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Meng J, Song Z, Cong S, Sun Q, Ma Q, Shi W, Wang L. Regulatory role of the miR-142-3p/ CDC25C axis in modulating autophagy in non-small cell lung cancer. Transl Lung Cancer Res 2024; 13:552-572. [PMID: 38601452 PMCID: PMC11002511 DOI: 10.21037/tlcr-24-82] [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: 01/22/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Background With its diverse genetic foundation and heterogeneous nature, non-small cell lung cancer (NSCLC) needs a better comprehension of prognostic evaluation and efficient treatment targeting. Methods Bioinformatics analysis was performed of The Cancer Genome Atlas (TCGA)-NSCLC and GSE68571 dataset. Overlapping differentially expressed genes (DEGs) were used for functional enrichment analysis and constructing the protein-protein interaction (PPI) network. In addition, key prognostic genes were identified through prognostic risk models, and their expression levels were verified. The phenotypic effects of cell division cycle 25C (CDC25C) regulation on NSCLC cell lines were assessed by in vitro experiments using various techniques such as flow cytometry, Transwell, and colony formation. Protein levels related to autophagy and apoptosis were assessed, specifically examining the impact of autophagy inhibition [3-methyladenine (3-MA)] and the miR-142-3p/CDC25C axis on this regulatory system. Results CDC25C was identified as a key prognostic marker in NSCLC, showing high expression in tumor samples. In vitro experiments showed that CDC25C knockdown markedly reduced the capacity of cells to proliferate, migrate, invade, trigger apoptosis, and initiate cell cycle arrest. CDC25C and miR-142-3p displayed a reciprocal regulatory relationship. CDC25C reversed the inhibitory impacts of miR-142-3p on NSCLC cell cycle proliferation and progression. The synergy of miR-142-3p inhibition, CDC25C silencing, and 3-MA treatment was shown to regulate NSCLC cell processes including proliferation, apoptosis, and autophagy. Conclusions MiR-142-3p emerged as a key player in governing autophagy and apoptosis by directly targeting CDC25C expression. This emphasizes the pivotal role of the miR-142-3p/CDC25C axis as a critical regulatory pathway in NSCLC.
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Affiliation(s)
- Jing Meng
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zongchang Song
- Department of Oncology, Shanghai University Affiliated Mengchao Cancer Hospital, Shanghai, China
| | - Shuxian Cong
- Department of Thoracic Surgery, PKUCare Zibo Hospital, Zibo, China
| | - Qiong Sun
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qinyun Ma
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Weiwei Shi
- Department of Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Linxuan Wang
- Department of Pulmonary and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
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Wickramasinghe B, Renzi C, Barclay M, Callister MEJ, Rafiq M, Lyratzopoulos G. Pre-diagnostic prescribing patterns in dyspnoea patients with as-yet-undiagnosed lung cancer: A longitudinal study of linked primary care and cancer registry data. Cancer Epidemiol 2023; 86:102429. [PMID: 37473578 DOI: 10.1016/j.canep.2023.102429] [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: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Patients with as-yet undiagnosed lung cancer (LC) can present to primary care with non-specific symptoms such as dyspnoea, often in the context of pre-existing chronic obstructive pulmonary disease (COPD). Related medication prescriptions pre-diagnosis might represent opportunities for earlier diagnosis, but UK evidence is limited. Consequently, we explored prescribing patterns of relevant medications in patients who presented with dyspnoea in primary care and were subsequently diagnosed with LC. METHOD Linked primary care (Clinical Practice Research Datalink) and National Cancer Registry data were used to identify 5434 patients with incident LC within a year of a dyspnoea presentation in primary care between 2006 and 2016. Primary care prescriptions relevant to dyspnoea management were examined: antibiotics, inhaled medications, oral steroids, and opioid analgesics. Poisson regression models estimated monthly prescribing rates during the year pre-diagnosis. Variation by COPD status (52 % pre-existing, 36 % COPD-free, 12 % new-onset) was examined. Inflection points were identified indicating when prescribing rates changed from the background rate. RESULTS 63 % of patients received 1 or more relevant prescriptions 1-12 months pre-diagnosis. Pre-existing COPD patients were most prescribed inhaled medications. COPD-free and new-onset COPD patients were most prescribed antibiotics. Most patients received 2 or more relevant prescriptions. Monthly prescribing rates of all medications increased towards time of diagnosis in all patient groups and were highest in pre-existing COPD patients. Increases in prescribing activity were observed earliest in pre-existing COPD patients 5 months pre-diagnosis for inhaled medications, antibiotics, and steroids, CONCLUSION: Results indicate that a diagnostic window of appreciable length exists for potential earlier LC diagnosis in some patients. Lung cancer diagnosis may be delayed if early symptoms are misattributed to COPD or other benign conditions.
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Affiliation(s)
- Bethany Wickramasinghe
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Dept. of Behavioural Science & Health, Institute of Epidemiology and Health Care (IEHC), University College London, United Kingdom.
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Dept. of Behavioural Science & Health, Institute of Epidemiology and Health Care (IEHC), University College London, United Kingdom
| | - Matthew Barclay
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Dept. of Behavioural Science & Health, Institute of Epidemiology and Health Care (IEHC), University College London, United Kingdom
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Meena Rafiq
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Dept. of Behavioural Science & Health, Institute of Epidemiology and Health Care (IEHC), University College London, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Dept. of Behavioural Science & Health, Institute of Epidemiology and Health Care (IEHC), University College London, United Kingdom
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Kong JE, Ong SK, Leong E, Naing L. Survival Analysis of Lung Cancer patients in Brunei Darussalam. Asian Pac J Cancer Prev 2023; 24:2389-2396. [PMID: 37505771 PMCID: PMC10676501 DOI: 10.31557/apjcp.2023.24.7.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Cancer has been the most common cause of deaths in Brunei Darussalam including lung cancer as one of the top killers. This study presents the survival analysis of primary lung cancer patients in Brunei Darussalam. METHODS This is a retrospective cohort study of a 15-year period (2002-2016) involving 797 primary lung cancer cases. De-identified data extracted from Brunei Darussalam Cancer Registry was analyzed using Kaplan-Meier method and log-rank test. Bonferroni corrections were performed. RESULTS 6 months, 1-year, 3-year, 5-year survival rates of lung cancer patients were 62.2%, 51.0%, 38.0% and 34.7% respectively. The median survival time was 12.4 months (95% Cl: 9.2, 15.7). Patients diagnosed 2002-2006 had significant longer survival than patients diagnosed 2007-2011 (p=0.039) and those diagnosed 2011-2016 (p<0.001). Survival time of patients diagnosed 2007-2011 was significantly longer than patients diagnosed 2012-2016 (p=0.049). Patients with localised disease had significantly longer survival time than patients with regional involvement (p<0.001) and distal site involvement (p<0.001). Patients with distal disease had significantly poorer survival rate than patients with regional involvement (p<0.001). Patients aged 50 or above had significantly shorter survival time than patients diagnosed at age 40-49 (p=0.003). There was no significant difference between survival time of other demographic characteristics. CONCLUSIONS The median survival time for lung cancer patients in this study was 12.4 months. Early diagnosis, early stage of cancer, and younger age were associated with longer survival time among lung cancer patients in Brunei Darussalam.
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Affiliation(s)
- Jia En Kong
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Bandar Seri Begawan, Brunei Darussalam.
| | - Sok King Ong
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Bandar Seri Begawan, Brunei Darussalam.
- Non-Communicable Disease (NCD) Prevention Unit, Ministry of Health, Commonwealth Drive, Bandar Seri Begawan, Brunei Darussalam.
| | - Elvynna Leong
- Faculty of Science, Universiti Brunei Darussalam, Jalan Tungku Link, Bandar Seri Begawan, Brunei Darussalam.
- Institute of Applied Data Analytics, Universiti Brunei Darussalam, Jalan Tungku Link, Bandar Seri Begawan, Brunei Darussalam.
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Bandar Seri Begawan, Brunei Darussalam.
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Saab MM, McCarthy M, O'Driscoll M, Sahm LJ, Leahy-Warren P, Noonan B, FitzGerald S, O'Malley M, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. A systematic review of interventions to recognise, refer and diagnose patients with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:42. [PMID: 36258020 PMCID: PMC9579201 DOI: 10.1038/s41533-022-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with lung cancer (LC) often experience delay between symptom onset and treatment. Primary healthcare professionals (HCPs) can help facilitate early diagnosis of LC through recognising early signs and symptoms and making appropriate referrals. This systematic review describes the effect of interventions aimed at helping HCPs recognise and refer individuals with symptoms suggestive of LC. Seven studies were synthesised narratively. Outcomes were categorised into: Diagnostic intervals; referral and diagnosis patterns; stage distribution at diagnosis; and time interval from diagnosis to treatment. Rapid access pathways and continuing medical education for general practitioners can help reduce LC diagnostic and treatment delay. Awareness campaigns and HCP education can help inform primary HCPs about referral pathways. However, campaigns did not significantly impact LC referral rates or reduce diagnostic intervals. Disease outcomes, such as LC stage at diagnosis, recurrence, and survival were seldom measured. Review findings highlight the need for longitudinal, powered, and controlled studies.
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Affiliation(s)
- Mohamad M Saab
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Megan McCarthy
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Michelle O'Driscoll
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brendan Noonan
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena FitzGerald
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Maria O'Malley
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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5
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Black GB, van Os S, Renzi C, Walter FM, Hamilton W, Whitaker KL. How does safety netting for lung cancer symptoms help patients to reconsult appropriately? A qualitative study. BMC PRIMARY CARE 2022; 23:179. [PMID: 35858826 PMCID: PMC9298706 DOI: 10.1186/s12875-022-01791-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
Abstract
Background
Safety netting in primary care is considered an important intervention for managing diagnostic uncertainty. This is the first study to examine how patients understand and interpret safety netting advice around low-risk potential lung cancer symptoms, and how this affects reconsultation behaviours.
Methods
Qualitative interview study in UK primary care. Pre-covid-19, five patients were interviewed in person within 2–3 weeks of a primary care consultation for potential lung cancer symptom(s), and again 2–5 months later. The general practitioner (GP) they last saw was interviewed face-to-face once. During the covid-19 pandemic, an additional 15 patients were interviewed only once via telephone, and their GPs were not interviewed or contacted in any way. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis.
Results
The findings from our thematic analysis suggest that patients prefer active safety netting, as part of thorough and logical diagnostic uncertainty management. Passive or ambiguous safety netting may be perceived as dismissive and cause delayed reconsultation. GP safety netting strategies are not always understood, potentially causing patient worry and dissatisfaction. Telephone consultations and the diagnostic overshadowing of COVID-19 on respiratory symptoms impacted GPs’ safety netting strategies and patients’ appetite for active follow up measures.
Conclusions
Safety netting guidelines do not yet offer solutions that have been proven to promote symptom vigilance and timely reconsultation for low-risk lung cancer symptoms. This may have been affected by primary care practices during the COVID-19 pandemic. Patients prefer active or pre-planned safety netting coupled with thorough consultation techniques and a comprehensible diagnostic strategy, and may respond adversely to passive safety netting advice.
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Peng T, Wang C, Zhang Y, Wang J. H-SegNet: hybrid segmentation network for lung segmentation in chest radiographs using mask region-based convolutional neural network and adaptive closed polyline searching method. Phys Med Biol 2022; 67. [PMID: 35287125 DOI: 10.1088/1361-6560/ac5d74] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
Chest x-ray (CXR) is one of the most commonly used imaging techniques for the detection and diagnosis of pulmonary diseases. One critical component in many computer-aided systems, for either detection or diagnosis in digital CXR, is the accurate segmentation of the lung. Due to low-intensity contrast around lung boundary and large inter-subject variance, it has been challenging to segment lung from structural CXR images accurately. In this work, we propose an automatic Hybrid Segmentation Network (H-SegNet) for lung segmentation on CXR. The proposed H-SegNet consists of two key steps: (1) an image preprocessing step based on a deep learning model to automatically extract coarse lung contours; (2) a refinement step to fine-tune the coarse segmentation results based on an improved principal curve-based method coupled with an improved machine learning method. Experimental results on several public datasets show that the proposed method achieves superior segmentation results in lung CXRs, compared with several state-of-the-art methods.
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Affiliation(s)
- Tao Peng
- Department of Radiation Oncology, Medical Artificial Intelligence and Automation Laboratory, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, United States of America
| | - Caishan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - You Zhang
- Department of Radiation Oncology, Medical Artificial Intelligence and Automation Laboratory, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, United States of America
| | - Jing Wang
- Department of Radiation Oncology, Medical Artificial Intelligence and Automation Laboratory, University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, United States of America
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Zhu Y, Ma K, Ye Y, Tang J, Zhu J. Long non-coding RNA LINRIS is upregulated in non-small cell lung cancer and its silencing inhibits cell proliferation by suppressing microRNA-10a maturation. Bioengineered 2022; 13:4340-4346. [PMID: 35137650 PMCID: PMC8973870 DOI: 10.1080/21655979.2022.2031672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Long noncoding RNA LINRIS (LINC00920) is known to participate in colorectal cancer. This study aimed to explore the role of LINRIS in non-small cell lung cancer (NSCLC). NSCLC and adjacent non-tumor tissues were collected from 62 NSCLC patients. LINRIS expression was detected using real-time quantitative PCR (RT-qPCRs). The 62 NSCLC patients were monitored every month for 5 years to evaluate the role of LINRIS in predicting the prognosis of NSCLC. The effects of LINRIS silencing on microRNA-10a (miR-10a) precursor and mature miR-10a levels were assessed by RT-qPCR. Cell proliferation was measured using Cell Counting Kit-8 (CCK-8) assays. LINRIS expression was upregulated in NSCLC tissues. High LINRIS levels predicted poor survival of NSCLC patients. LINRIS were positively correlated with mature (miR-10a) levels but not miR-10a precursor. In NSCLC cells, LINRIS silencing showed no role in miR-10a precursor accumulation but downregulated mature miR10a level. Moreover, LINRIS silencing inhibited cell proliferation, while miR-10a overexpression increased cell proliferation and inhibited the role of LINRIS silencing. Overall, LINRIS silencing may inhibit NSCLC cell proliferation by suppressing miR-10a maturation. Abbreviations: Non-small cell lung cancer (NSCLC); Reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR); LncRNA long intergenic noncoding RNA for IGF2BP2 stability (LINRIS).
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Affiliation(s)
- Yajie Zhu
- Department of Internal Medicine-Oncology, Sichuan Cancer Hospital, Chengdu City, Sichuan Province, China
| | - Ke Ma
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu City, Sichuan Province, China
| | - Yingxue Ye
- Department of Internal Medicine-Oncology, Sichuan Cancer Hospital, Chengdu City, Sichuan Province, China
| | - Jianning Tang
- Department of Internal Medicine-Oncology, Sichuan Cancer Hospital, Chengdu City, Sichuan Province, China
| | - Jiang Zhu
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu City, Sichuan Province, China
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Hardy V, Yue A, Archer S, Merriel SWD, Thompson M, Emery J, Usher-Smith J, Walter FM. Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review. BMJ Open 2022; 12:e053732. [PMID: 35074817 PMCID: PMC8788239 DOI: 10.1136/bmjopen-2021-053732] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Missed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood. OBJECTIVE To synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer. METHODS We searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice. DATA EXTRACTION AND SYNTHESIS Critical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis. RESULTS 29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. 'Gut feeling' predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive. CONCLUSIONS PCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or 'gut feeling', PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral. PROSPERO REGISTRATION NUMBER CRD420191560515.
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Affiliation(s)
- Victoria Hardy
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Adelaide Yue
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne VCCC, Parkville, Victoria, Australia
| | - Juliet Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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9
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Using patients' own knowledge of early sensations and symptoms to develop an interactive, individualized e-questionnaire to facilitate early diagnosis of lung cancer. BMC Cancer 2021; 21:544. [PMID: 33985458 PMCID: PMC8117555 DOI: 10.1186/s12885-021-08265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background One reason for the often late diagnosis of lung cancer (LC) may be that potentially-indicative sensations and symptoms are often diffuse, and may not be considered serious or urgent, making their interpretation complicated. However, with only a few exceptions, efforts to use people’s own in-depth knowledge about prodromal bodily experiences has been a missing link in efforts to facilitate early LC diagnosis. In this study, we describe and discuss facilitators and challenges in our process of developing and initial testing an interactive, self-completion e-questionnaire based on patient descriptions of experienced prodromal sensations and symptoms, to support early identification of lung cancer (LC). Methods E-questionnaire items were derived from in-depth, detailed explorative interviews with individuals undergoing investigation for suspected LC. The descriptors of sensations/symptoms and the background items obtained were the basis for developing an interactive, individualized instrument, PEX-LC, which was refined for usability through think-aloud and other interviews with patients, members of the public, and clinical staff. Results Major challenges in the process of developing PEX-LC related to collaboration among many actors, and design/user interface problems including technical issues. Most problems identified through the think-aloud interviews related to design/user interface problems and technical issues rather than content, for example we re-ordered questions to be in line with patients’ chronological, rather than retrospective, descriptions of their experiences. PEX-LC was developed into a final e-questionnaire on a touch-screen smart tablet with one background module covering sociodemographic characteristics, 10 interactive, individualized modules covering early sensations and symptoms, and a 12th assessing current symptoms. Conclusions Close collaboration with patients throughout the process was intrinsic for developing PEX-LC. Similarly, we recognized the extent to which clinicians and technical experts were also important in this process. Similar endeavors should assure all necessary competence is included in the core research team, to facilitate timely progress. Our experiences developing PEX-LC combined with new empirical research suggest that this individualized, interactive e-questionnaire, developed through systematizing patients’ own formulations of their prodromal symptom experiences, is both feasible for use and has potential value in the intended group.
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10
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Kowalski L, Krusen NE. Lung Cancer Screening Policy in Alaska and Occupational Therapy. Am J Occup Ther 2021; 75:12496. [PMID: 34781340 DOI: 10.5014/ajot.2021.048231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer claims more lives than any other cancer in the world and remains difficult to diagnose in the early stages. This article examines the current state of lung cancer detection and screening via low-dose computed tomography (LDCT) in Alaska and considers potential opportunities for occupational therapy practitioners in primary care settings. Medicare requires at least one documented shared decision-making encounter between provider and patient before LDCT lung cancer screening occurs. As a result of time constraints, documentation requirements, and the plethora of preventive health services they provide, primary care physicians often lack the time and training to conduct this essential service. This provides an opportunity for occupational therapy practitioners to perform these services as part of their practice and to play a role in this area as patient educators and prevention specialists in primary care settings. What This Article Adds: This article explores the national health crisis of lung cancer and describes how occupational therapists can participate in providing care in primary care settings.
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Affiliation(s)
- Lesleigh Kowalski
- Lesleigh Kowalski, PhD, MOT, OTR/L, ATP, is Research Scientist, Department of Family Medicine, University of Washington, Seattle; . At the time of the research, Kowalski was Doctoral Student, College of Health of Professions, Pacific University, Forest Grove, OR
| | - Nancy E Krusen
- Nancy E. Krusen, PhD, MA, OTR/L, is Program Director and Associate Professor, Division of Occupational Therapy Education, University of Nebraska Medical Center, Omaha
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11
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Kowalski L. Functional Decline as an Indicator of Ill-Health: A Retrospective Case Study of the Process Leading to Lung Cancer. J Multidiscip Healthc 2021; 14:919-927. [PMID: 33948085 PMCID: PMC8088295 DOI: 10.2147/jmdh.s295498] [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: 12/12/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Lung cancer claims more lives than any cancer in the world and remains difficult to diagnosis at early stages. Detecting lung cancer is challenging due to nonspecific symptom presentation. Literature was reviewed to consider functional decline as an indicator for ill-health. This study explored the process experienced from recognition in a change of health to receiving a lung cancer diagnosis from a patient’s perspective in order to examine this phase through a biopsychosocial lens. Patients and Methods A single-case design methodology was used for this study. The method of data collection was semi-structured interviews with people diagnosed with lung cancer utilizing criterion sampling. The case study was bound by diagnostic and geographical factors to frame the single-case: participants were limited to those living in Alaska diagnosed with stage III or stage IV lung cancer. Results One (n = 1) person participated in this study. Themes consistent with lung cancer detection process from a patient’s perspective include symptom denial, symptom reductionism, and gradual impact on function. Conclusion Although the number of participants was extremely limited due to the COVID-19 pandemic at the time of recruitment, this case study suggests a decline in function present prior to being diagnosed with lung cancer. Opportunities exist within the provider and patient interface to promote earlier detection include educating medical providers to ask specific, closed-ended, non-disease related functional questions to ascertain more details and a holistic representation of patients’ health. Raising public awareness of lung cancer symptoms, such as fatigue and dyspnea, is also warranted.
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Affiliation(s)
- Lesleigh Kowalski
- Department of Family Medicine, University of Washington, Seattle, WA, 98195, USA
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12
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Weller D. Early diagnosis of lung cancer: diverse populations need diverse solutions. Eur J Cancer Care (Engl) 2021; 30:e13444. [PMID: 33742507 DOI: 10.1111/ecc.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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McInerney CD, Scott BC, Johnson OA. Are Regulations Safe? Reflections From Developing a Digital Cancer Decision-Support Tool. JCO Clin Cancer Inform 2021; 5:353-363. [PMID: 33797951 PMCID: PMC8140795 DOI: 10.1200/cci.20.00148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/23/2020] [Accepted: 01/22/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Informatics solutions to early diagnosis of cancer in primary care are increasingly prevalent, but it is not clear whether existing and planned standards and regulations sufficiently address patients' safety nor whether these standards are fit for purpose. We use a patient safety perspective to reflect on the development of a computerized cancer risk assessment tool embedded within a UK primary care electronic health record system. METHODS We developed a computerized version of the CAncer Prevention in ExetER studies risk assessment tool, in compliance with the European Union's Medical Device Regulations. The process of building this tool afforded an opportunity to reflect on clinical concerns and whether current regulations for medical devices are fit for purpose. We identified concerns for patient safety and developed nine practical recommendations to mitigate these concerns. RESULTS We noted that medical device regulations (1) were initially created for hardware devices rather than software, (2) offer one-shot approval rather than supporting iterative innovation and learning, (3) are biased toward loss-transfer approaches that attempt to manage the fallout of harm instead of mitigating hazards becoming harmful, and (4) are biased toward known hazards, despite unknown hazards being an expected consequence of health care as a complex adaptive system. Our nine recommendations focus on embedding less-reductionist and stronger system perspectives into regulations and standards. CONCLUSION Our intention is to share our experience to support research-led collaborative development of health informatics solutions in cancer. We argue that regulations in the European Union do not sufficiently address the complexity of healthcare information systems with consequences for patient safety. Future standards and regulations should continue to follow a system-based approach to risk, safety, and accident avoidance.
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Affiliation(s)
| | | | - Owen A. Johnson
- School of Computing, University of Leeds, Leeds, United Kingdom
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14
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Hultstrand C, Coe AB, Lilja M, Hajdarevic S. GPs' perspectives of the patient encounter - in the context of standardized cancer patient pathways. Scand J Prim Health Care 2020; 38:238-247. [PMID: 32314634 PMCID: PMC8570742 DOI: 10.1080/02813432.2020.1753388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: We aim to explore how GPs assign meanings and act upon patients' symptoms in primary care encounters in the context of standardized cancer patient pathways (CPPs).Design, setting and subjects: Thirteen individual interviews were conducted with GPs, at primary healthcare centers (n = 4) in one county in northern Sweden. Interviews were analyzed using grounded theory method. The results were then linked to symbolic interactionism.Main outcome measures: GPs' perspectives about assigning meanings to patients' presented symptoms and perception about CPPs.Results: In the encounter, GPs engaged in two simultaneous interactions, one with patients' symptoms - and the other with CPPs. The core category Disentangling patients' care trajectory consists of three categories, interpreted as GPs' strategies developed to assign meaning to symptoms. These strategies are carried out not in a straightforward manner but rather in a conflicting way, illuminating the complexity of GPs' daily work.Conclusions: Interacting with patients is vital for assigning meaning to presented symptoms. However, nowadays GPs are not only required to interact with patients, they are also required to interact with CPPs. These standardized routines might create pressure and demands on GPs, especially for those experiencing a lack of information about CPPs. Beside of carrying out the challenging patient/person-centered dialogues and interpreting presented symptoms, GPs also need to link the interpreted symptoms to CPPs. Therefore, it is essential that GPs are given opportunities at their workplaces to continuously be informed and be supported in order to practice CPPs and thereby optimize trajectories for patients undergoing cancer diagnostics.Key points Current awareness: • GPs deliberation about patients' trajectories is a complex process, often dealing with vague symptoms. How CPPs influence this process within the encounter has not been studied. Main statements: • GPs in our study were involved in two simultaneous interactions, one with patients' symptoms in the encounter - and the other with CPPs within the healthcare organization. • Symbolic interactionism helped capture how GPs deliberated about conflicting and paradoxical aspects of the encounter, in terms of balancing two contradictory ways of action that GPs face when providing patient/person-centered care and linking to CPPs. • Based on our results, primary care needs support from healthcare organizations to build capacity about CPPs and how to use them.
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Affiliation(s)
- Cecilia Hultstrand
- Department of Nursing, Umeå University, Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden;
- CONTACT Cecilia Hultstrand Department of Nursing, Umeå University, Umeå, SE-901 87, Sweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden;
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden;
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15
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Hultstrand C, Coe AB, Lilja M, Hajdarevic S. Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways - an observational study in primary care. BMC Health Serv Res 2020; 20:46. [PMID: 31952534 PMCID: PMC6969453 DOI: 10.1186/s12913-020-4893-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). METHODS Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. RESULTS One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. CONCLUSIONS Patients and GPs seem to be mutually dependent on each other and both patients' expertise and GPs' medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients' needs as to standardized routines as CPPs.
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Affiliation(s)
- Cecilia Hultstrand
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Anna-Britt Coe
- Department of Sociology, Umeå University, SE-901 87, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital, Umeå University, SE-901 87, Umeå, Sweden
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87, Umeå, Sweden
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16
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Renzi C, Kaushal A, Emery J, Hamilton W, Neal RD, Rachet B, Rubin G, Singh H, Walter FM, de Wit NJ, Lyratzopoulos G. Comorbid chronic diseases and cancer diagnosis: disease-specific effects and underlying mechanisms. Nat Rev Clin Oncol 2019; 16:746-761. [PMID: 31350467 DOI: 10.1038/s41571-019-0249-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
Abstract
An earlier diagnosis is a key strategy for improving the outcomes of patients with cancer. However, achieving this goal can be challenging, particularly for the growing number of people with one or more chronic conditions (comorbidity/multimorbidity) at the time of diagnosis. Pre-existing chronic diseases might affect patient participation in cancer screening, help-seeking for new and/or changing symptoms and clinicians' decision-making on the use of diagnostic investigations. Evidence suggests, for example, that pre-existing pulmonary, cardiovascular, neurological and psychiatric conditions are all associated with a more advanced stage of cancer at diagnosis. By contrast, hypertension and certain gastrointestinal and musculoskeletal conditions might be associated with a more timely diagnosis. In this Review, we propose a comprehensive framework that encompasses the effects of disease-specific, patient-related and health-care-related factors on the diagnosis of cancer in individuals with pre-existing chronic illnesses. Several previously postulated aetiological mechanisms (including alternative explanations, competing demands and surveillance effects) are integrated with newly identified mechanisms, such as false reassurances, or patient concerns about appearing to be a hypochondriac. By considering specific effects of chronic diseases on diagnostic processes and outcomes, tailored early diagnosis initiatives can be developed to improve the outcomes of the large proportion of patients with cancer who have pre-existing chronic conditions.
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Affiliation(s)
- Cristina Renzi
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK.
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Aradhna Kaushal
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Willie Hamilton
- St Luke's Campus, University of Exeter Medical School, Exeter, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Greg Rubin
- Institute of Health and Society, Sir James Spence Institute, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Georgios Lyratzopoulos
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, UK
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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17
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Early symptoms and sensations as predictors of lung cancer: a machine learning multivariate model. Sci Rep 2019; 9:16504. [PMID: 31712735 PMCID: PMC6848139 DOI: 10.1038/s41598-019-52915-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/23/2019] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to identify a combination of early predictive symptoms/sensations attributable to primary lung cancer (LC). An interactive e-questionnaire comprised of pre-diagnostic descriptors of first symptoms/sensations was administered to patients referred for suspected LC. Respondents were included in the present analysis only if they later received a primary LC diagnosis or had no cancer; and inclusion of each descriptor required ≥4 observations. Fully-completed data from 506/670 individuals later diagnosed with primary LC (n = 311) or no cancer (n = 195) were modelled with orthogonal projections to latent structures (OPLS). After analysing 145/285 descriptors, meeting inclusion criteria, through randomised seven-fold cross-validation (six-fold training set: n = 433; test set: n = 73), 63 provided best LC prediction. The most-significant LC-positive descriptors included a cough that varied over the day, back pain/aches/discomfort, early satiety, appetite loss, and having less strength. Upon combining the descriptors with the background variables current smoking, a cold/flu or pneumonia within the past two years, female sex, older age, a history of COPD (positive LC-association); antibiotics within the past two years, and a history of pneumonia (negative LC-association); the resulting 70-variable model had accurate cross-validated test set performance: area under the ROC curve = 0.767 (descriptors only: 0.736/background predictors only: 0.652), sensitivity = 84.8% (73.9/76.1%, respectively), specificity = 55.6% (66.7/51.9%, respectively). In conclusion, accurate prediction of LC was found through 63 early symptoms/sensations and seven background factors. Further research and precision in this model may lead to a tool for referral and LC diagnostic decision-making.
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18
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McDonald L, Carroll R, Harish A, Tanna N, Mehmud F, Alikhan R, Ramagopalan SV. Suspected cancer symptoms and blood test results in primary care before a diagnosis of lung cancer: a case-control study. Future Oncol 2019; 15:3755-3762. [PMID: 31668096 DOI: 10.2217/fon-2019-0442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: To compare symptoms and blood test results prior to cancer diagnosis in individuals who developed lung cancer and those who did not. Patients & methods: Nested case-control study, lung cancer patients were matched to up four controls with no record of cancer. Differences in symptoms and blood test results were investigated in the 2-year period prior to diagnosis. Results: 26,379 lung cancer patients were matched to 92,125 controls. Elevated C-reactive protein (CRP) was independently predictive of lung cancer at every 2-month interval 12 months prior to diagnosis. Elevated CRP in conjunction with at least one symptom was associated with greater than fourfold higher odds of lung cancer. Conclusion: CRP may be a prediagnostic marker for lung cancer, and when present with other symptoms could facilitate the investigation of high-risk individuals.
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Affiliation(s)
- Laura McDonald
- Centre for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UB8 1DH, United Kingdom
| | - Robert Carroll
- Centre for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UB8 1DH, United Kingdom
| | | | - Nikhil Tanna
- Bristol-Myers Squibb, Uxbridge, UB8 1DH, United Kingdom
| | - Faisal Mehmud
- Bristol-Myers Squibb, Uxbridge, UB8 1DH, United Kingdom
| | - Raza Alikhan
- University Hospital of Wales, Cardiff & Vale University Health Board, CF14 4XW, United Kingdom
| | - Sreeram V Ramagopalan
- Centre for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UB8 1DH, United Kingdom
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19
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Dlamini SB, Sartorius B, Ginindza T. Mapping the evidence on interventions to raise awareness on lung cancer in resource poor settings: a scoping review protocol. Syst Rev 2019; 8:217. [PMID: 31445512 PMCID: PMC6708127 DOI: 10.1186/s13643-019-1138-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer is the most commonly diagnosed cancer with 11.6% of the total cases attributable to lung cancer. It is currently the leading cause of death among cancer-related deaths worldwide. This is a major public health concern. Death due to lung cancer is preventable with interventions encouraging early presentation, diagnosis, smoking cessation and prompt and proper treatment. Literature shows that people are willing to screen for lung cancer if they understand the related risk, because of their behaviour, thus, highlighting the need for tailored interventions to address the associated risks. The aim of the review is to map the available literature on interventions raising community awareness about lung cancer (knowledge, attitudes and health-seeking behaviour) and effectiveness thereof among adults in resource-poor settings. METHODS AND ANALYSIS A methodological framework of Arksey and O'Malley will be used to guide this scoping review of published data. This process will start by searching several databases, including the Cochrane Library, PubMed, Scopus, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Web of Science, Google Scholar and the Educational Resources Information Centre (ERIC). A two-stage process will be done, where, firstly, two reviewers will independently screen the titles and abstracts for eligibility to be included in the final selection of studies. Secondly, a full-text screening of the articles from selected titles and abstracts will then be conducted. A tool developed through an iterative process by the researchers will be used to analyse all bibliographic data and study characteristics of selected studies. DISCUSSION The results will be used to inform policy and practice in terms of developing interventions on lung cancer awareness. The results of this scoping review will be disseminated through scientific publication, conferences and future workshops with health care professionals involved in lung cancer awareness campaigns.
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Affiliation(s)
- Siyabonga B Dlamini
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Benn Sartorius
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.,Health Metrics Sciences, School of Medicine, University of Washington, Seattle, USA.,Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Themba Ginindza
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
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20
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Affiliation(s)
- Richard D Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK
| | - Fei Sun
- Leeds Teaching Hospitals Trust, St James's Hospital, Leeds LS9 7TF, UK
| | - Jon D Emery
- Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victorian Comprehensive Cancer Centre, Victoria 3000, Australia
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21
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Presentation of lung cancer in primary care. NPJ Prim Care Respir Med 2019; 29:21. [PMID: 31118415 PMCID: PMC6531460 DOI: 10.1038/s41533-019-0133-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/12/2019] [Indexed: 12/31/2022] Open
Abstract
Survival from lung cancer has seen only modest improvements in recent decades. Poor outcomes are linked to late presentation, yet early diagnosis can be challenging as lung cancer symptoms are common and non-specific. In this paper, we examine how lung cancer presents in primary care and review roles for primary care in reducing the burden from this disease. Reducing rates of smoking remains, by far, the key strategy, but primary care practitioners (PCPs) should also be pro-active in raising awareness of symptoms, ensuring lung cancer risk data are collected accurately and encouraging reluctant patients to present. PCPs should engage in service re-design and identify more streamlined diagnostic pathways—and more readily incorporate decision support into their consulting, based on validated lung cancer risk models. Finally, PCPs should ensure they are central to recruitment in future lung cancer screening programmes—they are uniquely placed to ensure the right people are targeted for risk-based screening programmes. We are now in an era where treatments can make a real difference in early-stage lung tumours, and genuine progress is being made in this devastating illness—full engagement of primary care is vital in effecting these improvements in outcomes.
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22
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Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Mazza D, Habgood E, Kutzer Y, Barnes DJ, Murchie P. The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax 2019; 74:362-370. [PMID: 30630891 PMCID: PMC6484693 DOI: 10.1136/thoraxjnl-2018-212506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/26/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
Background International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation. Conclusions A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk. Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.
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Affiliation(s)
- Jon D Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sonya R Murray
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia
| | - Fiona M Walter
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Emily Habgood
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Kutzer
- Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.,School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - David John Barnes
- Royal Prince Alfred Hospital, Newtown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Murchie
- The Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Wagland R, Brindle L, James E, Moore M, Esqueda AI, Corner J. Facilitating early diagnosis of lung cancer amongst primary care patients: The views of GPs. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28497588 PMCID: PMC5949863 DOI: 10.1111/ecc.12704] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/21/2022]
Abstract
Early diagnosis of lung cancer (LC) is a policy priority. However, symptoms are vague, associated with other morbidities, and frequently unrecognised by both patients and general practitioners (GPs). This qualitative study, part of a larger mixed methods study, explored GP views regarding the potential for early diagnosis of LC within primary care. Five focus group discussions (FGDs) were conducted with GPs (n = 16) at primary care practices (n = 5) across four counties in south England. FGDs were audio‐recorded, transcribed verbatim and analysed using a framework approach. Four broad themes emerged: patients’ reporting of symptoms; GP response to symptoms; investigating LC, and; potential initiatives for early diagnosis. GPs reported they often required high levels of suspicion to refer patients on to specialist respiratory consultations, and concerns of ‘system overload’ were prevalent. Greater access to more sensitive diagnostic investigations such as computed tomography, was argued for by some, particularly for symptomatic patients with negative chest X‐rays. GPs challenged current approaches to promoting earlier diagnosis through national symptom awareness campaigns, arguing instead that interventions targeted at high‐risk individuals might be more effective without burdening services already under pressure. Further work is needed to identify primary care patients who might most benefit from such targeted interventions.
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Affiliation(s)
- R Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - L Brindle
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - E James
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - M Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - A I Esqueda
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Corner
- Executive Office, The Nottingham University, University Park, Nottingham, UK
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25
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Weller D. Primary care-Taking the lead in cancer control. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- D. Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
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