1
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Strous MTA, Molenaar CJL, Franssen RFW, van Osch F, Belgers E, Bloemen JG, Slooter GD, Melenhorst J, Heemskerk J, de Bruïne AP, Janssen-Heijnen MLG, Vogelaar FJ. Treatment interval in curative treatment of colon cancer, does it impact (cancer free) survival? A non-inferiority analysis. Br J Cancer 2024; 130:251-259. [PMID: 38087040 PMCID: PMC10803312 DOI: 10.1038/s41416-023-02505-6] [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: 07/04/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND In treatment of colon cancer, strict waiting-time targets are enforced, leaving professionals no room to lengthen treatment intervals when advisable, for instance to optimise a patient's health status by means of prehabilitation. Good quality studies supporting these targets are lacking. With this study we aim to establish whether a prolonged treatment interval is associated with a clinically relevant deterioration in overall and cancer free survival. METHODS This retrospective multicenter non-inferiority study includes all consecutive patients who underwent elective oncological resection of a biopsy-proven primary non-metastatic colon carcinoma between 2010 and 2016 in six hospitals in the Southern Netherlands. Treatment interval was defined as time between diagnosis and surgical treatment. Cut-off points for treatment interval were ≤35 days and ≤49 days. FINDINGS 3376 patients were included. Cancer recurred in 505 patients (15.0%) For cancer free survival, a treatment interval >35 days and >49 days was non-inferior to a treatment interval ≤35 days. Results for overall survival were inconclusive, but no association was found. CONCLUSION For cancer free survival, a prolonged treatment interval, even over 49 days, is non-inferior to the currently set waiting-time target of ≤35 days. Therefore, the waiting-time targets set as fundamental objective in current treatment guidelines should become directional instead of strict targets.
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Affiliation(s)
- Maud T A Strous
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands.
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | | | - Ruud F W Franssen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frits van Osch
- Department of Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Eric Belgers
- Department of Surgery, Zuyderland Hospital, Heerlen, The Netherlands
| | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Jarno Melenhorst
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeroen Heemskerk
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | | | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Beaubrun-Renard M, Ulric-Gervaise S, Veronique-Baudin J, Macni J, Almont T, Aline-Fardin A, Furtos C, Jean-Laurent M, Escarmant P, Bougas S, Cabie A, Joachim C. Breast cancer time to treatment in Martinique: predictive factors and effect on survival. Public Health 2023; 225:147-150. [PMID: 37925839 DOI: 10.1016/j.puhe.2023.09.011] [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: 04/11/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Martinique is the second French Region with the lowest physician-to-population ratio, which may affect waiting times for access to care. OBJECTIVES To assess (i) factors influencing waiting times from diagnosis to cancer-related treatments in breast cancer women in Martinique, and (ii) the impact of waiting times on patients' survival. STUDY DESIGN Retrospective observational study. METHODS Data on women diagnosed with invasive breast cancer between 1st January 2013 and 31st December 2017 and initially treated by surgery were extracted from the Martinique population-based registry. A cox model was performed to find predictive factors for waiting times. A log-rank test was used to compare time-to-treatment between groups. RESULTS In total, 713 patients were included (mean age: 58 ± 13). Median time from diagnosis to surgery was 40 [25-60] days. Age at diagnosis was found to predict variations in waiting times. Patients > 75 had longer waiting time to surgery than those < 40 or [40-50] (P = 0.016 and P < 0.001, respectively). Women with a time-to-treatment ≥ 4 months had a significant lower survival (P < 0.01). CONCLUSIONS Specific interventions are needed to improve waiting time from diagnosis to initial treatment, as they are longer than recommended and affect survival time.
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Affiliation(s)
- M Beaubrun-Renard
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France; PCCEI, Université de Montpellier, INSERM, EFS, Université Antilles, Montpellier, France.
| | - S Ulric-Gervaise
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - J Veronique-Baudin
- UF 3596 Recherche en cancérologie hématologie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - J Macni
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - T Almont
- UF 3596 Recherche en cancérologie hématologie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - A Aline-Fardin
- Laboratoire d'anatomopathologie, Pôle de Biologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - C Furtos
- UF 1450 - Oncologie Médicale Hospitalisation de Semaine, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - M Jean-Laurent
- Unité de chirurgie gynécologique et mammaire, Maison de la Femme de la Mère et de l'Enfant, CHU de Martinique, Fort-de-France, Martinique, France
| | - P Escarmant
- Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - S Bougas
- UF 1401 Radiothérapie, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
| | - A Cabie
- PCCEI, Université de Montpellier, INSERM, EFS, Université Antilles, Montpellier, France; Service des maladies infectieuses et tropicales, Martinique, CHU de Martinique, Fort-de-France, Martinique, France; CIC-1424, INSERM, CHU de Martinique, Fort-de-France, Martinique, France
| | - C Joachim
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie, CHU de Martinique, Fort-de-France, Martinique, France
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3
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Bosque-Mercader L, Carrilero N, García-Altés A, López-Casasnovas G, Siciliani L. Socioeconomic inequalities in waiting times for planned and cancer surgery: Evidence from Spain. HEALTH ECONOMICS 2023; 32:1181-1201. [PMID: 36772982 DOI: 10.1002/hec.4661] [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: 05/26/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Waiting times act as a non-price rationing mechanism to bring together the demand for and the supply of public healthcare services and ensure equal access independently of ability to pay. This study tests for the presence of socioeconomic inequalities in waiting times for ten publicly-funded planned and cancer surgeries in Catalonia (Spain) in 2015-2019. Socioeconomic status (SES), measured by four categories (very low, low, middle, high), is based on co-payment levels for medicines which depend on patient's income. Using administrative data, we estimate the association between SES and waiting times controlling for patient characteristics and hospital fixed effects. Compared to patients with low SES, patients with middle SES wait 2-6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. These inequalities arise within hospitals and are not explained by patient nor hospital characteristics. For some surgeries, the results also show that patients with higher SES are more likely to voluntarily exit the waiting list and have a lower probability of having a surgery canceled for medical reasons and dying while waiting.
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Affiliation(s)
- Laia Bosque-Mercader
- Nuffield Department of Primary Care Health Sciences, Centre for Health Service Economics and Organisation, University of Oxford, Oxford, UK
- Department of Economics and Related Studies, University of York, York, UK
| | - Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, UK
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Kerekes DM, Frey AE, Bakkila BF, Johnson CH, Becher RD, Billingsley KG, Khan SA. Hepatopancreatobiliary malignancies: time to treatment matters. J Gastrointest Oncol 2023; 14:833-848. [PMID: 37201090 PMCID: PMC10186552 DOI: 10.21037/jgo-22-1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Background Initiation of oncologic care is often delayed, yet little is known about delays in hepatopancreatobiliary (HPB) cancers or their impact. This retrospective cohort study describes trends in time to treatment initiation (TTI), assesses the association between TTI and survival, and identifies predictors of TTI in HPB cancers. Methods The National Cancer Database was queried for patients with cancers of the pancreas, liver, and bile ducts between 2004 and 2017. Kaplan-Meier survival analysis and Cox regression were used to investigate the association between TTI and overall survival for each cancer type and stage. Multivariable regression identified factors associated with longer TTI. Results Of 318,931 patients with HPB cancers, median TTI was 31 days. Longer TTI was associated with increased mortality in patients with stages I-III extrahepatic bile duct (EHBD) cancer and stages I-II pancreatic adenocarcinoma. Patients treated within 3-30, 31-60, and 61-90 days had median survivals of 51.5, 34.9, and 25.4 months (log-rank P<0.001), respectively, for stage I EHBD cancer, and 18.8, 16.6, and 15.2 months for stage I pancreatic cancer, respectively (P<0.001). Factors associated with increased TTI included stage I disease (+13.7 days vs. stage IV, P<0.001), treatment with radiation only (β=+13.9 days, P<0.001), Black race (+4.6 days, P<0.001) and Hispanic ethnicity (+4.3 days, P<0.001). Conclusions Some HPB cancer patients with longer time to definitive care experienced higher mortality than patients treated expeditiously, particularly in non-metastatic EHBD cancer. Black and Hispanic patients are at risk for delayed treatment. Further research into these associations is needed.
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Affiliation(s)
| | | | | | - Caroline H. Johnson
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Robert D. Becher
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Sajid A. Khan
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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5
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Aparicio A, Guzman P, Morera M, Calvo Y, Obando M, Landaverde D, González I, Ramirez-Pena E. The First Population-Level Description of Women Diagnosed With Invasive Breast Cancer in Costa Rica From 2008 to 2012: A Cross-Sectional Study. Cancer Control 2023; 30:10732748231193550. [PMID: 37589443 PMCID: PMC10437208 DOI: 10.1177/10732748231193550] [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: 03/15/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Breast cancer is the leading cause of cancer-related deaths among women worldwide. In Costa Rica, it ranks first in incidence and fourth in terms of mortality. However, there is a lack of comprehensive information on treatment patterns and outcomes for breast cancer patients in Costa Rica. METHODS This study utilized data from the National Tumor Registry, which was merged with the Costa Rica Social Security Fund (CCSS) to ensure comprehensive access to clinical information. The study is prospective and focused on patients diagnosed with breast cancer between January 2008 and December 2012. This combined dataset allowed for a more comprehensive analysis of patient characteristics, treatment patterns, and outcomes related to breast cancer in Costa Rica. RESULTS Among the 4775 patients diagnosed during this period, 3160 met the inclusion criteria for our study. The average age at diagnosis was 59.1 years, with 32.5% of patients being over the age of 65. Most of the patients (55.4%) identified themselves as homemakers, while 46.5% underwent core needle biopsy for diagnosis. Approximately 60% of women were diagnosed with early-stage disease (IA, IIA, and IIB), while 1.7% had metastatic disease, mainly affecting the bone. The mean interval between diagnosis and surgery was 72 days. Most patients (88.7%) received surgery as their initial treatment, and over half (54.4%) received some form of adjuvant therapy. Additionally, 85.6% of patients completed their prescribed treatment. CONCLUSION This study provides a comprehensive and detailed description of the characteristics and treatment patterns among breast cancer patients in Costa Rica. The findings contribute to our understanding of the disease in this population and can serve as a foundation for further research and improvement in breast cancer management and care.
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Affiliation(s)
| | - Percy Guzman
- Cancer Prevention Fellowship Program (CPFP), Division of Cancer Prevention (DCP), National Cancer Institute (NCI), Bethesda, MD, USA
- Health Assessment Research Branch (HARB), Health Delivery Research Program (HDRP), Division of Cancer Control and Population Sciences (DCCPS), Bethesda, MD, USA
| | - Melvin Morera
- Costa Rica Social Security Fund, San Jose, Costa Rica
| | - Yoleni Calvo
- Costa Rica Social Security Fund, San Jose, Costa Rica
| | | | | | | | - Esmeralda Ramirez-Pena
- Cancer Prevention Fellowship Program (CPFP), Division of Cancer Prevention (DCP), National Cancer Institute (NCI), Bethesda, MD, USA
- Surveillance Research Program (SRP), Division of Cancer Control and Population Sciences (DCCPS), National Cancer Institute (NCI), Bethesda, MD, USA
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6
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Martinez A, Daubisse‐Marliac L, Lacaze J, Pons‐Tostivint E, Bauvin E, Delpierre C, Grosclaude P, Lamy S. Treatment time interval in breast cancer: A population-based study on the impact of type and number of cancer centres attended. Eur J Cancer Care (Engl) 2022; 31:e13654. [PMID: 35866619 PMCID: PMC9786268 DOI: 10.1111/ecc.13654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We studied both the independent and combined effects of the places of biopsy and treatment on the treatment time interval based on a population-based study. METHODS We analysed the proportion of patients having a treatment time interval higher than the EUSOMA recommendation of 6 weeks, as a function of the number and the type of care centres the patients attended, from a French population-based regional cohort of women treated in 2015 for an incident invasive non-metastatic cancer (n = 505). RESULTS About 33% [95% CI: 27; 38] of patients had a treatment time interval higher than 6 weeks. About 48% of the patients underwent their biopsy and their initial treatment in the different centres. Results from multivariable analyses supported the impact of the type and number of centres attended on the proportion of time intervals over 6 weeks. This proportion was higher among patients with biopsy and treatment in different centres and among patients treated in a university hospital. CONCLUSION We pointed out the independent impact of the type and the number of care centres the patients attended, from biopsy to first treatment, on the treatment time interval, which is a well-known prognosis factor.
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Affiliation(s)
- Amalia Martinez
- CERPOP, Université de Toulouse, Inserm, UPSToulouseFrance,Equipe labélisée LIGUE Contre le cancer, Faculté de Médecine, UMR 1295 InsermToulouseFrance,Regional Cancer Network of Occitanie (Onco‐Occitanie)ToulouseFrance
| | - Laetitia Daubisse‐Marliac
- CERPOP, Université de Toulouse, Inserm, UPSToulouseFrance,Equipe labélisée LIGUE Contre le cancer, Faculté de Médecine, UMR 1295 InsermToulouseFrance,Tarn Cancer Registry, Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance,Cancerology Coordination CentreToulouse University Hospital, IUCT‐OncopoleToulouseFrance,Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance
| | - Jean‐Louis Lacaze
- Department of Medical Oncology, Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance
| | | | - Eric Bauvin
- CERPOP, Université de Toulouse, Inserm, UPSToulouseFrance,Equipe labélisée LIGUE Contre le cancer, Faculté de Médecine, UMR 1295 InsermToulouseFrance,Regional Cancer Network of Occitanie (Onco‐Occitanie)ToulouseFrance
| | - Cyrille Delpierre
- CERPOP, Université de Toulouse, Inserm, UPSToulouseFrance,Equipe labélisée LIGUE Contre le cancer, Faculté de Médecine, UMR 1295 InsermToulouseFrance
| | - Pascale Grosclaude
- CERPOP, Université de Toulouse, Inserm, UPSToulouseFrance,Equipe labélisée LIGUE Contre le cancer, Faculté de Médecine, UMR 1295 InsermToulouseFrance,Tarn Cancer Registry, Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance,Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance
| | - Sébastien Lamy
- CERPOP, Université de Toulouse, Inserm, UPSToulouseFrance,Equipe labélisée LIGUE Contre le cancer, Faculté de Médecine, UMR 1295 InsermToulouseFrance,Tarn Cancer Registry, Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance,Claudius Regaud InstituteIUCT‐OncopoleToulouseFrance
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2021; 24:1-332. [PMID: 33252328 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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8
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Johnson BA, Waddimba AC, Ogola GO, Fleshman JW, Preskitt JT. A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic. Am J Surg 2020; 222:311-318. [PMID: 33317814 PMCID: PMC7834494 DOI: 10.1016/j.amjsurg.2020.12.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
Background Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers. Methods PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included. Results Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28–1.65), lung (HR 1.04, 95%CI 1.02–1.06) and colon (HR 1.24, 95%CI 1.12–1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16–1.40) and II (HR 1.13, 95%CI 1.02–1.24) but not in stage III (HR 1.20, 95%CI 0.94–1.53). Conclusion Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival. Delaying cancer surgeries during the COVID-19 pandemic may impact survival. Surgical delays of 12 weeks decreases survival in breast, lung and colon cancers. Surgical delays worsen survival in stage I and II breast cancers but not stage III. Triage recommendations for future waves of COVID-19 should consider this evidence.
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Affiliation(s)
- Brett A Johnson
- College of Medicine, Texas A&M Health Science Center, Dallas Campus, Texas, United States; Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - Anthony C Waddimba
- Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States; Baylor Scott and White Research Institute, Dallas, TX, United States.
| | - Gerald O Ogola
- Baylor Scott and White Research Institute, Dallas, TX, United States; Biostatistics, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - James W Fleshman
- Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - John T Preskitt
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
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9
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Agodirin O, Olatoke S, Rahman G, Olaogun J, Kolawole O, Agboola J, Olasehinde O, Katung A, Ayandipo O, Etonyeaku A, Ajiboye A, Oguntola S, Fatudimu O. Impact of Primary Care Delay on Progression of Breast Cancer in a Black African Population: A Multicentered Survey. J Cancer Epidemiol 2019; 2019:2407138. [PMID: 31485229 PMCID: PMC6702851 DOI: 10.1155/2019/2407138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/30/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reports are scanty on the impact of long primary care interval in breast cancer. Exploratory reports in Nigeria and other low-middle-income countries suggest detrimental impact. The primary aim was to describe the impact of long primary care interval on breast cancer progression, and the secondary aim was to describe the factors perceived by patients as the reason(s) for long intervals. METHOD Questionnaire-based survey was used in 9 Nigerian tertiary institutions between May 2017 and July 2018. The study hypothesis was that the majority of patients stayed >30 days, and the majority experienced stage migration in primary care interval. Assessment of the impact of the length of interval on tumor stage was done by survival analysis technique, and clustering analysis was used to find subgroups of the patient journey. RESULTS A total of 237 patients presented to primary care personnel with tumor ≤5cm (mean 3.4±1.2cm). A total of 151 (69.3%, 95% CI 62.0-75.0) stayed >30 days in primary care interval. Risk of stage migration in primary care interval was 49.3% (95% CI 42.5%-56.3%). The most common reasons for long intervals were symptom misinformation and misdiagnosis. Clustering analysis showed 4 clusters of patients' experience and journey: long interval due to distance, long interval due to misinformation, long interval due to deliberate delaying, and not short interval-prepared for treatment. CONCLUSION The majority of patients stayed longer than 30 days in primary care interval. Long primary care interval was associated with a higher risk of stage migration, and more patients reported misinformation and misdiagnosis as reasons for a long interval.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | - Ganiyu Rahman
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Julius Olaogun
- Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladapo Kolawole
- Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - John Agboola
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | | | - Aba Katung
- Department of Surgery, Federal Medical Center, Owo, Nigeria
| | | | | | - Anthony Ajiboye
- Department of Surgery, Bowen University Teaching Hospital, Nigeria
| | - Soliu Oguntola
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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Tørring ML, Falborg AZ, Jensen H, Neal RD, Weller D, Reguilon I, Menon U, Vedsted P, Almberg SS, Anandan C, Barisic A, Boylan J, Cairnduff V, Donnelly C, Fourkala EO, Gavin A, Grunfeld E, Hammersley V, Hawryluk B, Kearney T, Kelly J, Knudsen AK, Lambe M, Law R, Lin Y, Malmberg M, Moore K, Turner D, White V. Advanced‐stage cancer and time to diagnosis: An International Cancer Benchmarking Partnership (ICBP) cross‐sectional study. Eur J Cancer Care (Engl) 2019; 28:e13100. [DOI: 10.1111/ecc.13100] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/17/2019] [Accepted: 05/01/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Marie L. Tørring
- Department of Anthropology, School of Culture and Society Aarhus University Højbjerg Denmark
| | - Alina Z. Falborg
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care Aarhus C Denmark
| | - Henry Jensen
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care Aarhus C Denmark
| | - Richard D. Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences University of Leeds Leeds UK
| | - David Weller
- Centre for Population Health Sciences University of Edinburgh Edinburgh UK
| | | | - Usha Menon
- Gynaecological Cancer Research Centre, Institute for Women's Health University College London London UK
| | - Peter Vedsted
- Research Unit for General Practice Research Centre for Cancer Diagnosis in Primary Care Aarhus C Denmark
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11
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du Rouchet E, Dendoncker C. Accès au premier traitement : apport d’un centre de prise en charge rapide. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pour une patiente porteuse d’un cancer du sein, l’accès au premier traitement comprend plusieurs étapes : établissement d’un diagnostic anatomopathologique, annonce et établissement du plan personnalisé de soins, bilans préthérapeutiques, accès au plateau technique. La durée du délai global de ce parcours intervient dans le pronostic de la maladie pour les stades précoces. De plus, il convient de gérer toutes les incertitudes, diagnostiques puis pronostiques, qui vont inévitablement bouleverser l’équilibre psychologique de la patiente. À la lumière des écrits, des recommandations et de l’expérience de plus de 20 ans d’un centre multidisciplinaire, les auteurs proposent une organisation de centre expert de prise en charge de la personne avec suspicion de cancer du sein, dans son intégralité somatique et psychique.
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12
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Di Girolamo C, Walters S, Gildea C, Benitez Majano S, Rachet B, Morris M. Can we assess Cancer Waiting Time targets with cancer survival? A population-based study of individually linked data from the National Cancer Waiting Times monitoring dataset in England, 2009-2013. PLoS One 2018; 13:e0201288. [PMID: 30133466 PMCID: PMC6104918 DOI: 10.1371/journal.pone.0201288] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cancer Waiting Time targets have been integrated into successive cancer strategies as indicators of cancer care quality in England. These targets are reported in national statistics for all cancers combined, but there is mixed evidence of their benefits and it is unclear if meeting Cancer Waiting Time targets, as currently defined and published, is associated with improved survival for individual patients, and thus if survival is a good metric for judging the utility of the targets. METHODS AND FINDINGS We used individually-linked data from the National Cancer Waiting Times Monitoring Dataset (CWT), the cancer registry and other routinely collected datasets. The study population consisted of all adult patients diagnosed in England (2009-2013) with colorectal (164,890), lung (171,208) or ovarian (24,545) cancer, of whom 82%, 76%, and 77%, respectively, had a CWT matching record. The main outcome was one-year net survival for all matched patients by target attainment ('met/not met'). The time to each type of treatment for the 31-day and 62-day targets was estimated using multivariable analyses, adjusting for age, sex, tumour stage and deprivation. The two-week wait (TWW) from GP referral to specialist consultation and 31-day target from decision to treat to start of treatment were met for more than 95% of patients, but the 62-day target from GP referral to start of treatment was missed more often. There was little evidence of an association between meeting the TWW target and one-year net survival, but for the 31-day and 62-day targets, survival was worse for those for whom the targets were met (e.g. colorectal cancer: survival 89.1% (95%CI 88.9-89.4) for patients with 31-day target met, 96.9% (95%CI 96.1-91.7) for patients for whom it was not met). Time-to-treatment analyses showed that treatments recorded as palliative were given earlier in time, than treatments with potentially curative intent. There are possible limitations in the accuracy of the categorisation of treatment variables which do not allow for fully distinguishing, for example, between curative and palliative intent; and it is difficult in these data to assess the appropriateness of treatment by stage. These limitations in the nature of the data do not affect the survival estimates found, but do mean that it is not possible to separate those patients for whom the times between referral, decision to treat and start of treatment could actually have an impact on the clinical outcomes. This means that the use of these survival measures to evaluate the targets would be misleading. CONCLUSIONS Based on these individually-linked data, and for the cancers we looked at, we did not find that Cancer Waiting Time targets being met translates into improved one-year survival. Patients may benefit psychologically from limited waits which encourage timely treatment, but one-year survival is not a useful measure for evaluating Trust performance with regards to Cancer Waiting Time targets, which are not currently stratified by stage or treatment type. As such, the current composition of the data means target compliance needs further evaluation before being used for the assessment of clinical outcomes.
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Affiliation(s)
- Chiara Di Girolamo
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Medical and Surgical Sciences, Alma Mater Studorium–University of Bologna, Bologna, Italy
| | - Sarah Walters
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carolynn Gildea
- National Cancer Registration and Analysis Service, Public Health England, Vulcan House Steel, Sheffield, United Kingdom
| | - Sara Benitez Majano
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bernard Rachet
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Melanie Morris
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Nascimento MID, Silva GAE. [Effect of waiting time for radiotherapy on five-year overall survival in women with cervical cancer, 1995-2010]. CAD SAUDE PUBLICA 2016; 31:2437-48. [PMID: 26840822 DOI: 10.1590/0102-311x00004015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022] Open
Abstract
Overall 5-year survival and factors associated with death were evaluated in a cohort of 342 women with cervical cancer referred to radiotherapy in the Baixada Fluminense, in Greater Metropolitan Rio de Janeiro State, Brazil. Overall 5-year survival was 25.3%, reaching 60.8% in women with stage IIA or less. The model adjusted by extended Cox proportional regression showed an increase in mortality risk for patients with stages IIB-IIIB (HR = 1.89; 95%CI: 1.214; 2.957) and IVA-IVB (HR = 5.78; 95%CI: 2.973; 11.265). Cytology in asymptomatic women (HR = 0.58; 95%CI: 0.362; 0.961) and referral for first consultation in an oncology service in the Baixada Fluminense (HR = 0.60; 95%CI: 0.418; 0.875) were the main protective factors identified by the study. Waiting time (> 60 versus ≤ 60 days) was not statistically significant, but a delay of 4 days worsened the outcome. The 60-day limit for initiating radiotherapy should be respected, because delay greater than 64 days showed a significant association between all waiting time cut-off points and 5-year mortality risk.
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Affiliation(s)
| | - Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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14
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Ayrault-Piault S, Grosclaude P, Daubisse-Marliac L, Pascal J, Leux C, Fournier E, Tagri AD, Métais M, Lombrail P, Woronoff AS, Molinié F. Are disparities of waiting times for breast cancer care related to socio-economic factors? A regional population-based study (France). Int J Cancer 2016; 139:1983-93. [PMID: 27405647 DOI: 10.1002/ijc.30266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/30/2016] [Indexed: 01/27/2023]
Abstract
The increasing number of breast cancer cases may induce longer waiting times (WT), which can be a source of anxiety for patients and may play a role in survival. The aim of this study was to examine the factors, in particular socio-economic factors, related to treatment delays. Using French Cancer Registry databases and self-administered questionnaires, we included 1,152 women with invasive non-metastatic breast cancer diagnosed in 2007. Poisson regression analysis was used to identify WTs' influencing factors. For 973 women who had a malignant tissue sampling, the median of overall WT between the first imaging procedure and the first treatment was 44 days (9 days for pathological diagnostic WT and 31 days for treatment WT). The medical factors mostly explained inequalities in WTs. Socio-economic and behavioral factors had a limited impact on WTs except for social support which appeared to be a key point. Better identifying the factors associated with increase in WTs will make it possible to develop further interventional or prospective studies to confirm their causal role in delay and at last reduce disparities in breast cancer management.
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Affiliation(s)
| | - Pascale Grosclaude
- Registre Des Cancers Du Tarn, Institut Claudius Regaud, IUCT-O, LEASP-UMR 1027 Inserm-Université De Toulouse, Toulouse, France
| | - Laetitia Daubisse-Marliac
- Registre Des Cancers Du Tarn, Institut Claudius Regaud, IUCT-O, LEASP-UMR 1027 Inserm-Université De Toulouse, Toulouse, France
| | - Jean Pascal
- Département D'Information Médicale, Cellule d'Identito-Vigilance, CHU Toulouse, Toulouse, France
| | | | - Evelyne Fournier
- Registre Des Tumeurs Du Doubs Et Du Territoire De Belfort, CHRU Besançon, EA3181, Université De Franche-Comté, Besançon, France
| | | | - Magali Métais
- Registre Des Cancers De Loire-Atlantique-Vendée, Nantes, France
| | - Pierre Lombrail
- Laboratoire « Éducations Et Pratiques De Santé » EA3412, Université Paris 13-Sorbonne Paris Cité, Bobigny, France
| | - Anne-Sophie Woronoff
- Registre Des Tumeurs Du Doubs Et Du Territoire De Belfort, CHRU Besançon, EA3181, Université De Franche-Comté, Besançon, France
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15
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Limam M, Ajmi T, Zedini C, Khelifi A, Mellouli M, El Ghardallou M, Sahli J, Khairi H, Mtiraoui A. Étude des délais de traitement du cancer du sein à Sousse, Tunisie. SANTÉ PUBLIQUE 2016. [DOI: 10.3917/spub.163.0331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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16
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 614] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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Carney P, Gavin A, O'Neill C. The role of private care in the interval between diagnosis and treatment of breast cancer in Northern Ireland: an analysis of Registry data. BMJ Open 2013; 3:e004074. [PMID: 24302511 PMCID: PMC3855491 DOI: 10.1136/bmjopen-2013-004074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine the differences in the interval between diagnosis and initiation of treatment among women with breast cancer in Northern Ireland. DESIGN A cross-sectional observational study. SETTING All breast cancer care patients in the Northern Ireland Cancer Registry in 2006. PARTICIPANTS All women diagnosed and treated for breast cancer in Northern Ireland in 2006. MAIN OUTCOME MEASURE The number of days between diagnosis and initiation of treatment for breast cancer. RESULTS The mean (median) interval between diagnosis and initiation of treatment among public patients was 19 (15) compared with 14 (12) among those whose care involved private providers. The differences between individual public providers were as marked as those between the public and private sector-the mean (median) ranging between 14 (12) and 25 (22) days. Multivariate models revealed that the differences were evident when a range of patient characteristics were controlled for including cancer stage. CONCLUSIONS A relatively small number of women received care privately in Northern Ireland but experienced shorter intervals between diagnosis and initiation of treatment than those who received care wholly in the public system. The variation among public providers was as great as that between the public and private providers. The impact of such differences on survival and in light of waiting time targets introduced in Northern Ireland warrants investigation.
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Affiliation(s)
- Patricia Carney
- School of Business and Economics, Economics of Cancer Research Group, NUI Galway, Galway Ireland
| | - Anna Gavin
- Northern Ireland Cancer Registry, Belfast, Northern Ireland
| | - Ciaran O'Neill
- School of Business and Economics, Economics of Cancer Research Group, NUI Galway, Galway Ireland
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