring physician's specialty with disease stage at diagnosis.MethodsWe meta‐analyzed reports of oral/oropharyngeal carcinomas detailing PCI start‐ and endpoints, i.e., the time needed by a primary care physician to refer a suspected oral cancer patient to a specialist.Results17 studies with a total of 2530 patients were eligible; nine provided data on the relative length of PCI, and 10 reported on the impact of the referring professional's specialty on oral cancer diagnostic delay. The average PCI length was slightly longer for general practitioners (GPs) (30.5 days) than for general dental practitioners (GDPs) (27.6 days), while that for the total group was 28.7 days. One‐third of the total pre‐hospital time spent on diagnosis elapses in GP practices (PCI%: 0.31 [95% CI: 0.23, 0.40]). GDPs refer their patients for treatment at earlier disease stages (TNM I‐II) than GPs (Odds Ratio: 0.58; 95% CI: 0.34–0.98).ConclusionsPrimary care accounts for a considerable pre‐hospital amount of time of what is necessary for reaching a diagnosis of oral cancer patients. This calls for enhancing early oral cancer recognition in primary care settings.
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Affiliation(s)
| | - Narmeen Mallah
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP) Instituto de Investigación Sanitaria de Santiago (IDIS) Santiago de Compostela Spain
- WHO Collaborating Centre for Vaccine Safety Santiago de Compostela Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER‐ESP) Madrid Spain
- Department of Preventive Medicine University of Santiago de Compostela (USC) Santiago de Compostela Spain
- Instituto de Psicología (IPsiUS) University of Santiago de Compostela (USC) Santiago de Compostela Spain
| | - Pablo Ignacio Varela‐Centelles
- Centro de Saúde Praza de Ferrol Galician Health Service Lugo Spain
- Department of Surgery and Medical‐Surgical Specialties, School of Medicine and Dentistry University of Santiago de Compostela Santiago de Compostela Spain
- Health Research Institute of Santiago de Compostela (IDIS) Santiago de Compostela Spain
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London and WHO Collaborating Centre for Oral Cancer London UK
| | - Bahi Takkouche
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER‐ESP) Madrid Spain
- Department of Preventive Medicine University of Santiago de Compostela (USC) Santiago de Compostela Spain
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18
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Chima S, Hunter B, Martinez-Gutierrez J, Lumsden N, Nelson C, Manski-Nankervis JA, Emery J. Adoption, acceptance, and use of a decision support tool to promote timely investigations for cancer in primary care. Fam Pract 2024; 41:1048-1057. [PMID: 39425610 PMCID: PMC11642683 DOI: 10.1093/fampra/cmae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND The complexities of diagnosing cancer in general practice has driven the development of quality improvement (QI) interventions, including clinical decision support (CDS) and auditing tools. Future Health Today (FHT) is a novel QI tool, consisting of CDS at the point-of-care, practice population-level auditing, recall, and the monitoring of QI activities. OBJECTIVES Explore the acceptability and usability of the FHT cancer module, which flags patients with abnormal test results that may be indicative of undiagnosed cancer. METHODS Interviews were conducted with general practitioners (GPs) and general practice nurses (GPNs), from practices participating in a randomized trial evaluating the appropriate follow-up of patients. Clinical Performance Feedback Intervention Theory (CP-FIT) was used to analyse and interpret the data. RESULTS The majority of practices reported not using the auditing and QI components of the tool, only the CDS which was delivered at the point-of-care. The tool was used primarily by GPs; GPNs did not perceive the clinical recommendations to be within their role. For the CDS, facilitators for use included a good workflow fit, ease of use, low time cost, importance, and perceived knowledge gain. Barriers for use of the CDS included accuracy, competing priorities, and the patient population. CONCLUSIONS The CDS aligned with the clinical workflow of GPs, was considered non-disruptive to the consultation and easy to implement into usual care. By applying the CP-FIT theory, we were able to demonstrate the key drivers for GPs using the tool, and what limited the use by GPNs.
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Affiliation(s)
- Sophie Chima
- Department of General Practice and Primary Care, University of Melbourne, 780 Elizabeth St, Melbourne, 3010, Australia
- Centre for Cancer Research, University of Melbourne, 305 Grattan St, Melbourne, 3010, Australia
| | - Barbara Hunter
- Centre for Cancer Research, University of Melbourne, 305 Grattan St, Melbourne, 3010, Australia
| | - Javiera Martinez-Gutierrez
- Department of General Practice and Primary Care, University of Melbourne, 780 Elizabeth St, Melbourne, 3010, Australia
- Centre for Cancer Research, University of Melbourne, 305 Grattan St, Melbourne, 3010, Australia
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4686, Santiago, Chile
| | - Natalie Lumsden
- Centre for Cancer Research, University of Melbourne, 305 Grattan St, Melbourne, 3010, Australia
| | - Craig Nelson
- Department of Medicine, Western Health, University of Melbourne, 176 Furlong Road, Melbourne, 3021, Australia
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, University of Melbourne, 780 Elizabeth St, Melbourne, 3010, Australia
- Department of Primary Care and Family Medicine, LKC Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore
| | - Jon Emery
- Department of General Practice and Primary Care, University of Melbourne, 780 Elizabeth St, Melbourne, 3010, Australia
- Centre for Cancer Research, University of Melbourne, 305 Grattan St, Melbourne, 3010, Australia
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19
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Liu Q, Medina HN, Koru-Sengul T, Rodriguez E, Lopes G, Penedo FJ, Islami F, Pinheiro PS. Intra-ethnic and geographic disparities in stage at diagnosis for non-small cell lung cancer. J Natl Cancer Inst 2024; 116:2022-2031. [PMID: 39167098 DOI: 10.1093/jnci/djae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/29/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Despite the importance of early detection for lung cancer outcomes, staging disparities among the growing US Hispanic population remain underexplored. This population-based study aimed to identify racial/ethnic disparities among non-Hispanic White, non-Hispanic Black, and Hispanic (including specific subgroups) patients in stage at diagnosis for potentially curable non-small cell lung cancer (NSCLC). METHODS Incident NSCLC cases (2005-2018) were extracted from the Florida cancer registry. Stage was categorized as early (localized/regional) or advanced (distant). Multivariable logistic regression assessed the association between race/ethnicity and stage at diagnosis, adjusting for socioeconomic status, smoking, and clinical factors. RESULTS Among 157 034 NSCLC patients, 47.8% were diagnosed at an advanced stage. Multivariable models showed higher odds of advanced-stage diagnosis for non-Hispanic Blacks (adjusted odds ratio [ORadj] = 1.22, 95% confidence interval [CI] = 1.17 to 1.26) and Hispanics (ORadj = 1.03, 95% CI = 1.00 to 1.08) compared with non-Hispanic Whites. Regional differences were stark for Hispanics compared with non-Hispanic Whites: ORadj = 0.96 (95% CI = 0.91 to 1.01) in South Florida vs 1.12 (95% CI = 1.05 to 1.19) in the rest of Florida. In South Florida, Central Americans (ORadj = 1.49, 95% CI = 1.20 to 1.85) were the only Hispanic group showing a staging disadvantage compared with non-Hispanic Whites. CONCLUSION Pronounced disparities in NSCLC staging among non-Hispanic Black and Hispanic populations, with notable regional variations within Florida's Hispanic communities, indicate that targeted interventions could significantly enhance early detection. The relative advantage observed in nearly all minority groups in multicultural South Florida compared with the rest of Florida underscores the need for future research exploring how specific Hispanic and multiracial sociocultural contexts can positively influence the landscape of cancer early detection across the United States.
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Affiliation(s)
- Qinran Liu
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Heidy N Medina
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Departments of Psychology and Medicine, University of Miami, Miami, FL, USA
| | - Farhad Islami
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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20
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Rogers I, Cooper M, Memon A, Forbes L, van Marwijk H, Ford E. The effect of comorbidities on diagnostic interval for lung cancer in England: a cohort study using electronic health record data. Br J Cancer 2024; 131:1147-1157. [PMID: 39179794 PMCID: PMC11442666 DOI: 10.1038/s41416-024-02824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 07/29/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Comorbid conditions may delay lung cancer diagnosis by placing demand on general practioners' time reducing the possibility of prompt cancer investigation ("competing demand conditions"), or by offering a plausible non-cancer explanation for signs/symptoms ("alternative explanation conditions"). METHOD Patients in England born before 1955 and diagnosed with incident lung cancer between 1990 and 2019 were identified in the Clinical Practice Research Datalink and linked hospital admission and cancer registry data. Diagnostic interval was defined as time from first presentation in primary care with a relevant sign/symptom to the diagnosis date. 14 comorbidities were classified as ten "competing demand" and four "alternative explanation" conditions. Associations with diagnostic interval were investigated using multivariable linear regression models. RESULTS Complete data were available for 11870 lung cancer patients. In adjusted analyses diagnostic interval was longer for patients with "alternative explanation" conditions, by 31 and 74 days in patients with one and ≥2 conditions respectively versus those with none. Number of "competing demand" conditions did not remain in the final adjusted regression model for diagnostic interval. CONCLUSIONS Conditions offering alternative explanations for lung cancer symptoms are associated with increased diagnostic intervals. Clinical guidelines should incorporate the impact of alternative and competing causes upon delayed diagnosis.
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Affiliation(s)
- Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK.
| | - Max Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Lindsay Forbes
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
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Bosch X, Montori-Palacin E, Gomes TM, Naval-Álvarez J, Moreno P, López-Soto A. Clinical characterisation of patients diagnosed with cancer following emergency self-referral. Cancer Epidemiol 2024; 92:102609. [PMID: 38991388 DOI: 10.1016/j.canep.2024.102609] [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: 02/12/2024] [Revised: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Despite their frequency and potential impact on prognosis, cancers diagnosed via self-referral to the emergency department are poorly documented. We conducted a detailed analysis of cancer patients diagnosed following emergency self-referral and compared them with those diagnosed following emergency referral from primary care. Given the challenges associated with measuring intervals in the emergency self-referral pathway, we also aimed to provide a definition of the diagnostic interval for these cancers. METHODS A retrospective observational analysis was performed on patients diagnosed with 13 cancers, either following emergency self-referral or emergency referral from primary care. We analysed demographics, tumour stage, clinical data (including 28 presenting symptoms categorised by body systems), and diagnostic intervals by cancer site, then testing for differences between pathways. RESULTS Out of 3624 patients, 37 % were diagnosed following emergency self-referral and 63 % via emergency referral from primary care. Emergency self-referrals were associated with a higher likelihood of being diagnosed with cancers manifesting with localising symptoms (e.g., breast and endometrial cancer), whereas the likelihood of being diagnosed with cancers featuring nonspecific symptoms and abdominal pain (e.g., pancreatic and ovarian cancer) was higher among patients referred from primary care. Diagnostic intervals in self-referred patients were half as long as those in patients referred from primary care, with most significant differences for pancreatic cancer (28 [95 % CI -34 to -23] days shorter, respectively). CONCLUSION These findings enrich the best available evidence on cancer diagnosis through emergency self-referral and showed that, compared with the emergency referral pathway from primary care, these patients had a significantly increased likelihood of presenting with symptoms that are strongly predictive of cancer. Since the starting point for the diagnostic interval in these patients is their emergency presentation, comparing it with that of those referred from primary care as an emergency is likely to result in biased data.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain.
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | | | - José Naval-Álvarez
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
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Suryani ND, Wiranata JA, Puspitaningtyas H, Hutajulu SH, Prabandari YS, Handaya AY, Hardianti MS, Taroeno-Hariadi KW, Kurnianda J, Purwanto I. Determining factors of presentation and diagnosis delays in patients with colorectal cancer and the impact on stage: a cross sectional study in Yogyakarta, Indonesia. Ecancermedicalscience 2024; 18:1761. [PMID: 39430075 PMCID: PMC11489102 DOI: 10.3332/ecancer.2024.1761] [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: 03/13/2024] [Indexed: 10/22/2024] Open
Abstract
Background Early colorectal cancer (CRC) symptom recognition and prompt diagnosis are crucial for the identification of cases in the earliest stage and for improving survival. This study investigates the incidence of presentation and diagnosis delays, their contributing determinants and their impact on the cancer stage at diagnosis. Methods This cross-sectional study recruited 227 CRC patients between November 2022 and October 2023. We developed a semi-structured questionnaire to collect information on the factors related to delays in the presentation and diagnosis. Presentation delay was defined as the time between the initial symptoms and the first consultation exceeding 1 month, while diagnosis delay was defined as the time between presentation and the pathological diagnosis confirmation exceeding 4 months. We examined the impact of these delays on the status of the metastatic disease and identified the determinants of the presentation and diagnosis delays. Results The median values for presentation and diagnosis delay are 1 and 4 months, respectively. Patients aged ≥60 years were less likely to experience diagnosis delays odds ratio (OR = 0.52, 95% confidence interval (CI) 0.28-0.95, p = 0.035), as opposed to those who were younger. The absence of red flag symptoms at presentation (OR = 2.73, 95% CI 1.47-5.10, p = 0.002), the utilisation of complementary and alternative medicine (OR = 2.01, 95% CI 1.12-3.61, p = 0.019) and ≥3 distinct healthcare facility visits before diagnosis (OR = 3.51, 95% CI 1.95-6.29, p < 0.001) were associated with an increased risk of diagnosis delays. Diagnosis delays were also correlated with a higher risk of metastatic disease at diagnosis (OR = 2.04, 95% CI 1.17-3.53, p = 0.011). Conclusion Our CRC patients experience considerable delays in their presentation and diagnosis. Diagnosis delays were observed to increase the likelihood of presenting with metastatic disease. Given the determinants and the patients' perspectives revealed in this study, future research to explore evidence-based approaches to reducing these delays is warranted.
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Affiliation(s)
- Norma Dewi Suryani
- Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Juan Adrian Wiranata
- Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Academic Hospital, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Herindita Puspitaningtyas
- Doctorate Program of Health and Medical Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Susanna Hilda Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta 55281, Indonesia
| | - Yayi Suryo Prabandari
- Department of Health Behaviour, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Center of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Adeodatus Yuda Handaya
- Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Mardiah Suci Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta 55281, Indonesia
| | - Kartika Widayati Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta 55281, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta 55281, Indonesia
| | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta 55281, Indonesia
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Singal AG, Kurtzman KN, Thompson MJ. Leveraging multi-cancer blood tests to improve diagnostic efficiency for patients with nonspecific signs and symptoms. Future Oncol 2024; 20:2603-2607. [PMID: 39193702 PMCID: PMC11534101 DOI: 10.1080/14796694.2024.2388505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024] Open
Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | | | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA 98195, USA
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Bosch X, Mota Gomes T, Montori-Palacin E, Moreno P, López-Soto A. Time to Diagnosis and Presenting Symptoms of Patients Diagnosed With Cancer Through Emergency and Nonemergency Routes: A Large Retrospective Study From a High-Volume Center. JCO Oncol Pract 2024; 20:932-942. [PMID: 38457754 DOI: 10.1200/op.23.00567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE The symptoms with which a patient with cancer presents and the route taken to diagnosis (emergency v nonemergency) may affect the speed with which the diagnosis of cancer is made, thereby affecting outcomes. We examined time to diagnosis by symptom for cancers diagnosed through emergency and nonemergency routes (NERs). METHODS We performed a retrospective review of patients diagnosed with 10 solid cancers at Hospital Clínic of Barcelona between March 2013 and June 2023. Cancers were diagnosed through emergency presentation and admission (inpatient emergency route [IER]), emergency presentation and outpatient referral (outpatient emergency route [OER]), and primary care presentation and outpatient referral (NER). We assessed the effect of diagnostic routes on intervals to diagnosis for 19 cancer symptoms. RESULTS A total of 5,174 and 1,607 patients were diagnosed with cancer through emergency routes and NERs, respectively. Over 85% of patients presenting with alarm (localizing) symptoms such as hematuria through emergency routes were diagnosed with the expected cancer, whereas those with nonlocalizing symptoms such as abdominal pain had a more heterogeneous cancer-site composition. Median intervals were shorter for alarm than nonlocalizing symptoms and tended to be shorter in IERs than OERs. However, for most symptoms, intervals in both routes were invariably shorter than in the NER. For example, diagnostic intervals for hematuria and abdominal pain were 3 and 5 days shorter in IERs than OERs, but they were 5-8 and 17-22 days shorter than in the NER, respectively. CONCLUSION For patients with alarm symptoms, intervals were shorter than for those with nonlocalizing symptoms and, for most symptoms, intervals were shorter when patients were evaluated by emergency routes rather than NERs.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Tiago Mota Gomes
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
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25
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Rafiq M, Renzi C, White B, Zakkak N, Nicholson B, Lyratzopoulos G, Barclay M. Predictive value of abnormal blood tests for detecting cancer in primary care patients with nonspecific abdominal symptoms: A population-based cohort study of 477,870 patients in England. PLoS Med 2024; 21:e1004426. [PMID: 39078806 PMCID: PMC11288431 DOI: 10.1371/journal.pmed.1004426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/13/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms. METHODS AND FINDINGS Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged ≥30 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations. A total of 9,427/425,549 (2.2%) patients with abdominal pain and 1,148/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged ≥60, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient's cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use. CONCLUSIONS In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged ≥60 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.
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Affiliation(s)
- Meena Rafiq
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Becky White
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
| | - Nadine Zakkak
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
| | - Brian Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
| | - Matthew Barclay
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science, Institute of Epidemiology and Health Care (IEHC), UCL, London, United Kingdom
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26
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Rafiq M, Drosdowsky A, Solomon B, Alexander M, Gibbs P, Wright G, Yeung JM, Lyratzopoulos G, Emery J. Trends in primary care blood tests prior to lung and colorectal cancer diagnosis-A retrospective cohort study using linked Australian data. Cancer Med 2024; 13:e70006. [PMID: 39001673 PMCID: PMC11245636 DOI: 10.1002/cam4.70006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/20/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Abnormal results in common blood tests may occur several months before lung cancer (LC) and colorectal cancer (CRC) diagnosis. Identifying early blood markers of cancer and distinct blood test signatures could support earlier diagnosis in general practice. METHODS Using linked Australian primary care and hospital cancer registry data, we conducted a cohort study of 855 LC and 399 CRC patients diagnosed between 2001 and 2021. Requests and results from general practice blood tests (six acute phase reactants [APR] and six red blood cell indices [RBCI]) were examined in the 2 years before cancer diagnosis. Poisson regression models were used to estimate monthly incidence rates and examine pre-diagnostic trends in blood test use and abnormal results prior to cancer diagnosis, comparing patterns in LC and CRC patients. RESULTS General practice blood test requests increase from 7 months before CRC and 6 months before LC diagnosis. Abnormalities in many APR and RBCI tests increase several months before cancer diagnosis, often occur prior to or in the absence of anaemia (in 51% of CRC and 81% of LC patients with abnormalities), and are different in LC and CRC patients. CONCLUSIONS This study demonstrates an increase in diagnostic activity in Australian general practice several months before LC and CRC diagnosis, indicating potential opportunities for earlier diagnosis. It identifies blood test abnormalities and distinct signatures that are early markers of LC and CRC. If combined with other pre-diagnostic information, these blood tests have potential to support GPs in prioritising patients for cancer investigation of different sites to expedite diagnosis.
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Affiliation(s)
- Meena Rafiq
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IECH), UCL, London, UK
| | - Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Solomon
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Gavin Wright
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Justin M Yeung
- Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care (IECH), UCL, London, UK
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
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Benton CB, He D, Todoroff K, Coignet MV, Luan Y, Wong JC, Kurtzman KN, Zackon I. Nonspecific Signs and/or Symptoms of Cancer: A Retrospective, Observational Analysis from a Secondary Care, US Community Oncology Dataset. Curr Oncol 2024; 31:3643-3656. [PMID: 39057140 PMCID: PMC11276305 DOI: 10.3390/curroncol31070268] [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: 05/09/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
To help determine the unmet need for improved diagnostic tools to evaluate patients with nonspecific signs and/or symptoms (NSSS) and suspicion of cancer, we examined patient characteristics, diagnostic journey, and cancer incidence of patients with NSSS within The US Oncology Network (The Network), a secondary care community oncology setting. This retrospective, observational cohort study included patients aged ≥40 years with ≥1 NSSS in their problem list at their first visit within The Network (the index date) between 1 January 2016 and 31 December 2020. Patients were followed longitudinally with electronic health record data for initial cancer diagnosis, new noncancer diagnosis, death, end of study observation period, or 12 months, whichever occurred first. Of 103,984 patients eligible for inclusion, 96,722 presented with only 1 NSSS at index date; 6537/103,984 (6.3%) were diagnosed with 1 primary cancer within 12 months after the index date; 3825/6537 (58.5%) with hematologic malignancy, and 2712/6537 (41.5%) with solid tumor. Among patients diagnosed with cancer (n = 6774), the median time to cancer diagnosis after their first visit within The Network was 5.13 weeks. This study provides a real-world perspective on cancer incidence in patients with NSSS referred to a secondary care setting and highlights the unmet need for improved diagnostic tools to improve cancer outcomes.
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Affiliation(s)
| | - Ding He
- Ontada, Boston, MA 02109, USA
| | | | | | - Ying Luan
- GRAIL, LLC, Menlo Park, CA 94025, USA; (M.V.C.)
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Hajjafari A, Sadr S, Rahdar A, Bayat M, Lotfalizadeh N, Dianaty S, Rezaei A, Moghaddam SP, Hajjafari K, Simab PA, Kharaba Z, Borji H, Pandey S. Exploring the integration of nanotechnology in the development and application of biosensors for enhanced detection and monitoring of colorectal cancer. INORG CHEM COMMUN 2024; 164:112409. [DOI: 10.1016/j.inoche.2024.112409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
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29
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Venning B, Emery JD. Symptomatic cancer diagnosis in general practice: a critical perspective of current guidelines and risk assessment tools. Med J Aust 2024; 220:446-450. [PMID: 38679756 DOI: 10.5694/mja2.52287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Brent Venning
- Centre for Cancer Research, University of Melbourne, Melbourne, VIC
| | - Jon D Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, VIC
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30
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Thompson CA, Sheridan P, Metwally E, Peacock Hinton S, Mullins MA, Dillon EC, Thompson M, Pettit N, Kurian AW, Pruitt SL, Lyratzopoulos G. Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study. JNCI Cancer Spectr 2024; 8:pkae039. [PMID: 38796687 PMCID: PMC11193434 DOI: 10.1093/jncics/pkae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. METHODS We analyzed Surveillance, Epidemiology, and End Results Program-Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have "ED involvement" in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. RESULTS Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. CONCLUSIONS The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations.
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Affiliation(s)
- Caroline A Thompson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Eman Metwally
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon Peacock Hinton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Megan A Mullins
- Peter O’Donnell Jr School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Nicholas Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Sandi L Pruitt
- Peter O’Donnell Jr School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
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Khalafizadeh A, Hashemizadegan SD, Shokri F, Bakhshinejad B, Jabbari K, Motavaf M, Babashah S. Competitive endogenous RNA networks: Decoding the role of long non-coding RNAs and circular RNAs in colorectal cancer chemoresistance. J Cell Mol Med 2024; 28:e18197. [PMID: 38506091 PMCID: PMC10951891 DOI: 10.1111/jcmm.18197] [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: 06/08/2023] [Revised: 11/17/2023] [Accepted: 02/04/2024] [Indexed: 03/21/2024] Open
Abstract
Colorectal cancer (CRC) is recognized as one of the most common gastrointestinal malignancies across the globe. Despite significant progress in designing novel treatments for CRC, there is a pressing need for more effective therapeutic approaches. Unfortunately, many patients undergoing chemotherapy develop drug resistance, posing a significant challenge for cancer treatment. Non-coding RNAs (ncRNAs) have been found to play crucial roles in CRC development and its response to chemotherapy. However, there are still gaps in our understanding of interactions among various ncRNAs, such as long non-coding RNAs (lncRNAs), circular RNAs (circRNAs) and microRNAs (miRNAs). These ncRNAs can act as either oncogenes or tumour suppressors, affecting numerous biological functions in different cancers including CRC. A class of ncRNA molecules known as competitive endogenous RNAs (ceRNAs) has emerged as a key player in various cellular processes. These molecules form networks through lncRNA/miRNA/mRNA and circRNA/miRNA/mRNA interactions. In CRC, dysregulation of ceRNA networks has been observed across various cellular processes, including proliferation, apoptosis and angiogenesis. These dysregulations are believed to play a significant role in the progression of CRC and, in certain instances, may contribute to the development of chemoresistance. Enriching our knowledge of these dysregulations holds promise for advancing the field of diagnostic and therapeutic modalities for CRC. In this review, we discuss lncRNA- and circRNA-associated ceRNA networks implicated in the emergence and advancement of drug resistance in colorectal carcinogenesis.
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Affiliation(s)
- Ali Khalafizadeh
- Department of Molecular Genetics, Faculty of Biological SciencesTarbiat Modares UniversityTehranIran
| | | | - Fatemeh Shokri
- Research and Development Center of BiotechnologyTarbiat Modares UniversityTehranIran
| | - Babak Bakhshinejad
- Department of Molecular Genetics, Faculty of Biological SciencesTarbiat Modares UniversityTehranIran
| | - Keyvan Jabbari
- Department of Molecular Genetics, Faculty of Biological SciencesTarbiat Modares UniversityTehranIran
| | - Mahsa Motavaf
- Department of Molecular Genetics, Faculty of Biological SciencesTarbiat Modares UniversityTehranIran
| | - Sadegh Babashah
- Department of Molecular Genetics, Faculty of Biological SciencesTarbiat Modares UniversityTehranIran
- Research and Development Center of BiotechnologyTarbiat Modares UniversityTehranIran
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Zakkak N, Barclay ME, Swann R, McPhail S, Rubin G, Abel GA, Lyratzopoulos G. The presenting symptom signatures of incident cancer: evidence from the English 2018 National Cancer Diagnosis Audit. Br J Cancer 2024; 130:297-307. [PMID: 38057397 PMCID: PMC10803766 DOI: 10.1038/s41416-023-02507-4] [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: 03/16/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Understanding relationships between presenting symptoms and subsequently diagnosed cancers can inform symptom awareness campaigns and investigation strategies. METHODS We used English National Cancer Diagnosis Audit 2018 data for 55,122 newly diagnosed patients, and examined the relative frequency of presenting symptoms by cancer site, and of cancer sites by presenting symptom. RESULTS Among 38 cancer sites (16 cancer groups), three classes were apparent: cancers with a dominant single presenting symptom (e.g. melanoma); cancers with diverse presenting symptoms (e.g. pancreatic); and cancers that are often asymptomatically detected (e.g. chronic lymphocytic leukaemia). Among 83 symptoms (13 symptom groups), two classes were apparent: symptoms chiefly relating to cancers of the same body system (e.g. certain respiratory symptoms mostly relating to respiratory cancers); and symptoms with a diverse cancer site case-mix (e.g. fatigue). The cancer site case-mix of certain symptoms varied by sex. CONCLUSION We detailed associations between presenting symptoms and cancer sites in a large, representative population-based sample of cancer patients. The findings can guide choice of symptoms for inclusion in awareness campaigns, and diagnostic investigation strategies post-presentation when cancer is suspected. They can inform the updating of clinical practice recommendations for specialist referral encompassing a broader range of cancer sites per symptom.
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Affiliation(s)
- N Zakkak
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - M E Barclay
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - R Swann
- National Disease Registration Service, NHS England, London, UK
- Cancer Intelligence, Cancer Research UK, London, UK
| | - S McPhail
- National Disease Registration Service, NHS England, London, UK
| | - G Rubin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - G A Abel
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, London, UK
| | - G Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Drayson M, Jennis T, Laketic-Ljubojevic I, Patel D, Pratt G, Renwick S, Richter A, Wheeler R, Sheldon J, Sadler R, Stapleton M, Willis F, Whiston M. Laboratory practice is central to earlier myeloma diagnosis: Utilizing a primary care diagnostic tool and laboratory guidelines integrated into haematology services. Br J Haematol 2024; 204:476-486. [PMID: 38168756 DOI: 10.1111/bjh.19224] [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: 08/14/2023] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024]
Abstract
Treatment advances have greatly improved survival, but myeloma is among the worst of all cancers for delayed diagnosis, causing serious morbidities and early deaths. This delay is largely because the symptom profile of myeloma has very low specificity, and in primary care, myeloma is rare. However, initiating the journey to diagnosis simply requires considering myeloma and sending blood to test for monoclonal immunoglobulin. Laboratory tests reliably detect monoclonal immunoglobulin, which is present in 99% of myeloma cases, so why do health care systems have such a problem with delayed diagnosis? The Myeloma UK early diagnosis programme has brought together diverse expertise to investigate this problem, and this article was prepared by the programme's working group for laboratory best practice. It reviews evidence for test requesting, analysis and reporting, for which there is large variation in practice across the United Kingdom. It presents a 'GP Myeloma diagnostic tool' and how it can be integrated into laboratory practice alongside a laboratory best practice tool. It proposes improved requesting and integration with haematology services for reporting and interpretation. Here the laboratory has a central role in creating efficient and cost-effective pathways for appropriate and timely bone marrow examination for myeloma diagnosis.
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Affiliation(s)
- Mark Drayson
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | | | | | - Dina Patel
- UK NEQAS Immunology, Immunochemistry & Allergy, Sheffield Teaching Hospitals, Sheffield, UK
| | - Guy Pratt
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Alex Richter
- Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Rachel Wheeler
- Protein Reference Unit, South West London Pathology, St Georges Hospital, London, UK
| | - Joanna Sheldon
- Protein Reference Unit, South West London Pathology, St Georges Hospital, London, UK
| | - Ross Sadler
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Farraj H, Alriyalat S. Urinary Incontinence Following Robotic-Assisted Radical Prostatectomy: A Literature Review. Cureus 2024; 16:e53058. [PMID: 38410341 PMCID: PMC10896250 DOI: 10.7759/cureus.53058] [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: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Prostate cancer ranks as one of the most prevalent cancers among men in the United States, contributing significantly to cancer-related mortality. Robot-assisted radical prostatectomy (RARP) has become a cornerstone in the management of localized prostate cancer. This literature review delves into the outcomes of RARP, specifically its impact on urinary incontinence (UI) compared to other surgical methods. We also present the importance of patient perception versus medical reports. Recent studies and trials have unveiled that postoperative UI and erectile dysfunction (ED) remain common concerns following prostatectomy. However, studies have shown that RARP has lower occurrences of UI and ED compared to radical retropubic prostatectomy (RRP). While the choice of surgical method may not drastically affect these outcomes, the review emphasizes that urinary incontinence extends beyond physical symptoms. It profoundly impacts patients' psychological well-being, social interactions, and overall quality of life. Differences in symptom recording and interpretation between patients and healthcare professionals can significantly influence the diagnosis and treatment of prostate cancer. Enhanced patient-physician communication and patient-centered care are essential to providing a holistic approach to prostate cancer management. The choice of surgical methods may not significantly impact postoperative urinary incontinence and erectile dysfunction. Continued research and advancements in treatment and patient care are crucial for improving outcomes and the overall well-being of prostate cancer patients.
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Affiliation(s)
- Hamzeh Farraj
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
| | - Sulieman Alriyalat
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
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35
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Johnston AJ, Sivakumar S, Zhou Y, Funston G, Bradley SH. Improving early diagnosis of pancreatic cancer in symptomatic patients. Br J Gen Pract 2023; 73:534-535. [PMID: 38035808 PMCID: PMC10688932 DOI: 10.3399/bjgp23x735585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
| | - Shivan Sivakumar
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham
| | - Yin Zhou
- National Institute for Health and Care Research (NIHR) Academic Clinical Lecturer, Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Garth Funston
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Stephen H Bradley
- NIHR Academic Clinical Lecturer, Leeds Institute of Health Sciences, University of Leeds, Leeds
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Conroy S, Catto JWF, Bex A, Brown JE, Cartledge J, Fielding A, Jones RJ, Khoo V, Nicol D, Stewart GD, Sullivan M, Tran MGB, Woodward R, Cumberbatch MG. Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019. BJU Int 2023; 132:541-553. [PMID: 37436368 DOI: 10.1111/bju.16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES To report the NHS Digital (NHSD) data for patients diagnosed with kidney cancer (KC) in England. We explore the incidence, route to diagnosis (RTD), treatment, and survival patterns from 2013 to 2019. MATERIALS AND METHODS Data was extracted from the Cancer Data NHSD portal for International Classification of Diseases, 10th edition coded KC; this included Cancer Registry data, Hospital Episode Statistics, and cancer waiting times data. RESULTS Registrations included 66 696 individuals with KC. Incidence of new KC diagnoses increased (8998 in 2013, to 10 232 in 2019), but the age-standardised rates were stable (18.7-19.4/100 000 population). Almost half of patients (30 340 [45.5%]) were aged 0-70 years and the cohort were most frequently diagnosed with Stage 1-2 KC (n = 26 297 [39.4%]). Most patients were diagnosed through non-urgent general practitioner referrals (n = 16 814 [30.4%]), followed by 2-week-wait (n = 15 472 [28.0%]) and emergency routes (n = 11 796 [21.3%]), with older patients (aged ≥70 years), Stage 4 KCs, and patients with non-specified renal cell carcinoma being significantly more likely to present through the emergency route (all P < 0.001). Invasive treatment (surgery or ablation), radiotherapy, or systemic anti-cancer therapy use varied with disease stage, patient factors, and treatment network (Cancer Alliance). Survival outcomes differed by Stage, histological subtype, and social deprivation class (P < 0.001). Age-standardised mortality rates did not change over the study duration, although immunotherapy usage is likely not captured in this study timeline. CONCLUSION The NHSD resource provides useful insight about the incidence, diagnostic pathways, treatment, and survival of patients with KC in England and a useful benchmark for the upcoming commissioned National Kidney Cancer Audit. The RTD data may be limited by incidental diagnoses, which could confound the high proportion of 'emergency' diagnoses. Importantly, survival outcomes remained relatively unchanged.
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Affiliation(s)
- Samantha Conroy
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - James W F Catto
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Axel Bex
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Janet E Brown
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Alison Fielding
- Bladder and Renal Cancer Clinical Studies Group, National Cancer Research Institute, London, UK
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - David Nicol
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
| | - Maxine G B Tran
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rose Woodward
- Action Kidney Cancer, Manchester, UK
- International Kidney Cancer Coalition, UK
| | - Marcus G Cumberbatch
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Halgren Olsen M, Maltesen T, Lassen P, Kjaer TK, Johansen J, Primdahl H, Andersen E, Kristensen CA, Andersen M, Farhadi M, Overgaard J, Dalton SO. Socioeconomic position and the pre-diagnostic interval among patients diagnosed with head and neck squamous cell carcinoma - a population-based study from DAHANCA. Acta Oncol 2023; 62:1394-1402. [PMID: 37672036 DOI: 10.1080/0284186x.2023.2254478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The socioeconomic differences in survival are pronounced for patients diagnosed with head and neck cancer; disease stage at diagnosis is suggested to be a main driver of this association. This nationwide, population-based study investigates socioeconomic differences in the pre-diagnostic interval and disease stage at diagnosis. MATERIAL AND METHODS Information on patient-reported symptoms, symptom onset and disease-specific factors was obtained from the nationwide population-based Danish Head and Neck Cancer Group (DAHANCA) database for patients diagnosed with head and neck squamous cell carcinoma between 2008 and 2019 in Denmark. Socioeconomic position (SEP) was measured by individual-level education, income and cohabitation status obtained from administrative registers. Socioeconomic differences in the interval from symptom onset to diagnosis were investigated in general linear models with 95% confidence intervals (CIs); overall and by subsite, symptom and comorbidity score. Consultation patterns prior to diagnosis were examined using methods for change-point detection. Associations with advanced-stage disease were estimated in logistic regression models. RESULTS Patients with low, medium and high SEP had a similar interval from patient-reported symptom onset to diagnosis of 10 weeks. Although this interval varied according to primary symptom and anatomical subsite, no apparent socioeconomic differences were observed within these subgroups. Aligned with the patient-reported symptom onset, a distinct increase in consultation rates was observed at 9 weeks (95% CI [7.3; 10.7]) for patients with low SEP and 7 weeks (95% CI [4.8; 9.2]) for patients with high SEP, with overlapping CIs. Patients with low compared to high SEP had increased odds for advanced-stage glottic and oral cavity squamous cell carcinoma. For the remaining subsites the association varied according to SEP-indicator and TNM-edition. CONCLUSION The interval from symptom onset to diagnosis and consultation patterns were similar across SEP groups. Still, socioeconomic differences in stage at diagnosis were observed for some - but not all - subsites.
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Affiliation(s)
- Maja Halgren Olsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Pernille Lassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Elo Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev, Herlev, Denmark
| | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mohammad Farhadi
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Bosch X, Montori-Palacin E, Calvo J, Carbonell I, Naval-Álvarez J, Moreno P, López-Soto A. Time intervals and previous primary care consultations in the pathway to emergency cancer diagnosis. Cancer Epidemiol 2023; 86:102445. [PMID: 37651939 DOI: 10.1016/j.canep.2023.102445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Time intervals and number of prior consultations in primary care (PC) are recognised metrics of diagnostic timeliness of cancer and are interrelated. However, whether and how the two measures correlate with each other in the emergency diagnostic pathway is unknown. We investigated the association between the number of prereferral consultations and the length of intervals from PC presentation to cancer diagnosis following emergency referral to hospital. METHODS Patients were eligible if they first consulted in PC and were diagnosed with cancer following emergency or nonemergency referral to hospital. We analysed for differences in PC and diagnostic intervals and number of consultations between emergency and nonemergency presenters and determined their associations by cancer type. Differences in presenting symptoms and stage at diagnosis between populations and according to number of consultations were also examined. RESULTS There were 796 emergency and 865 nonemergency presenters with comparable sociodemographic and comorbidity data. Correlation analysis in emergency presenters revealed a strong positive association between number of consultations and intervals for seven of 13 different cancers, including cancers characterised by high proportions of > 3 consultations and long intervals (pancreatic, lung, and colorectal cancer) and vice versa for others (e.g., endometrial, cervical, or oesophageal cancer). Additionally, emergency presenters with > 3 consultations were more likely than those with 1-2 to report nonspecific symptoms (60 vs. 40%, respectively) and to be diagnosed at a later stage. CONCLUSION System level interventions are needed to reduce unnecessary delays in the emergency diagnostic pathway, particularly in cancer patients with multiple prereferral consultations. The findings also suggest opportunities to reduce the proportion of emergency diagnoses by targeting symptomatic individuals pre-presentation.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Julia Calvo
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Irene Carbonell
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - José Naval-Álvarez
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Koltai T. Earlier Diagnosis of Pancreatic Cancer: Is It Possible? Cancers (Basel) 2023; 15:4430. [PMID: 37760400 PMCID: PMC10526520 DOI: 10.3390/cancers15184430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 09/29/2023] Open
Abstract
Pancreatic ductal adenocarcinoma has a very high mortality rate which has been only minimally improved in the last 30 years. This high mortality is closely related to late diagnosis, which is usually made when the tumor is large and has extensively infiltrated neighboring tissues or distant metastases are already present. This is a paradoxical situation for a tumor that requires nearly 15 years to develop since the first founding mutation. Response to chemotherapy under such late circumstances is poor, resistance is frequent, and prolongation of survival is almost negligible. Early surgery has been, and still is, the only approach with a slightly better outcome. Unfortunately, the relapse percentage after surgery is still very high. In fact, early surgery clearly requires early diagnosis. Despite all the advances in diagnostic methods, the available tools for improving these results are scarce. Serum tumor markers permit a late diagnosis, but their contribution to an improved therapeutic result is very limited. On the other hand, effective screening methods for high-risk populations have not been fully developed as yet. This paper discusses the difficulties of early diagnosis, evaluates whether the available diagnostic tools are adequate, and proposes some simple and not-so-simple measures to improve it.
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Affiliation(s)
- Tomas Koltai
- Hospital del Centro Gallego de Buenos Aires, Buenos Aires C1094, Argentina
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40
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Moore SF, Price SJ, Bostock J, Neal RD, Hamilton W. Incidence of 'Low-Risk but Not No-Risk' Features of Cancer Prior to High-Risk Feature Occurrence: An Observational Cohort Study in Primary Care. Cancers (Basel) 2023; 15:3936. [PMID: 37568751 PMCID: PMC10417692 DOI: 10.3390/cancers15153936] [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: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Diagnosing cancer may be expedited by decreasing referral risk threshold. Clinical Practice Research Datalink participants (≥40 years) had a positive predictive value (PPV) ≥3% feature for breast, lung, colorectal, oesophagogastric, pancreatic, renal, bladder, prostatic, ovarian, endometrial or laryngeal cancer in 2016. The numbers of participants with features representing a 1-1.99% or 2-2.99% PPV for same cancer in the previous year were reported, alongside the time difference between meeting the ≥3% criteria and the lower threshold criteria. A total of 8616 participants had a PPV ≥3% feature, of whom 365 (4.2%) and 1147 (13.3%), respectively, met 2-2.99% and 1-1.99% criteria in the preceding year. The median time difference was 131 days (Interquartile Range (IQR) 27 to 256) for the 2-2.99% band and 179 days (IQR 58 to 289) for the 1-1.99% band. Results were heterogeneous across cancer sites. For some cancers, participants may progress from presenting lower- to higher-risk features before meeting urgent referral criteria; however, this was not usually the case. The details of specific features across multiple cancer sites will allow for a tailored approach to future reductions in referral thresholds, potentially improving the efficiency of urgent cancer referrals for the benefit both of individuals and the National Health Service (NHS).
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Affiliation(s)
- Sarah F. Moore
- Faculty of Health and Life Sciences, University of Exeter, Exeter EX2 4TH, UK
| | - Sarah J. Price
- Faculty of Health and Life Sciences, University of Exeter, Exeter EX2 4TH, UK
| | - Jennifer Bostock
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London, Mile End Rd., London E1 4NS, UK
| | - Richard D. Neal
- Faculty of Health and Life Sciences, University of Exeter, Exeter EX2 4TH, UK
| | - Willie Hamilton
- Faculty of Health and Life Sciences, University of Exeter, Exeter EX2 4TH, UK
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Nicholson BD, Oke J, Virdee PS, Harris DA, O'Doherty C, Park JE, Hamady Z, Sehgal V, Millar A, Medley L, Tonner S, Vargova M, Engonidou L, Riahi K, Luan Y, Hiom S, Kumar H, Nandani H, Kurtzman KN, Yu LM, Freestone C, Pearson S, Hobbs FR, Perera R, Middleton MR. Multi-cancer early detection test in symptomatic patients referred for cancer investigation in England and Wales (SYMPLIFY): a large-scale, observational cohort study. Lancet Oncol 2023; 24:733-743. [PMID: 37352875 DOI: 10.1016/s1470-2045(23)00277-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND Analysis of circulating tumour DNA could stratify cancer risk in symptomatic patients. We aimed to evaluate the performance of a methylation-based multicancer early detection (MCED) diagnostic test in symptomatic patients referred from primary care. METHODS We did a multicentre, prospective, observational study at National Health Service (NHS) hospital sites in England and Wales. Participants aged 18 or older referred with non-specific symptoms or symptoms potentially due to gynaecological, lung, or upper or lower gastrointestinal cancers were included and gave a blood sample when they attended for urgent investigation. Participants were excluded if they had a history of or had received treatment for an invasive or haematological malignancy diagnosed within the preceding 3 years, were taking cytotoxic or demethylating agents that might interfere with the test, or had participated in another study of a GRAIL MCED test. Patients were followed until diagnostic resolution or up to 9 months. Cell-free DNA was isolated and the MCED test performed blinded to the clinical outcome. MCED predictions were compared with the diagnosis obtained by standard care to establish the primary outcomes of overall positive and negative predictive value, sensitivity, and specificity. Outcomes were assessed in participants with a valid MCED test result and diagnostic resolution. SYMPLIFY is registered with ISRCTN (ISRCTN10226380) and has completed follow-up at all sites. FINDINGS 6238 participants were recruited between July 7 and Nov 30, 2021, across 44 hospital sites. 387 were excluded due to staff being unable to draw blood, sample errors, participant withdrawal, or identification of ineligibility after enrolment. Of 5851 clinically evaluable participants, 376 had no MCED test result and 14 had no information as to final diagnosis, resulting in 5461 included in the final cohort for analysis with an evaluable MCED test result and diagnostic outcome (368 [6·7%] with a cancer diagnosis and 5093 [93·3%] without a cancer diagnosis). The median age of participants was 61·9 years (IQR 53·4-73·0), 3609 (66·1%) were female and 1852 (33·9%) were male. The MCED test detected a cancer signal in 323 cases, in whom 244 cancer was diagnosed, yielding a positive predictive value of 75·5% (95% CI 70·5-80·1), negative predictive value of 97·6% (97·1-98·0), sensitivity of 66·3% (61·2-71·1), and specificity of 98·4% (98·1-98·8). Sensitivity increased with increasing age and cancer stage, from 24·2% (95% CI 16·0-34·1) in stage I to 95·3% (88·5-98·7) in stage IV. For cases in which a cancer signal was detected among patients with cancer, the MCED test's prediction of the site of origin was accurate in 85·2% (95% CI 79·8-89·3) of cases. Sensitivity 80·4% (95% CI 66·1-90·6) and negative predictive value 99·1% (98·2-99·6) were highest for patients with symptoms mandating investigation for upper gastrointestinal cancer. INTERPRETATION This first large-scale prospective evaluation of an MCED diagnostic test in a symptomatic population demonstrates the feasibility of using an MCED test to assist clinicians with decisions regarding urgency and route of referral from primary care. Our data provide the basis for a prospective, interventional study in patients presenting to primary care with non-specific signs and symptoms. FUNDING GRAIL Bio UK.
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Affiliation(s)
- Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Pradeep S Virdee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - John Es Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zaed Hamady
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vinay Sehgal
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew Millar
- North Middlesex Hospital NHS Foundation Trust, London, UK
| | - Louise Medley
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Monika Vargova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lazarina Engonidou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sarah Pearson
- Department of Oncology, University of Oxford, Oxford, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bowcock S, Atkin C, Iqbal G, Pratt G, Yong K, Neal RD, Planche T, Karunanithi K, Jenkins S, Stern S, Arnott S, Toth P, Wandroo F, Dunn J, Drayson MT. Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial. Cancers (Basel) 2023; 15:3337. [PMID: 37444449 PMCID: PMC10341254 DOI: 10.3390/cancers15133337] [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: 02/28/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients' own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of 'bone pain', simply 'pain'. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47-8.44]), bone disease (OR 3.71 [CI 1.88-7.32]) and age >65 years (OR 1.58 [CI 1.15-2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28-3.91]), age >65 years (OR 2.14 [CI1.28-3.91]) and absence of back pain (OR 0.44 [CI 0.29-0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of 'symptom-directed' screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures.
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Affiliation(s)
- Stella Bowcock
- Department of Haematological Medicine, King’s College Hospital NHS Trust, London SE5 9RS, UK
- Princess Royal Hospital, King’s College Hospital NHS Trust, Orpington Common, London BR6 8ND, UK
| | - Catherine Atkin
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham B15 2GW, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Guy Pratt
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham B15 2TH, UK
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, London NW1 2BU, UK
| | - Richard D. Neal
- Department of Primary Care Medicine, University of Exeter, Exeter EX1 2LU, UK
| | - Tim Planche
- Department of Medical Microbiology, St George’s Hospital NHS Trust, London SW17 0QT, UK
| | - Kamaraj Karunanithi
- Royal Stoke University Hospital, University Hospitals North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK
| | - Stephen Jenkins
- Russell Halls Hospital, The Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK
| | - Simon Stern
- Epsom and St Helier NHS Trust, London SM5 1AA, UK
| | | | - Peter Toth
- Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
| | - Farooq Wandroo
- Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
| | - Mark T. Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
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Dera AA, Zaib S, Hussain N, Rana N, Javed H, Khan I. Identification of Potent Inhibitors Targeting EGFR and HER3 for Effective Treatment of Chemoresistance in Non-Small Cell Lung Cancer. Molecules 2023; 28:4850. [PMID: 37375404 DOI: 10.3390/molecules28124850] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. Despite the existence of various therapeutic options, NSCLC is still a major health concern due to its aggressive nature and high mutation rate. Consequently, HER3 has been selected as a target protein along with EGFR because of its limited tyrosine kinase activity and ability to activate PI3/AKT pathway responsible for therapy failure. We herein used a BioSolveIT suite to identify potent inhibitors of EGFR and HER3. The schematic process involves screening of databases for constructing compound library comprising of 903 synthetic compounds (602 for EGFR and 301 for HER3) followed by pharmacophore modeling. The best docked poses of compounds with the druggable binding site of respective proteins were selected according to pharmacophore designed by SeeSAR version 12.1.0. Subsequently, preclinical analysis was performed via an online server SwissADME and potent inhibitors were selected. Compound 4k and 4m were the most potent inhibitors of EGFR while 7x effectively inhibited the binding site of HER3. The binding energies of 4k, 4m, and 7x were -7.7, -6.3 and -5.7 kcal/mol, respectively. Collectively, 4k, 4m and 7x showed favorable interactions with the most druggable binding sites of their respective proteins. Finally, in silico pre-clinical testing by SwissADME validated the non-toxic nature of compounds 4k, 4m and 7x providing a promising treatment option for chemoresistant NSCLC.
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Affiliation(s)
- Ayed A Dera
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Sumera Zaib
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain P.O. Box 64141, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Nehal Rana
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Hira Javed
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Imtiaz Khan
- Department of Chemistry and Manchester Institute of Biotechnology, The University of Manchester, 131 Princess Street, Manchester M1 7DN, UK
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Martins T, Ukoumunne OC, Lyratzopoulos G, Hamilton W, Abel G. Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study. Cancers (Basel) 2023; 15:3100. [PMID: 37370710 PMCID: PMC10296232 DOI: 10.3390/cancers15123100] [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: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated ethnic differences in the presenting features recorded in primary care before cancer diagnosis. METHODS English population-based cancer-registry-linked primary care data were analysed. We identified the coded features of six cancers (breast, lung, prostate, colorectal, oesophagogastric, and myeloma) in the year pre-diagnosis. Logistic regression models investigated ethnic differences in first-incident cancer features, adjusted for age, sex, smoking status, deprivation, and comorbidity. RESULTS Of 130,944 patients, 92% were White. In total, 188,487 incident features were recorded in the year pre-diagnosis, with 48% (89,531) as sole features. Compared with White patients, Asian and Black patients with breast, colorectal, and prostate cancer were more likely than White patients to have multiple features; the opposite was seen for the Black and Other ethnic groups with lung or prostate cancer. The proportion with relevant recorded features was broadly similar by ethnicity, with notable cancer-specific exceptions. Asian and Black patients were more likely to have low-risk features (e.g., cough, upper abdominal pain) recorded. Non-White patients were less likely to have alarm features. CONCLUSION The degree to which these differences reflect disease, patient or healthcare factors is unclear. Further research examining the predictive value of cancer features in ethnic minority groups and their association with cancer outcomes is needed.
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Affiliation(s)
- Tanimola Martins
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK;
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Willie Hamilton
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
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45
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Elshami M, Ayyad M, Hamdan FK, Alser M, Al-Slaibi I, Naji SA, Mohamad BM, Isleem WS, Shurrab A, Yaghi B, Qabaja YA, Dwikat MF, Sweity RR, Jneed RT, Assaf KA, Albandak ME, Hmaid MM, Awwad II, Alhabil BK, Alarda MN, Alsattari AS, Aboyousef MS, Aljbour OA, AlSharif R, Giacaman CT, Alnaga AY, Nemer RMA, Almadhoun NM, Skaik SM, Abu-El-Noor N, Bottcher B. Perceived barriers to early presentation and symptom-specific time to seek medical advice for possible colorectal cancer symptoms among Palestinians. Sci Rep 2023; 13:6871. [PMID: 37105988 PMCID: PMC10140026 DOI: 10.1038/s41598-023-34136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
This study explored the anticipated time to seek medical advice for possible colorectal cancer (CRC) signs/symptoms and its association with CRC symptom awareness. In addition, it examined perceived barriers that may delay seeking medical advice. Palestinian adults were recruited from hospitals, primary healthcare centers, and public spaces in 11 governorates. A modified, translated-into-Arabic version of the validated Bowel Cancer Awareness Measure was used. The questionnaire comprised three sections: sociodemographics, assessment of CRC symptom awareness and time to seek medical advice, and barriers to early presentation. A total of 4623 participants were included. The proportion that reported seeking immediate medical advice for possible CRC signs/symptoms with blood or mass ranged from 47.1% for 'blood in stools' to 59.5% for 'bleeding from back passage'. Less than half of the participants reported immediate seeking of medical advice for non-specific symptoms (ranging from 5.4% for 'loss of appetite' to 42.0% for 'anemia') and other gastrointestinal symptoms (ranging from 7.7% for 'feeling persistently full' to 35.7% for 'change in bowel habits'). Good CRC symptom awareness was associated with higher likelihood of seeking medical advice within a week from recognizing a CRC symptom. About 13.0% reported a delay to visit their doctor after recognizing a CRC symptom. The most reported barriers were practical with 'would try some herbs first' (50.9%) as the leading barrier. CRC symptoms with blood or mass prompted earlier help seeking. Participants with good CRC awareness were more likely to seek medical advice within a week.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH, 44106, USA.
- Ministry of Health, Gaza, Palestine.
| | - Mohammed Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Mohammed Alser
- The United Nations Relief and Works Agency for Palestine Refugees in The Near East (UNRWA), Amman, Jordan
| | | | | | | | | | | | - Bashar Yaghi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | - Khayria Ali Assaf
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | | | | | - Iyas Imad Awwad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | | | - Rinad AlSharif
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | - Sondos Mahmoud Skaik
- Faculty of Medicine, Al-Quds Abu Dis University Al-Azhar Branch of Gaza, Gaza, Palestine
| | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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46
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Prado MG, Kessler LG, Au MA, Burkhardt HA, Zigman Suchsland M, Kowalski L, Stephens KA, Yetisgen M, Walter FM, Neal RD, Lybarger K, Thompson CA, Al Achkar M, Sarma EA, Turner G, Farjah F, Thompson MJ. Symptoms and signs of lung cancer prior to diagnosis: case-control study using electronic health records from ambulatory care within a large US-based tertiary care centre. BMJ Open 2023; 13:e068832. [PMID: 37080616 PMCID: PMC10124310 DOI: 10.1136/bmjopen-2022-068832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Lung cancer is the most common cause of cancer-related death in the USA. While most patients are diagnosed following symptomatic presentation, no studies have compared symptoms and physical examination signs at or prior to diagnosis from electronic health records (EHRs) in the USA. We aimed to identify symptoms and signs in patients prior to diagnosis in EHR data. DESIGN Case-control study. SETTING Ambulatory care clinics at a large tertiary care academic health centre in the USA. PARTICIPANTS, OUTCOMES We studied 698 primary lung cancer cases in adults diagnosed between 1 January 2012 and 31 December 2019, and 6841 controls matched by age, sex, smoking status and type of clinic. Coded and free-text data from the EHR were extracted from 2 years prior to diagnosis date for cases and index date for controls. Univariate and multivariable conditional logistic regression were used to identify symptoms and signs associated with lung cancer at time of diagnosis, and 1, 3, 6 and 12 months before the diagnosis/index dates. RESULTS Eleven symptoms and signs recorded during the study period were associated with a significantly higher chance of being a lung cancer case in multivariable analyses. Of these, seven were significantly associated with lung cancer 6 months prior to diagnosis: haemoptysis (OR 3.2, 95% CI 1.9 to 5.3), cough (OR 3.1, 95% CI 2.4 to 4.0), chest crackles or wheeze (OR 3.1, 95% CI 2.3 to 4.1), bone pain (OR 2.7, 95% CI 2.1 to 3.6), back pain (OR 2.5, 95% CI 1.9 to 3.2), weight loss (OR 2.1, 95% CI 1.5 to 2.8) and fatigue (OR 1.6, 95% CI 1.3 to 2.1). CONCLUSIONS Patients diagnosed with lung cancer appear to have symptoms and signs recorded in the EHR that distinguish them from similar matched patients in ambulatory care, often 6 months or more before diagnosis. These findings suggest opportunities to improve the diagnostic process for lung cancer.
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Affiliation(s)
- Maria G Prado
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Larry G Kessler
- Health Services, University of Washington, Seattle, Washington, USA
| | - Margaret A Au
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Hannah A Burkhardt
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | | | - Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- The Primary Care Unit Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kevin Lybarger
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Caroline A Thompson
- Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Grace Turner
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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47
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Black GB, Boswell L, Harris J, Whitaker KL. What causes delays in diagnosing blood cancers? A rapid review of the evidence. Prim Health Care Res Dev 2023; 24:e26. [PMID: 37039465 PMCID: PMC10156470 DOI: 10.1017/s1463423623000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours. METHODS We used rapid review methodology following Tricco et al. to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English. RESULTS Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals' (HCPs') non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway. CONCLUSION Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
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Affiliation(s)
- Georgia B. Black
- Reader in Applied Health Research, Wolfson Institute of Population Health,
Queen Mary University of London, London,
UK
| | - Laura Boswell
- PhD student, School of Health Sciences, University of
Surrey, Guildford, UK
| | - Jenny Harris
- Senior Lecturer in Cancer Care, School of Health Sciences,
University of Surrey, Guildford,
UK
| | - Katriina L. Whitaker
- Professor of Psychology and Lead for Cancer Care, School of Health
Sciences, University of Surrey, Guildford,
UK
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48
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Factors influencing the timeliness of care for patients with lung cancer in Bangladesh. BMC Health Serv Res 2023; 23:261. [PMID: 36927788 PMCID: PMC10018894 DOI: 10.1186/s12913-023-09154-8] [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: 04/05/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND This study explored the factors associated with timeliness of care in the healthcare seeking pathway among patients with lung cancer in Bangladesh. METHODS A structured questionnaire was used for data collection from 418 patients with lung cancer through face-to-face interviews in three tertiary care hospitals. Log-rank tests were performed to test differences in the length of intervals between points in healthcare by socioeconomic characteristics and care seeking behaviours of the patients. Cox Proportional Hazard (PH) regression analysis was performed to identify the predictors of the intervals after adjustment for variations in other variables. RESULTS A higher education level was associated significantly (p < 0.05) with a shorter interval between first contact with a healthcare provider (HCP) and diagnosis (median 81 days) and initiation of treatment (median 101 days). Higher monthly household income was associated significantly with a shorter time from first contact and diagnosis (median 91 days), onset of symptom and diagnosis (median 99 days), onset of symptom and treatment (median 122 days), and first contact with any HCP to treatment (median 111 days). Consulting with additional HCPs prior to diagnosis was associated significantly with longer intervals from first contact with any HCP and diagnosis (median 127 days), onset of symptom and diagnosis (median 154 days), onset of symptom and treatment (median 205 days), and first contact with any HCP to treatment (median 174 days). Consulting with informal HCPs was associated significantly with a longer time interval from symptom to treatment (median 171 days). Having more than one triggering symptom was associated significantly with a shorter interval between onset of symptoms and first contact with any HCP. CONCLUSION The predictors for timeliness of lung cancer care used in this study affected different intervals in the care seeking pathway. Higher education and income predicted shorter intervals whereas consulting informal healthcare providers and multiple providers were associated with longer intervals.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia. .,Institute for Breathing and Sleep (IBAS), Melbourne, Australia.
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.,Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Department of Respiratory & Sleep Medicine, Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia.,Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia.,School of Health, Federation University Australia, Berwick, 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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49
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Smith L, Carmichael J, Cook G, Shinkins B, Neal RD. Development and Internal Validation of a Risk Prediction Model to Identify Myeloma Based on Routine Blood Tests: A Case-Control Study. Cancers (Basel) 2023; 15:975. [PMID: 36765931 PMCID: PMC9913376 DOI: 10.3390/cancers15030975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Myeloma is one of the hardest cancers to diagnose in primary care due to its rarity and non-specific symptoms. A rate-limiting step in diagnosing myeloma is the clinician considering myeloma and initiating appropriate investigations. We developed and internally validated a risk prediction model to identify those with a high risk of having undiagnosed myeloma based on results from routine blood tests taken for other reasons. A case-control study, based on 367 myeloma cases and 1488 age- and sex-matched controls, was used to develop a risk prediction model including results from 15 blood tests. The model had excellent discrimination (C-statistic 0.85 (95%CI 0.83, 0.89)) and good calibration (calibration slope 0.87 (95%CI 0.75, 0.90)). At a prevalence of 15 per 100,000 population and a probability threshold of 0.4, approximately 600 patients would need additional reflex testing to detect one case. We showed that it is possible to combine signals and abnormalities from several routine blood test parameters to identify individuals at high-risk of having undiagnosed myeloma who may benefit from additional reflex testing. Further work is needed to explore the full potential of such a strategy, including whether it is clinically useful and cost-effective and how to make it ethically acceptable.
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Affiliation(s)
- Lesley Smith
- Leeds Diagnosis and Screening Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Jonathan Carmichael
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds LS2 9JT, UK
- NIHR (Leeds) Medtech & In Vitro Diagnostics Cooperative, Leeds LS2 9JT, UK
| | - Gordon Cook
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds LS2 9JT, UK
- NIHR (Leeds) Medtech & In Vitro Diagnostics Cooperative, Leeds LS2 9JT, UK
| | - Bethany Shinkins
- Leeds Diagnosis and Screening Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK
- NIHR (Leeds) Medtech & In Vitro Diagnostics Cooperative, Leeds LS2 9JT, UK
| | - Richard D. Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX2 5DW, UK
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Price S, Wiering B, Mounce LTA, Hamilton W, Abel G. Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: An exemplar applied to oesophagogastric cancer. Cancer Epidemiol 2023; 82:102310. [PMID: 36508967 DOI: 10.1016/j.canep.2022.102310] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current methods for estimating the timeliness of cancer diagnosis are not robust because dates of key defining milestones, for example first presentation, are uncertain. This is exacerbated when patients have other conditions (multimorbidity), particularly those that share symptoms with cancer. Methods independent of this uncertainty are needed for accurate estimates of the timeliness of cancer diagnosis, and to understand how multimorbidity impacts the diagnostic process. METHODS Participants were diagnosed with oesophagogastric cancer between 2010 and 2019. Controls were matched on year of birth, sex, general practice and multimorbidity burden calculated using the Cambridge Multimorbidity Score. Primary care data (Clinical Practice Research Datalink) was used to explore population-level consultation rates for up to two years before diagnosis across different multimorbidity burdens. Five approaches were compared on the timing of the consultation frequency increase, the inflection point for different multimorbidity burdens, different aggregated time-periods and sample sizes. RESULTS We included 15,410 participants, of which 13,328 (86.5 %) had a measurable multimorbidity burden. Our new maximum likelihood estimation method found evidence that the inflection point in consultation frequency varied with multimorbidity burden, from 154 days (95 %CI 131.8-176.2) before diagnosis for patients with no multimorbidity, to 126 days (108.5-143.5) for patients with the greatest multimorbidity burden. Inflection points identified using alternative methods were closer to diagnosis for up to three burden groups. Sample size reduction and changing the aggregation period resulted in inflection points closer to diagnosis, with the smallest change for the maximum likelihood method. DISCUSSION Existing methods to identify changes in consultation rates can introduce substantial bias which depends on sample size and aggregation period. The direct maximum likelihood method was less prone to this bias than other methods and offers a robust, population-level alternative for estimating the timeliness of cancer diagnosis.
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Affiliation(s)
- Sarah Price
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - Bianca Wiering
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - Luke T A Mounce
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - Willie Hamilton
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - Gary Abel
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
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