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Nakamura S, Ishii Y, Serikawa M, Hanada K, Eguchi N, Sasaki T, Fujimoto Y, Yamaguchi A, Sugiyama S, Noma B, Kamigaki M, Minami T, Okazaki A, Yukutake M, Mouri T, Tatsukawa Y, Ikemoto J, Arihiro K, Oka S. Diagnostic Ability and Safety of Repeated Pancreatic Juice Cytology Using an Endoscopic Nasopancreatic Drainage Catheter for Pancreatic Ductal Adenocarcinoma: A Multicenter Prospective Study. Diagnostics (Basel) 2023; 13:2696. [PMID: 37627955 PMCID: PMC10453209 DOI: 10.3390/diagnostics13162696] [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: 06/29/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Pathological examination is essential for the diagnosis and treatment of pancreatic ductal adenocarcinoma (PDAC). Moreover, a reliable pathological diagnosis is extremely important for improving prognosis, especially in early-stage PDAC. This study prospectively evaluated the usefulness of repeated pancreatic juice cytology (PJC) using an endoscopic nasopancreatic drainage (ENPD) catheter for the diagnosis of PDAC. We enrolled 82 patients suspected of having resectable PDAC, based on imaging studies, and judged the necessity for cytology. The diagnostic yield of up to six repeated PJCs and the incidence of complications, such as pancreatitis, was evaluated. A total of 60 patients were diagnosed with PDAC. The overall sensitivity and specificity were 46.7% and 95.5%, respectively. The cumulative positivity rate increased with the number of sampling sessions, reaching 58.3% in the sixth session. The sensitivity was significantly higher in the pancreatic head than in the pancreatic tail (p = 0.043). Additionally, it was 100% in four patients with a tumor size ≤10 mm. Pancreatitis occurred in six patients (7.3%), all of whom were treated conservatively. In the diagnosis of PDAC, repeated PJC using an ENPD catheter revealed a cumulative effect of sensitivity up to six times and an excellent diagnostic yield for small PDAC.
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Affiliation(s)
- Shinya Nakamura
- Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.N.); (M.S.); (Y.T.); (J.I.); (S.O.)
| | - Yasutaka Ishii
- Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.N.); (M.S.); (Y.T.); (J.I.); (S.O.)
| | - Masahiro Serikawa
- Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.N.); (M.S.); (Y.T.); (J.I.); (S.O.)
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Onomichi 722-8508, Japan;
| | - Noriaki Eguchi
- Department of Gastroenterology, Hiroshima Memorial Hospital, Hiroshima 730-0802, Japan;
| | - Tamito Sasaki
- Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan;
| | - Yoshifumi Fujimoto
- Department of Gastroenterology, Hiroshima General Hospital, Hatsukaichi 738-8503, Japan;
| | - Atsushi Yamaguchi
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan;
| | - Shinichiro Sugiyama
- Department of Gastroenterology, Saiseikai Hiroshima Hospital, Aki 731-4311, Japan;
| | - Bunjiro Noma
- Department of Gastroenterology, Kure Kyosai Hospital, Kure 737-8508, Japan;
| | - Michihiro Kamigaki
- Department of Gastroenterology, Saiseikai Kure Hospital, Kure 737-0921, Japan;
| | - Tomoyuki Minami
- Department of Gastroenterology, Hiroshima Red Cross & Atomic-Bomb Survivors Hospital, Hiroshima 730-8619, Japan;
| | - Akihito Okazaki
- Department of Gastroenterology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima 739-0041, Japan;
| | - Masanobu Yukutake
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan;
| | - Teruo Mouri
- Department of Gastroenterology, Chugoku Rosai Hospital, Kure 737-0193, Japan;
| | - Yumiko Tatsukawa
- Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.N.); (M.S.); (Y.T.); (J.I.); (S.O.)
| | - Juri Ikemoto
- Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.N.); (M.S.); (Y.T.); (J.I.); (S.O.)
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima 734-8551, Japan;
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (S.N.); (M.S.); (Y.T.); (J.I.); (S.O.)
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Yao W, Chen X, Fan B, Zeng L, Zhou Z, Mao Z, Shen Q. Multidisciplinary team diagnosis and treatment of pancreatic cancer: Current landscape and future prospects. Front Oncol 2023; 13:1077605. [PMID: 37007078 PMCID: PMC10050556 DOI: 10.3389/fonc.2023.1077605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
The pathogenesis of pancreatic cancer has not been completely clear, there is no highly sensitive and specific detection method, so early diagnosis is very difficult. Despite the rapid development of tumor diagnosis and treatment, it is difficult to break through in the short term and the overall 5-year survival rate of pancreatic cancer is less than 8%. In the face of the increasing incidence of pancreatic cancer, in addition to strengthening basic research, exploring its etiology and pathogenesis, it is urgent to optimize the existing diagnosis and treatment methods through standard multidisciplinary team (MDT), and formulate personalized treatment plan to achieve the purpose of improving the curative effect. However, there are some problems in MDT, such as insufficient understanding and enthusiasm of some doctors, failure to operate MDT according to the system, lack of good communication between domestic and foreign peers, and lack of attention in personnel training and talent echelon construction. It is expected to protect the rights and interests of doctors in the future and ensure the continuous operation of MDT. To strengthen the research on the diagnosis and treatment of pancreatic cancer, MDT can try the Internet +MDT mode to improve the efficiency of MDT.
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Affiliation(s)
- Weirong Yao
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xiaoliang Chen
- Department of Hepatobiliary Surgery, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Bin Fan
- Department of Radiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Lin Zeng
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhiyong Zhou
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Zhifang Mao
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Qinglin Shen
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Institute of Clinical Medicine, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- *Correspondence: Qinglin Shen,
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3
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Crawford SM. Everyone should have ready access to a competent cancer service. BMJ 2022; 379:o2786. [PMID: 36414250 DOI: 10.1136/bmj.o2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hultstrand C, Hörnsten C, Lilja M, Coe A, Fjällström P, Hajdarevic S. The association between sociodemographic factors and time to diagnosis for colorectal cancer in northern Sweden. Eur J Cancer Care (Engl) 2022; 31:e13687. [PMID: 35970596 PMCID: PMC9787547 DOI: 10.1111/ecc.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study examined whether sociodemographic factors, including distance to hospital, were associated with differences in the diagnostic interval and the treatment interval for colorectal cancer in northern Sweden. METHODS Data were retrieved from the Swedish cancer register on patients (n = 446) diagnosed in three northern regions during 2017-2018, then linked to data from Statistics Sweden and medical records. Also, Google maps was used to map the distance between patients' place of residence and nearest hospital. The different time intervals were analysed using Mann-Whitney U-test and Cox regression. RESULTS Differences in time to diagnosis were found between groups for income and distance to hospital, favouring those with higher income and shorter distance. The unadjusted regression analysis showed higher income to be associated with more rapid diagnosis (HR 1.004, CI 1.001-1.007). This association remained in the fully adjusted model for income (HR 1.004, CI 1.000-1.008), but not for distance. No differences between sociodemographic groups were found in the treatment interval. CONCLUSION Higher income and shorter distance to hospital were in the unadjusted models associated with shorter time to diagnosis for patients with CRC in northern Sweden. The association remained for income when adjusting for other variables even though the difference was small.
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Affiliation(s)
- Cecilia Hultstrand
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and DevelopmentÖstersund Hospital, Umeå UniversityUmeåSweden
| | | | | | - Senada Hajdarevic
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
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Murchie P, Fielding S, Turner M, Iversen L, Dibben C. Is place or person more important in determining higher rural cancer mortality? A data-linkage study to compare individual versus area-based measures of deprivation. Int J Popul Data Sci 2021; 6:1403. [PMID: 34007900 PMCID: PMC8103996 DOI: 10.23889/ijpds.v6i1.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Data from Northeast Scotland for 11,803 cancer patients (diagnosed 2007-13) were linked to UK Censuses to explore relationships between hospital travel-time, timely-treatment and one-year-mortality, adjusting for both area and individual-level socioeconomic status (SES). Adjusting for area-based SES, those living >60 minutes from hospital received timely-treatment more often than those living <15 minutes. Substituting individual-level SES changed little. Adjusting for area-based SES those living >60 minutes from hospital died within one year more often than those living <15 minutes. Again, substituting individual-level SES changed little. In Northeast Scotland distance to services, rather than individual SES, likely explains poorer rural cancer survival. BACKGROUND AND OBJECTIVE The Northeast and Aberdeen Scottish Cancer and Residence (NASCAR) study found rural-dwellers are treated quicker but more likely to die within a year of a cancer diagnosis. A potential confounder of the relationship between geography and cancer mortality is socioeconomic status (SES). We linked the original NASCAR cohort to the UK Censuses of 2001 and 2011, at an individual level, to explore the relationship between travel time to key healthcare facilities, timely cancer treatment and one-year mortality adjusting for both area and individual-level markers of socioeconomic status. METHODS A data linkage study of 11803 patients examined the association between travel times, timely treatment and one-year mortality with adjustment for area, and for individual-level, markers of socioeconomic status. RESULTS Following adjustment for area-based SES measures those living more than 60 minutes from the cancer treatment centre were significantly more likely to be treated within 62 days of GP referral than those living within 15 minutes (Odds Ratio [OR]) 1.41; 95% (Confidence Interval [CI]) 1.23, 1.60]. Replacing area-based with individual-level SES measures from UK Censuses made little impact on the results [OR 1.39; 95% CI 1.22, 1.57].Following adjustment for area-based SES measures of socioeconomic status those living more than 60 minutes from the cancer treatment centre were significantly more likely to die within one year than those living closer by [OR 1.22; 95% CI 1.08, 1.38]. Again, replacing area-based with individual-level SES measures from UK Censuses made little impact on the result [OR 1.20; CI 1.06, 1.35]. CONCLUSIONS Distribution of individual measures of socioeconomic status did not differ significantly between rural and urban cancer patients. The relationship between distance to service, timely treatment and one-year survival were the same adjusting for both area-based and individual SES. Overall, it seems that distance to services, rather than personal characteristics, influences poorer rural cancer survival.
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Affiliation(s)
- Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Shona Fielding
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Melanie Turner
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Lisa Iversen
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Chris Dibben
- School of Geosciences, Drummond Street, University of Edinburgh EH8 9XP
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Mazzucco W, Vitale F, Mazzola S, Amodio R, Zarcone M, Alba D, Marotta C, Cusimano R, Allemani C. Does access to care play a role in liver cancer survival? The ten-year (2006-2015) experience from a population-based cancer registry in Southern Italy. BMC Cancer 2021; 21:307. [PMID: 33761907 PMCID: PMC7988914 DOI: 10.1186/s12885-021-07935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. Methods We included 2018 adult patients (15–99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006–2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care (“easy access to care” versus “poor access to care”), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15–64, 65–74 and ≥ 75 years). Results Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65–74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006–2015, age-standardised net survival was higher among HCC patients with “easy access to care” than in those with “poor access to care” (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with “easy access to care” in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. Conclusions During 2006–2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.
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Affiliation(s)
- Walter Mazzucco
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy. .,Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy. .,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA. .,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Francesco Vitale
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Sergio Mazzola
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Rosalba Amodio
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Davide Alba
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Claudia Marotta
- Department for Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | | | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Murchie P, Adam R, Khor WL, Smith S, McNair E, Swann R, Witt J, Weller D. Impact of geography on Scottish cancer diagnoses in primary care: Results from a national cancer diagnosis audit. Cancer Epidemiol 2020; 66:101720. [PMID: 32361641 DOI: 10.1016/j.canep.2020.101720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND A recent meta-analysis of global research found cancer patients living in rural locations are 5% less likely to survive than their urban counterparts, a survival disadvantage that has never been satisfactorily explained. AIMS [1] To describe and compare primary-care involvement in the diagnosis of cancer between rural and urban patients in Scotland. [2] To compare the length of key diagnostic pathway intervals between rural and urban cancer patients in Scotland. METHODS Participating GPs in the Scottish National Cancer Audit of cancer diagnosis (2017) collected data from primary-care medical records on the diagnostic pathway of patients diagnosed in 2014. Residential postcodes designated the patients as rural or urban dwellers. Key cancer diagnostic pathway intervals (primary, diagnostic, secondary, and treatment) were compared using binary logistic regression. Descriptive analysis included comparison of patient characteristics, and routes to diagnosis. RESULTS 73 Scottish general practices provided data on 1,905 cancer diagnoses. Rural patients did not have higher odds of prolonged diagnostic intervals compared to urban patients but were significantly more likely to have had a cancer alarm feature at presentation and three or more primary-care consultations prior to referral. Rural GPs were significantly more likely to perceive an avoidable delay in their patient's diagnostic pathway. CONCLUSION There was no evidence that rural patients were more likely to be subject to prolonged cancer diagnostic delays than urban patients. Rural patients may experience primary care differently in the lead-up to a cancer diagnosis. The effect on outcome is probably negligible, but further research is required to confirm this.
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Affiliation(s)
- Peter Murchie
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom.
| | - Rosalind Adam
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Wei Lynn Khor
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Sarah Smith
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom
| | - Emma McNair
- Information Services Division (ISD), NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom
| | - Ruth Swann
- Cancer Research UK, 2 Redman Place, Stratford, London, E20 1JQ, United Kingdom; Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom
| | - Jana Witt
- Cancer Research UK, 2 Redman Place, Stratford, London, E20 1JQ, United Kingdom
| | - David Weller
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom
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Murchie P, Khor WL, Adam R, Esteva M, Smyrnakis E, Petek D, Thulesius H, Vedsted P, McLernon D, Harris M. Influences of rurality on action to diagnose cancer by primary care practitioners - Results from a Europe-wide survey in 20 countries. Cancer Epidemiol 2020; 65:101698. [PMID: 32151979 DOI: 10.1016/j.canep.2020.101698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rural-dwellers have poorer cancer outcomes than urban counterparts, for reasons which are unclear. At healthcare institution level, poorer access to investigations and different clinical decision-making by rural primary healthcare practitioners (PCPs) could be important. AIM To compare access to investigations, attitudes to cancer diagnosis and clinical decision-making between rural and urban PCPs. SETTING A vignette-based cross-sectional survey of rural and urban PCPs in 20 European countries. METHODS Data on PCPs' decision-making and attitudes to cancer diagnosis were based on clinical scenarios. Comparisons were made using tests of proportion, univariable and multivariable binary logistic regression. RESULTS Of the 1779 PCPs completing the survey 541 30.4 %) practiced rurally. Rural PCPs had significantly less direct access to all investigative modalities: ultrasound; endoscopy; x-ray and advanced screening (all p < 0.001). Rural PCPs were as likely as urban PCPs to take diagnostic action (investigation and/or referral) at the index consultation in all four clinical vignettes ((OR, 95 % CI) for lung: 0.90, 0.72-1.12; ovarian: 0.95, 0.75-1.19; breast: 0.87, 0.69-1.09; colorectal: 0.98, 0.75-1.30). Rural PCPs were less likely to refer to a specialist at the index consultation for ovarian cancer (OR 0.71 95 % CI 0.51-0.99). Rural PCPs were significantly more likely to report that their patients faced barriers to accessing specialist care, but practitioners did not report greater difficulties making specialist referral than their urban counterparts CONCLUSIONS: European rural PCPs report poorer access to investigations but are at least as likely as urban PCPs to investigate or refer patients that might have cancer at the index consultation.
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Affiliation(s)
- Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Wei Lynn Khor
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Magdalena Esteva
- Cap Formació Continuada, Majorca Primary Care Department, Unit of Research, Balearic Islands Health Research Institute (IdISBa), Preventive Activities and Health Promotion Network (redIAPP), Escola Graduada 3, 07002 Palma Mallorca, Spain
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research - Medical School, Aristotle University of Thessaloniki, Greece
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia
| | | | - Peter Vedsted
- Research Unit for General Practice in Aarhus, Bartholins Allé 2, Aarhus University, 8000 Aarhus C, Denmark
| | - David McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Michael Harris
- Department for Health, University of Bath, England, BA2 7AY, UK; Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
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Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041455. [PMID: 32102462 PMCID: PMC7068553 DOI: 10.3390/ijerph17041455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022]
Abstract
Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.
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Virgilsen LF, Møller H, Vedsted P. Travel distance to cancer-diagnostic facilities and tumour stage. Health Place 2019; 60:102208. [DOI: 10.1016/j.healthplace.2019.102208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/01/2023]
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Murchie P, Adam R, Wood R, Fielding S. Can we understand and improve poorer cancer survival in rural-dwellers? BJGP Open 2019; 3:bjgpopen19X101646. [PMID: 31366677 PMCID: PMC6662870 DOI: 10.3399/bjgpopen19x101646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/18/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Peter Murchie
- Professor of Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Senior Clinical Fellow, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Rose Wood
- Clinical Academic Fellow, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Senior Lecturer in Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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