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Bolgeo T, Ruta F, Gatti D, Gambalunga F, Iacorossi L, Di Matteo R, Cotroneo S, Boccafoschi C, Maconi A. Management of the patient with urostomy: Caregiver needs during the three months after discharge. A qualitative study. Arch Ital Urol Androl 2023; 95:11024. [PMID: 36924380 DOI: 10.4081/aiua.2023.11024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To examine caregivers' experiences and training needs after radical cystectomy with urinary diversion for the first three months following the patient's discharge. METHODS This study applied a phenomenological design approach through open-ended interviews and descriptive analysis. Phenomenology applied to empirical research requires researchers to explore the empirical facts narrated by partici-pants. This study followed the Consolidated Criteria for Reporting Qualitative Research guidelines, a 32 - item checklist for inter-views and focus groups. The study population included caregivers of bladder cancer patients, admitted to three Italian hospitals. Data were collected between March 2020 and March 2022. RESULTS Fifty-two caregivers of patients who underwent cystecto-my with urinary diversion from three Italian hospitals (41 males and 11 females) participated to the study. The data analysis con-verged in the identification of three themes - with sub-themes -that included various aspects of the caregiver's lived experiences: 1) living with the burden of being indispensable, for the family member, 2) feeling abandoned by institutions, 3) tiredness and less willingness to look after the relative due to work burden. CONCLUSIONS Our study demonstrates that the caregiver of a patient with bladder cancer and urostomy in the first three months of hospital discharge is very worried and stressed. Despite the training program received in hospital, the caregiver does not recognize the newly acquired skills and has difficulty applying them. Further study would be required.
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Affiliation(s)
- Tatiana Bolgeo
- Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | | | - Denise Gatti
- Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - Francesca Gambalunga
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome.
| | | | - Roberta Di Matteo
- Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - Salvatore Cotroneo
- SC Urology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | | | - Antonio Maconi
- Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
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Leow JJ, Tan WS, Tan WP, Tan TW, Chan VWS, Tikkinen KAO, Kamat A, Sengupta S, Meng MV, Shariat S, Roupret M, Decaestecker K, Vasdev N, Chong YL, Enikeev D, Giannarini G, Ficarra V, Teoh JYC. A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond. Front Surg 2022; 9:879774. [PMID: 36268209 PMCID: PMC9577485 DOI: 10.3389/fsurg.2022.879774] [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: 02/20/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC. Methods We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. Results We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery. Conclusions A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.
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Affiliation(s)
- Jeffrey J. Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wei Shen Tan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom,Department of Urology, University College London Hospital, London, United Kingdom
| | - Wei Phin Tan
- Department of Urology, NYU Langone Health, New York City, NY, United States
| | - Teck Wei Tan
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vinson Wai-Shun Chan
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom,Leeds Institute of Medical Research, University of Leeds, Leeds, United Kindgom,Division of Surgery and Interventional Sciences, University College London, United Kingdom
| | - Kari A. O. Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
| | - Ashish Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shomik Sengupta
- Urology Department, Eastern Health, Box Hill, Victoria, Australia,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Maxwell V. Meng
- Department of Urology, University of California San Francisco, San Francisco, CA, United States
| | - Shahrokh Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria,Department of Urology, Weill Cornell Medical College, New York, New York, USA,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA,Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Morgan Roupret
- Sorbonne University, GRC N 5, Predicitive Onco-uro, AP-HP, Hôpital Pitié-Salpêtriére, Paris, France
| | - Karel Decaestecker
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium,Department of Urology, Ghent University Hospital, Ghent, Belgium,Department of Human Structure and Repair, Ghent University, Belgium
| | - Nikhil Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital Stevenage, School of Medicine and Life Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Yew Lam Chong
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Dmitry Enikeev
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Messina, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China,European Association of Urology – Young Academic Urologists Urothelial Carcinoma Working Group (EAU-YAU), Arnhem, Netherlands,Correspondence: Jeremy Yuen-Chun Teoh
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2021; 24:1-332. [PMID: 33252328 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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A Systematic Review and Meta-analysis of Delay in Radical Cystectomy and the Effect on Survival in Bladder Cancer Patients. Eur Urol Oncol 2020; 3:239-249. [DOI: 10.1016/j.euo.2019.09.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/05/2019] [Accepted: 09/27/2019] [Indexed: 11/21/2022]
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METE BURAK, PEHLİVAN ERKAN, SÖYİLER VEDAT. Türkiye’nin doğusunda bir kentte kanser vakalarının dağılımı ve yaşam analizi sonuçları: retrospektif bir çalışma. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.529414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Furukawa K, Irino T, Makuuchi R, Koseki Y, Nakamura K, Waki Y, Fujiya K, Omori H, Tanizawa Y, Bando E, Kawamura T, Terashima M. Impact of preoperative wait time on survival in patients with clinical stage II/III gastric cancer. Gastric Cancer 2019; 22:864-872. [PMID: 30535877 DOI: 10.1007/s10120-018-00910-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative wait time is affected by various factors, and a certain time is needed before surgery. There is a concern that cancer treatment delay can lead to poor survival. The present study aimed to evaluate the impact of preoperative wait time on survival in patients with clinical stage (cStage) II/III gastric cancer. METHODS The study included patients with cStage II/III primary gastric cancer undergoing surgery between 2002 and 2012. Preoperative wait time was defined as the time from endoscopy for initial diagnosis to surgery. Patients were divided into the following three groups according to wait time: short wait group (≤ 30 days), intermediate wait group (> 30 and ≤ 60 days), and long wait group (> 60 and ≤ 90 days). Patient characteristics and survival were compared among the groups. RESULTS This study included 467 male (67%) and 229 female (33%) patients, and the median patient age was 67 years. The numbers of cStage II and III patients were 332 (48%) and 364 (52%), respectively. The median wait time was 45 days. The body mass index was lower in the short wait group than in the other groups. A shorter wait time tended to be associated with a more advanced cStage. Although survival was significantly worse in the short wait group than in the long wait group, wait time was not identified as an independent prognostic factor in multivariate analysis. CONCLUSION Preoperative wait time up to 90 days does not affect survival in patients with cStage II/III gastric cancer.
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Affiliation(s)
- Kenichiro Furukawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tomoyuki Irino
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yusuke Koseki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kenichi Nakamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yuhei Waki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hayato Omori
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Survival Rate of Patients with Bladder Cancer in Yazd, Central Province of Iran. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.61436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Subramonian KR, Puranik S, Mufti GR. How will the Two-Weeks-Wait Rule Affect Delays in Management of Urological Cancers? J R Soc Med 2017; 96:398-9. [PMID: 12893857 PMCID: PMC539570 DOI: 10.1177/014107680309600809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The UK National Health Service has now specified a maximum interval of two weeks between general practitioner (GP) referral and specialist assessment for patients with suspected cancer. We examined progress through the cancer pathway in 160 patients with potentially curable cancers of the prostate, bladder, kidney and testis before implementation of this rule. Median intervals with interquartile ranges were quantified from the first GP consultation to hospital referral, then to the first hospital consultation, confirmation of diagnosis and definitive surgery. 34% of patients were seen at the hospital within two weeks of referral. The overall median interval from GP consultation to radical surgery was 137 days, the longest being for prostate cancer (median 244). For prostate, bladder and renal cancers the principal element of delay was from the time of diagnosis to surgery (76, 73 and 26 days respectively). These results indicate that, under the two-weeks-wait rule, 2 out of every 3 patients achieve earlier initial assessment. However, the overall delay will not be substantially reduced without concomitant increases in diagnostic facilities, theatre time and human resources.
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Affiliation(s)
- K R Subramonian
- Department of Urology, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY, UK
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McCombie SP, Bangash HK, Kuan M, Thyer I, Lee F, Hayne D. Delays in the diagnosis and initial treatment of bladder cancer in Western Australia. BJU Int 2017; 120 Suppl 3:28-34. [DOI: 10.1111/bju.13939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Melvyn Kuan
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Isaac Thyer
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Fran Lee
- Fiona Stanley Hospital; Murdoch WA Australia
| | - Dickon Hayne
- Fiona Stanley Hospital; Murdoch WA Australia
- University of Western Australia; Perth WA Australia
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Park JC, Gandhi NM, Carducci MA, Eisenberger MA, Baras AS, Netto GJ, Liu JJ, Drake CG, Schoenberg MP, Bivalacqua TJ, Hahn NM. A Retrospective Analysis of the Effect on Survival of Time from Diagnosis to Neoadjuvant Chemotherapy to Cystectomy for Muscle Invasive Bladder Cancer. J Urol 2015; 195:880-5. [PMID: 26598426 DOI: 10.1016/j.juro.2015.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE We determine the impact of the timing of radical cystectomy from the diagnosis of muscle invasive bladder cancer on survival in patients also treated with neoadjuvant chemotherapy. MATERIALS AND METHODS We performed a retrospective chart review of consecutive patients with muscle invasive bladder cancer who received neoadjuvant chemotherapy followed by cystectomy between 1996 and 2014 at a single institution. Cox proportional hazards regression models were used to investigate the effect of treatment time intervals on overall survival. Three treatment intervals were analyzed for survival impact, from diagnosis of muscle invasive bladder cancer to initiation of neoadjuvant chemotherapy, from initiation of neoadjuvant chemotherapy to cystectomy and from diagnosis to cystectomy. Other pretreatment and posttreatment clinicopathological parameters were also analyzed. RESULTS Median time from the diagnosis of muscle invasive bladder cancer to radical cystectomy was 28 weeks. Cystectomy performed less than 28 weeks from the diagnosis did not result in significant improvement in overall survival outcomes (HR 0.68, 95% CI 0.28-1.63, p=0.388). Neither the timing of neoadjuvant chemotherapy initiation from diagnosis (median 6 weeks) nor the timing of cystectomy from neoadjuvant chemotherapy initiation (median 22 weeks) was associated with survival. Patient age, variant histology, extravesical and/or lymph node involvement (T3-4 and/or N1 or greater) were significantly associated with survival. CONCLUSIONS The timing of radical cystectomy in relation to muscle invasive bladder cancer diagnosis date does not significantly impact overall survival in patients with muscle invasive bladder cancer receiving neoadjuvant chemotherapy.
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Affiliation(s)
- Jong Chul Park
- Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Nilay M Gandhi
- Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Michael A Carducci
- Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Mario A Eisenberger
- Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Alexander S Baras
- Department of Pathology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - George J Netto
- Department of Pathology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Jen-Jane Liu
- Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Charles G Drake
- Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Immunology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Mark P Schoenberg
- Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York
| | - Trinity J Bivalacqua
- Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Noah M Hahn
- Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland; Department of Urology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
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Abstract
Background Alarm symptom presentations are predictive of cancer diagnosis but may also be associated with cancer survival. Aim To evaluate diagnostic time intervals, and consultation patterns after presentation with alarm symptoms, and their association with cancer diagnosis and survival. Design and setting Cohort study using the Clinical Practice Research Database, with linked Cancer Registry data, in 158 general practices. Method Participants included those with haematuria, haemoptysis, dysphagia, and rectal bleeding or urinary tract cancer, lung cancer, gastro-oesophageal cancer, and colorectal cancer. Results The median (interquartile range) interval in days from first symptom presentation to the corresponding cancer diagnosis was: haematuria and urinary tract cancer, 59 (28–109); haemoptysis and lung cancer, 35 (18–89); dysphagia and gastro-oesophageal cancer, 25 (12–48); rectal bleeding and colorectal cancer, 49 (20–157). Three or more alarm symptom consultations were associated with increased odds of diagnosis of urinary tract cancer (odds ratio [OR] 1.84, 95% CI = 1.50 to 2.27), lung cancer (OR = 1.76, 95% CI = 1.07 to 2.90) and gastro-oesophageal cancer (OR = 2.17, 95% CI = 1.48 to 3.19). Longer diagnostic intervals were associated with increased mortality only for urinary tract cancer (hazard ratio 2.23, 95% CI = 1.35 to 3.69). Patients with no preceding alarm symptom had shorter survival from diagnosis of urinary tract, lung or colorectal cancer than those presenting with a relevant alarm symptom. Conclusion After alarm symptom presentation, repeat consultations are associated with cancer diagnoses. Longer diagnostic intervals appeared to be associated with a worse prognosis for urinary tract cancer only. Mortality is higher when cancer is diagnosed in the absence of alarm symptoms.
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12
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 614] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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13
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Rezaianzadeh A, Mohammadbeigi A, Mobaleghi J, Mohammadsalehi N. Survival analysis of patients with bladder cancer, life table approach. J Midlife Health 2013; 3:88-92. [PMID: 23372326 PMCID: PMC3555033 DOI: 10.4103/0976-7800.104468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Bladder cancer is the fourth most common malignancy in men and the eighth most common in women. It causes 8% of all malignancies in men and 3% of all malignancies in women. The trend of bladder cancer is increasing in Iran. This study was conducted to estimate the survival rate of bladder cancer based on life table method. MATERIALS AND METHODS In this study, at first, data were collected based on individual variables of 514 patients suffering from bladder cancer and referred them to cancer registry center of Shiraz University of Medical Sciences from 2001-2009. Data were collected at two stages and analyzed by life table method and Wilcox on test. Significant level considered at 0.05. RESULTS Our findings showed that probability of survival accumulation at the end of 1, 3, 5, 10 years in patients with bladder cancer were equal to 0.8989, 0.7132, 0.5752 and 0.2459 respectively. There was significant difference in survival rate among age groups and treatment types (P < 0.05). However, we did not observe any difference in survival time based on smoking (P = 0.578), alcohol (P = 0.419) and education level (P = 0.371) of patients. CONCLUSION The overall survival rate of bladder cancer in the present study was less than other areas. Patients' age and treatment type were the influential factor in survival time. So continuous screening for early diagnosis suggested for older people.
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Affiliation(s)
- Abbas Rezaianzadeh
- Research Center for Health Sciences, Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Bozkurt Y, Sancaktutar AA, Soylemez H, Atar M. A solution for delay and survival in bladder cancer: the use of reminder text messages. J Telemed Telecare 2012; 18:241. [DOI: 10.1258/jtt.2012.120116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yasar Bozkurt
- Department of Urology, Faculty of Medicine, Dicle University, Turkey
| | | | - Haluk Soylemez
- Department of Urology, Faculty of Medicine, Dicle University, Turkey
| | - Murat Atar
- Department of Urology, Faculty of Medicine, Dicle University, Turkey
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15
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Affiliation(s)
- Martin Gulliford
- King's College London, Department of Primary Care and Public Health Sciences, London, UK.
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16
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Jibawi A, Ahmed I, El-Sakka K, Yusuf SW. Management of concomitant cancer and abdominal aortic aneurysm. Cardiol Res Pract 2011; 2011:516146. [PMID: 21559270 PMCID: PMC3087962 DOI: 10.4061/2011/516146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 01/04/2011] [Accepted: 02/23/2011] [Indexed: 12/31/2022] Open
Abstract
Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA) presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present) were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair) as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres.
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Affiliation(s)
- Abdullah Jibawi
- The Vascular Unit, Brighton and Sussex University Hospital, Brighton BN25BE, UK
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17
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Hollenbeck BK, Dunn RL, Ye Z, Hollingsworth JM, Skolarus TA, Kim SP, Montie JE, Lee CT, Wood DP, Miller DC. Delays in diagnosis and bladder cancer mortality. Cancer 2011; 116:5235-42. [PMID: 20665490 DOI: 10.1002/cncr.25310] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mortality from invasive bladder cancer is common, even with high-quality care. Thus, the best opportunities to improve outcomes may precede the diagnosis. Although screening currently is not recommended, better medical care of patients who are at risk (ie, those with hematuria) has the potential to improve outcomes. METHODS The authors used the Surveillance, Epidemiology, and End Results-Medicare linked database for the years 1992 through 2002 to identify 29,740 patients who had hematuria in the year before a bladder cancer diagnosis and grouped them according to the interval between their first claim for hematuria and their bladder cancer diagnosis. Cox proportional hazards models were fitted to assess relations between these intervals and bladder cancer mortality, adjusting first for patient demographics and then for disease severity. Adjusted logistic models were used to estimate the patient's probability of receiving a major intervention. RESULTS Patients (n = 2084) who had a delay of 9 months were more likely to die from bladder cancer compared with patients who were diagnosed within 3 months (adjusted hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.20-1.50). This risk was not markedly attenuated after adjusting for disease stage and tumor grade (adjusted HR, 1.29; 95% CI, 1.14-1.45). In fact, the effect was strongest among patients who had low-grade tumors (adjusted HR, 2.11; 95% CI, 1.69-2.64) and low-stage disease (ie, a tumor [T] classification of Ta or tumor in situ; adjusted HR, 2.02; 95% CI, 1.54-2.64). CONCLUSIONS A delay in the diagnosis of bladder cancer increased the risk of death from disease independent of tumor grade and or disease stage. Understanding the mechanisms that underlie these delays may improve outcomes among patients with bladder cancer.
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Affiliation(s)
- Brent K Hollenbeck
- Department of Urology, Division of Oncology, University of Michigan Health System, Ann Arbor, MI, USA.
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18
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Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ. Effect of Surgeon Training, Specialization, and Experience on Outcomes for Cancer Surgery: A Systematic Review of the Literature. Ann Surg Oncol 2009; 16:1799-808. [DOI: 10.1245/s10434-009-0467-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 11/18/2022]
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Nielsen ME, Palapattu GS, Karakiewicz PI, Lotan Y, Bastian PJ, Lerner SP, Sagalowsky AI, Schoenberg MP, Shariat SF. A delay in radical cystectomy of >3 months is not associated with a worse clinical outcome. BJU Int 2007; 100:1015-20. [PMID: 17784888 DOI: 10.1111/j.1464-410x.2007.07132.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between the interval from the last transurethral resection (TUR) to radical cystectomy (RC) and bladder cancer-specific outcome, as the decision to proceed to RC for an individual patient is complex, and recent reports suggest an interval from diagnosis to RC of >3 months is associated with adverse outcomes. PATIENTS AND METHODS The records of 592 patients who had RC were reviewed; the interval from the last TUR was analysed as both a continuous and categorical variable (<3 vs >/=3 months). Logistic regression and survival analyses were used to evaluate the association between the interval to RC with pathological characteristics and clinical outcomes. RESULTS The mean (sd) actuarial cancer-specific survival was 70.5 (2.3)% and 60.7 (3.2)% at 3 and 7 years, respectively. Overall, the median (range) time from TUR to RC was 1.8 (0.3-11.6) months. The interval to RC analysed as a continuous or categorical variable was not associated with extravesical or nodal disease, lymph node metastases, disease recurrence, overall or cancer-specific survival. The results were similar in the subgroup of 320 patients (54%) with clinically muscle-invasive disease. CONCLUSIONS These results suggest that a reasonable delay from the last TUR to RC is not independently associated with stage progression or with decreased recurrence-free or disease-specific survival. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Nevertheless, we see no reason to advocate anything less than the timely consideration of definitive treatment for patients with high-risk bladder cancer.
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Affiliation(s)
- Matthew E Nielsen
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
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20
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Holmäng S, Johansson SL. Impact of diagnostic and treatment delay on survival in patients with renal pelvic and ureteral cancer. ACTA ACUST UNITED AC 2007; 40:479-84. [PMID: 17130100 DOI: 10.1080/00365590600864093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the relationships between diagnostic and treatment delay and tumour stage and survival among patients with malignant tumours in the renal pelvis and ureter. MATERIAL AND METHODS A clinical and histopathological review was performed on 943 patients with a primary malignant tumour in the renal pelvis and ureter. We selected 394 patients who had macrohaematuria as an initial symptom, had no previous history of bladder cancer, had undergone surgery and had adequate follow-up. We performed uni- and multivariate analyses of prognostic factors for disease-specific survival. RESULTS The median number of days between the first occurrence of macrohaematuria and surgery was 83.5 days (range 4-1770 days). Patients with advanced tumours had the shortest median delay. Advanced tumour stage, a solid growth pattern and vascular invasion were of prognostic importance for disease-specific survival in the multivariate analysis, but diagnostic and treatment delay were not. CONCLUSIONS Although the delay was unacceptably long it still had no impact on survival, probably because macroscopic haematuria is a late symptom, in particular in high-grade tumours. New screening methods for the early detection of cancer and new treatment modalities are needed to improve the poor prognosis in stage pT3-pT4 tumours.
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Affiliation(s)
- Sten Holmäng
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.
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21
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Delay in the surgical treatment of bladder cancer and survival: systematic review of the literature. Eur Urol 2006; 50:1176-82. [PMID: 16846680 DOI: 10.1016/j.eururo.2006.05.046] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 05/30/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Eighty per cent of the newly diagnosed invasive bladder tumours are invasive from the outset. Half of these patients already have occult distant metastases reflecting the rapid nature of progression. The aim of the current study was to review the literature to determine if delay in cystectomy leads to worse prognosis and to determine if a possible cutoff point for delay exists, after which a worse outcome would be expected. METHODS We performed a systematic review of publications indexed in Medline and other scientific databases by analyzing types and causes of delay in performing radical cystectomy. Information on the impact of such delays on tumour recurrence and survival was collected and summarized. Papers that described only delay without any outcome correlation were excluded from the study. RESULTS A total of 13 papers published from 1965 to 2006 were included in this study. Three (23%) papers did not find any correlation between pretreatment delays and survival. Two (15%) papers reported a trend towards worse survival with delay. Eight (62%) papers documented significant association between delay and worse prognosis. Delay influenced survival as an independent variable in two (25%) of these eight papers. In the remaining six (75%) manuscripts, delay was significantly associated with a higher pathologic stage. CONCLUSIONS Although studies on bladder cancer failed to show a linear relationship between delay and prognosis, the majority confirmed that delays are associated with worse outcome. Studies suggested a window of opportunity of less than 12 weeks from diagnosis of invasive disease to radical cystectomy.
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22
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Mahmud SM, Fong B, Fahmy N, Tanguay S, Aprikian AG. Effect of Preoperative Delay on Survival in Patients With Bladder Cancer Undergoing Cystectomy in Quebec: A Population Based Study. J Urol 2006; 175:78-83; discussion 83. [PMID: 16406875 DOI: 10.1016/s0022-5347(05)00070-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 07/05/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE In Canada there is growing concern that waiting time for cancer surgery has been increasing. We used population based data to estimate the average PD for RC in Quebec and assess whether delayed surgery has a negative impact on long-term survival. MATERIALS AND METHODS We used the provincial billing database of the maladie du Quebec to identify all patients with bladder cancer 18 years or older who underwent RAMQ from 1990 to 2002. PD was calculated as the time elapsed between the most recent transurethral resection and the date of RC. Patients were categorized according to PD tertiles into 3 groups, namely 1) 20 or less, 2) 21 to 47 and (C) 48 days or greater. Cox proportional hazards models were used to assess the effect of PD on overall survival, while adjusting for patient and provider factors. RESULTS During the study period 1,592 radical cystectomies were performed. Overall median PD was 33 days (95% CI 30 to 35). Median PD increased from 23 days in 1990 to 50 in 2002. After adjusting for calendar year, and patient and provider variables there were no significant differences in survival among the 3 delay categories. However, patients subject to greater than 12 weeks of delay were at 20% greater risk for dying (95% CI 1.0 to 1.5, p = 0.051). CONCLUSIONS In line with previous reports PD greater than 12 weeks seems to be associated with a worse long-term prognosis.
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23
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Effect of Preoperative Delay on Survival in Patients With Bladder Cancer Undergoing Cystectomy in Quebec. J Urol 2006. [DOI: 10.1097/00005392-200601000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Begum G, Dunn JA, Bryan RT, Bathers S, Wallace DMA. Socio-economic deprivation and survival in bladder cancer. BJU Int 2004; 94:539-43. [PMID: 15329108 DOI: 10.1111/j.1464-410x.2004.04997.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the relationship between deprivation, delay and survival from bladder cancer in the West Midlands, as socio-economic deprivation is associated with worse survival in many malignancies, and it has been suggested that treatment differences and delay in seeking care are major contributing causes. PATIENTS AND METHODS Data were prospectively collected on 1537 newly diagnosed cases of urothelial cancer presenting in the West Midlands between January 1991 and June 1992. Survival was censored at 31 July 2000, when 785 (51%) patients had died. The influence of deprivation on survival was explored using cause-specific and all-cause mortality. RESULTS Patients in less affluent groups had significantly worse survival than patients in more affluent groups when considering deaths from all causes (P = 0.02), which held true when adjusting for independent prognostic factors (age, smoking history, and tumour grade, stage, type and size). Bladder cancer-specific mortality showed no significant difference between socio-economic groups (P = 0.30). CONCLUSION Socio-economic deprivation is a significant predictor of survival when death from all causes is considered. However, this does not hold true for bladder cancer-specific death. The perceived differences in treatment and delay between socio-economic groups do not seem to occur for bladder cancer in the West Midlands.
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Affiliation(s)
- Gulnaz Begum
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, University of Birmingham, Birmingham, UK
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25
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Chahal R, Harrison S. Re: An Interval Longer than 12 Weeks Between the Diagnosis of Muscle Invasion and Cystectomy is Associated with Worse Outcome in Bladder Carcinoma. J Urol 2003. [DOI: 10.1016/s0022-5347(05)63167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R. Chahal
- Department of Urology, Orchard House, Pinderfields and Pontefract NHS Trust, Wakefield, West Yorkshire, WF1 4DG, United Kingdom
| | - S.C.W. Harrison
- Department of Urology, Orchard House, Pinderfields and Pontefract NHS Trust, Wakefield, West Yorkshire, WF1 4DG, United Kingdom
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McTiernan A. Issues surrounding the participation of adolescents with cancer in clinical trials in the UK. Eur J Cancer Care (Engl) 2003; 12:233-9. [PMID: 12919302 DOI: 10.1046/j.1365-2354.2003.00406.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cancer in adolescents is rare with approximately 600 adolescents being diagnosed with cancer in the UK each year. With such small numbers, clinical trials are imperative if improvements in treatment and prognosis are to be achieved. However, the availability of such trials and the issues surrounding clinical trials in adolescents with cancer has rarely been reviewed. There are a number of issues regarding clinical trials that are particularly pertinent to this group. Primarily, despite evidence that adolescents with cancer fare better when treated on clinical trials, it would appear that adolescents do not have equal access to trials because of the fragmentation of adolescent cancer care between adult and paediatric oncology. For those who are treated within clinical trials, issues of informed consent need to be addressed, such as who should give consent and the provision of age-appropriate information. Finally, it has been suggested that adolescents are less compliant with treatment than both their adult and paediatric counterparts. As many adolescents with cancer can now be cured, this should be an area of great concern and more research is needed to ascertain the full extent of the problem and ways of overcoming it. The availability of clinical trials, along with the issues surrounding clinical trials in adolescents, need to be addressed if continued improvements in the outcome of this group of patients are to be seen.
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Affiliation(s)
- A McTiernan
- The Meyerstein Institute of Oncology, Oncology Research Office, 3rd Floor Jules Thorn, The Middlesex Hospital, Mortimer Street, London W1T 3AA, UK.
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Subramonian KR, Puranik S, Mufti GR. How will the two-weeks-wait rule affect delays in management of urological cancers? J R Soc Med 2003. [PMID: 12893857 PMCID: PMC539570 DOI: 10.1258/jrsm.96.8.398] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The UK National Health Service has now specified a maximum interval of two weeks between general practitioner (GP) referral and specialist assessment for patients with suspected cancer. We examined progress through the cancer pathway in 160 patients with potentially curable cancers of the prostate, bladder, kidney and testis before implementation of this rule. Median intervals with interquartile ranges were quantified from the first GP consultation to hospital referral, then to the first hospital consultation, confirmation of diagnosis and definitive surgery. 34% of patients were seen at the hospital within two weeks of referral. The overall median interval from GP consultation to radical surgery was 137 days, the longest being for prostate cancer (median 244). For prostate, bladder and renal cancers the principal element of delay was from the time of diagnosis to surgery (76, 73 and 26 days respectively). These results indicate that, under the two-weeks-wait rule, 2 out of every 3 patients achieve earlier initial assessment. However, the overall delay will not be substantially reduced without concomitant increases in diagnostic facilities, theatre time and human resources.
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Affiliation(s)
- K R Subramonian
- Department of Urology, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY, UK
| | - S Puranik
- Department of Urology, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY, UK
| | - G R Mufti
- Department of Urology, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY, UK
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Abstract
OBJECTIVE To assess in detail and evaluate the effect on survival of delays in the diagnosis and treatment of cancer (which might lead to a worse prognosis), dividing the delay from onset of symptoms to first treatment into several components, comprising patient delay, general practitioner (GP) delay, and two or more periods of hospital delay. PATIENTS AND METHODS Data were prospectively collected on 1537 new cases of urothelial cancer in the West Midlands from 1 January 1991 to 30 June 1992. Death information was obtained from the West Midlands Cancer Intelligence Unit and censored at 31 July 2000. The influence of delay times on survival was explored. RESULTS The median delay from onset of symptoms to GP referral was 14 days (Delay 1), from GP referral to first hospital attendance was 28 days (Delay 2), and from first hospital attendance to first transurethral resection of bladder tumour was 20 days (Delay 3). The median hospital delay (Delay 2 + 3) was 68 days and the median total delay (Delay 1 + 2 + 3) was 110 days. Patients with a shorter Delay 1 had a lower tumour stage and a 5% better 5-year survival. Patients with a shorter hospital delay had worse survival; total delay had no effect on survival. CONCLUSIONS There was significantly better survival for patients referred to hospital within 14 days of the onset of symptoms. The relationship between delay and survival in bladder cancer is complex. Hospital delays may be influenced more by comorbidity than by the characteristics of the tumour. However, the adverse effects of delay seem to be most pronounced for patients with pT1 tumours.
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Affiliation(s)
- D M A Wallace
- Department of Urology, The Queen Elizabeth Hospital, Birmingham, UK.
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29
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Mayfield MP, Whelan P. Bladder tumours detected on screening: results at 7 years. BRITISH JOURNAL OF UROLOGY 1998; 82:825-8. [PMID: 9883219 DOI: 10.1046/j.1464-410x.1998.00879.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To report the outcome at a minimum follow-up of 7 years of a cohort of tumours that were asymptomatic at presentation and detected in a previous community-based screening programme (with reduced mortality and progression at 3 years of follow-up). PATIENTS AND METHODS In the original screening, 2356 men aged > or = 60 years had a dipstick test for microscopic haematuria; 474 (20%) had positive results and of these, 317 agreed to further investigation. Twenty-one were found to have bladder tumours; this was reduced to 17 after pathological review. No tumours were muscle-invasive at diagnosis. The outcome of this cohort was evaluated at 7 years of follow-up. RESULTS The patients were grouped on the basis of their original histology. In group A, four patients had no tumour on histological review and none progressed in grade or stage. In group B, eight patients reported to have well differentiated superficial tumours (i.e. G1pTa) had no recorded deaths from cancer or progression to muscle-invasive disease. In group C, of nine patients with tumours having a potentially worse prognosis (G1-2, > or = pT1, or carcinoma in situ, three died from bladder cancer, two progressed to muscle-invasive disease (one of whom died from unrelated causes) and two further patients died from unrelated causes. CONCLUSION This cohort of patients represents a unique group, in that all had superficial disease at the time of diagnosis. The outcome at 3 years was excellent, but in the subsequent 4 years many patients had progression of their cancer. All patients who developed invasive disease were in group C; as their disease was identified at a superficial stage it may have been amenable to aggressive early management not usually associated with such grade and stage.
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Affiliation(s)
- M P Mayfield
- Pyrah Department of Urology, St James's University Hospital, Leeds, UK
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Yip SK, Peh WC, Tam PC, Li JH, Lam CH. Day case hematuria diagnostic service: use of ultrasonography and flexible cystoscopy. Urology 1998; 52:762-6. [PMID: 9801095 DOI: 10.1016/s0090-4295(98)00325-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess the efficacy of a day case diagnostic service employing ultrasonography and flexible cystoscopy in the evaluation of patients presenting with painless gross hematuria. METHODS From July 1994 to June 1997 a prospective study was conducted for 312 consecutive patients presenting with painless gross hematuria. They were evaluated in a day case diagnostic service setting, where ultrasonography and flexible cystoscopy were performed together with other laboratory investigations. Intravenous urography was subsequently performed for possible additional diagnostic information. RESULTS Eighty-one urinary malignancies were detected in 78 patients; 51 were carcinoma of the bladder, and the next most common was renal cell carcinoma (n = 15). Definitive diagnoses were made in 68 patients and an abnormality was noted in 9 other patients after the day case workup. The day case diagnostic workup has led to highly selective use of computed tomography scans with high diagnostic yield; intravenous urography only added important diagnostic information, not available from the earlier workup, in 9 patients. CONCLUSIONS Day case diagnostic service is a feasible arrangement. By combining ultrasonography and flexible cystoscopy, most carcinomas were diagnosed and abnormalities detected. Such a service enhances rapid completion of diagnostic workup, and operations for surgical conditions can be scheduled more promptly.
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Affiliation(s)
- S K Yip
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong
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31
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Lobel B, Abbou CC, Brausi M, Flanigan R, Kameyama S, Orikasa S, MacCaffrey J, Tachibana M. Guidelines for diagnosis, treatment, and follow-up of bladder cancer. Urol Oncol 1998; 4:94-105. [DOI: 10.1016/s1078-1439(99)00019-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/1999] [Indexed: 11/28/2022]
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32
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Grilli R, Minozzi S, Tinazzi A, Labianca R, Sheldon TA, Liberati A. Do specialists do it better? The impact of specialization on the processes and outcomes of care for cancer patients. Ann Oncol 1998; 9:365-74. [PMID: 9636826 DOI: 10.1023/a:1008201331167] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the impact of specialization on processes and outcomes of care for cancer patients. DATA SOURCE Papers published in English between 1980 and 1995 and identified through MEDLINE and Embase (MeSH terms: NEOPLASM (exploded), and PHYSICIAN PRACTICE PATTERNS (or DECISION MAKING, ATTITUDE OF HEALTH PERSONNEL, QUALITY OF HEALTH CARE, DELIVERY OF HEALTH CARE, HEALTH EDUCATION or OUTCOME ASSESSMENT HEALTH CARE), or through the reference lists of review articles. STUDY SELECTION Studies providing information on the association between quality of care indicators for cancer patients and clinician/centre degree of specialization. A total of 47 papers concerning 46 empirical studies were considered. DATA EXTRACTION For studies using process of care indicators, the proportion of specific procedures performed by specialists and non-specialists was abstracted. For studies using outcome indicators (e.g., mortality), the effect of specialization was quantified in terms of odds ratio (OR) expressing relative reduction in risk of death. The quality of individual studies using process or outcome indicators was assessed according to study design, avoidance of selection bias in patient identification and data analysis, degree of adjustment of the comparison between clinicians/centres with different levels of specialization. DATA SYNTHESIS Specialized centres/clinicians fared better both when process and outcome indicators were used. While the former varied widely in different studies and their clinical relevance was often questionable, mortality was consistently lower when care was provided by specialized centres/clinicians, with the effect size being greater in smaller studies. For breast cancer, where all the studies were of sufficiently good quality, a pooled estimate of the effect of specialization was performed which showed that specialized cancer care was associated with an 18% (95% CI: 12%-23%) reduction in mortality. CONCLUSIONS Despite the fact that care provided by specialized centres/clinicians appeared to be better both when assessed in relation to process indicators and to mortality, this evidence should be considered far from conclusive because of major methodological flaws in these studies. Relative to current efforts to promote evidence-based policy-making, this review underscores the limited capability of scientific information to provide reliable guidelines for structuring better health care systems.
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Affiliation(s)
- R Grilli
- Unit of Clinical Policy Analysis, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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33
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Porta M, Fernandez E, Belloc J, Malats N, Gallén M, Alonso J. Emergency admission for cancer: a matter of survival? Br J Cancer 1998; 77:477-84. [PMID: 9472647 PMCID: PMC2151307 DOI: 10.1038/bjc.1998.76] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to compare the pre-hospital health care process, clinical characteristics at admission and survival of patients with a digestive tract cancer first admitted to hospital either electively or via the emergency department. The study involved cross-sectional analysis of information elicited through personal interview and prospective follow-up. The setting was a 450-bed public teaching hospital primarily serving a low-income area of Barcelona, Catalonia, Spain. Two hundred and forty-eight symptomatic patients were studied, who had cancer of the oesophagus (n = 31), stomach (n = 70), colon (n = 82) and rectum (n = 65). The main outcome measures were stage, type and intention of treatment and time elapsed from admission to surgery; the relative risk of death was calculated using Cox's regression. There were 161 (65%) patients admitted via the emergency department and 87 (35%) electively. The type of physician seen at the first pre-hospital visit had more often been a general practitioner in the emergency than in the elective group (89% vs 75%, P < 0.01). Emergency patients had seen a lower number of physicians from symptom onset until admission, but two-thirds had made repeated visits to a primary care physician. Emergency patients were less likely to have a localized tumour and a diagnosis of cancer at admission, and surgery as the initial treatment. Median survival was 30 months for elective patients and 8 months for emergency patients (P < 0.001), and the relative risk of death (RR) was 1.83 (95% confidence interval, CI, 1.32-2.54). After adjustment for strong prognostic factors, emergency patients continued to experience a significant excess risk (RR = 1.58; CI 1.10-2.27). In conclusion, in digestive tract cancers, admission to hospital via the emergency department is a clinically important marker of a poorer prognosis. Emergency departments can only partly counterbalance deficiencies in the effectiveness of and integration among the different levels of the health system.
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Affiliation(s)
- M Porta
- Institut Municipal d'Investigació Mèdica, Universitat Autònoma de Barcelona, Spain
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34
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Affiliation(s)
- D Lacombe
- Investigational Agent Unit, EORTC Data Centre, Brussels, Belgium
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35
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Gulliford M. The reliability of cancer registry records. Qual Health Care 1996; 5:120-1. [PMID: 10158590 PMCID: PMC1055376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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36
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Järhult J. The importance of volume for outcome in cancer surgery--an overview. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1996; 22:205-10. [PMID: 8654596 DOI: 10.1016/s0748-7983(96)80002-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J Järhult
- Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden
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37
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Gulliford M. The reliability of cancer registry records. Qual Health Care 1996. [DOI: 10.1136/qshc.5.2.120-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Gulliford M. The reliability of cancer registry records. Qual Health Care 1996. [DOI: 10.1136/qshc.5.2.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Packham CJ. Differences in mortality after fracture of hip. Casemix factors may not have been considered sufficiently. BMJ (CLINICAL RESEARCH ED.) 1995; 311:571-2; author reply 572-3. [PMID: 7663232 PMCID: PMC2550629 DOI: 10.1136/bmj.311.7004.571b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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40
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41
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Kehoe S, Powell J, Wilson S, Woodman C. The influence of the operating surgeon's specialisation on patient survival in ovarian carcinoma. Br J Cancer 1994; 70:1014-7. [PMID: 7947077 PMCID: PMC2033561 DOI: 10.1038/bjc.1994.440] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A retrospective analysis of ovarian cancer patients registered with the West Midlands Cancer Registry from 1 January 1985 to 31 December 1987 was undertaken to examine the variables associated with survival patterns, with particular reference to the specialty of the surgeon. A total of 1,654 patients were registered, of whom 1,184 had histologically confirmed ovarian cancer, with the operator identified. This consisted of 870 patients operated on by gynaecologists and 314 operated on by general surgeons. A significantly older population and a greater number of patients with stage III/IV disease were operated on by general surgeons. The median survival of patients under the general surgeons' care was 9.87 months, significantly lower (P < 0.0001) than the survival of the gynaecologists' patients (median survival = 29.1 months). Univariate and multivariate analysis correlated poor prognosis with advanced stage disease, older age, the presence of bulky residual tumour and a general surgeon as the operator. Stepwise Cox's proportional hazard analysis confirmed the general surgeon as an independent adverse prognostic factor with a relative hazard ratio of 1.34 (95% confidence interval = 1.05-1.71). Accepting the limitations of retrospective reviews, these findings suggest that every attempt be made to ensure that a gynaecologist is involved in the treatment of patients with ovarian pathology.
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Affiliation(s)
- S Kehoe
- Department of Obstetrics & Gynaecology, City Hospital, Birmingham, UK
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42
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Correspondence. BJU Int 1994. [DOI: 10.1111/j.1464-410x.1994.tb16607.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Abstract
A review was carried out of the published literature on survival rates for cancer in relation to patterns of organisation of medical care, specifically treatment at specialist centres or at hospitals treating larger numbers of patients and treatment by protocol, usually within the context of a clinical trial. Centralised referral or entry to trials was frequently associated with a higher survival rate, particularly for the less common cancers, and was never found to be associated with a lower survival rate. Few studies were identified for any one cancer site and some antedated current methods of treatment. At a time when the health service in the United Kingdom is undergoing far-reaching organisational change, further research is needed to establish the most beneficial patterns of care for people with cancer. Population-based cancer registries are an invaluable source of data for such studies.
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Affiliation(s)
- C A Stiller
- University of Oxford, Department of Paediatrics, UK
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44
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45
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46
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Lynch TH, Waymont B, Dunn JA, Hughes MA, Wallace DM. Rapid diagnostic service for patients with haematuria. BRITISH JOURNAL OF UROLOGY 1994; 73:147-51. [PMID: 8131015 DOI: 10.1111/j.1464-410x.1994.tb07482.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To assess the feasibility of a clinic for the investigation of haematuria, with open access to general practitioners. PATIENTS AND METHODS A total of 395 patients (198 men and 197 women), with mean age 51 years (range 19-73), were referred from 13 general practitioner clinics. All investigations were performed at the patient's first visit at which time either a provisional or a definitive diagnosis was made. RESULTS Urinary tract infection was the most common diagnosis. Of all the patients, 43 (11%) had a malignancy of whom nine presented with microscopic haematuria. Fifty-nine per cent of patients were discharged after their first visit and 26% were placed on the waiting list for in-patient procedures. CONCLUSION An open access clinic such as this is efficient and easily run. The high incidence of pathological abnormalities makes it a worthwhile facility.
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Affiliation(s)
- T H Lynch
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
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47
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48
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49
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Månsson A, Anderson H, Colleen S. Time lag to diagnosis of bladder cancer--influence of psychosocial parameters and level of health-care provision. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1993; 27:363-9. [PMID: 8290917 DOI: 10.3109/00365599309180448] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Delay in diagnosis of carcinoma of the urinary bladder was studied in 343 patients. The median patient's delay (time from first symptom to first consultation) was 15 days, and was longer when the only presenting symptom was urgency of micturition than when it was haematuria (45 vs. 5 days, p < 0.001). In advanced (T2-T4) tumour, patient's delay was 21 days and in Ta-T1 it was 13 days (NS). The median doctor's delay (time from first consultation to diagnosis) was 62 days. It comprised two phases: A from consultation to first referral and B from first referral to diagnosis-respective medians 6 and 47 days. Median doctor's delay (A+B) was longer when the initial consultation was with a general practitioner than with a urologist (78 vs. 21 days, p < 0.001) and longer in patients older than 70 years (69 vs. 54 days, p < 0.01). Doctor's delay correlated with symptoms, being longest in cases with only urgency and shortest in haematuria plus pain (114 vs. 44 days, p < 0.001), and also with number of referrals (33, 63, 230 and 117 days, respectively, for 0, 1, 2 and 3 referrals). More women than men were referred a second or third time (25.6% vs. 8.6%, p < 0.001), and doctor's delay was longer for women (76 vs. 59 days, p < 0.05). A questionnaire completed by 203 of the 229 surviving patients revealed no significant correlation between psychosocioeconomic factors and patient's delay.
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Affiliation(s)
- A Månsson
- Department of Urology, University Hospital, Lund, Sweden
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50
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Abel PD. Follow-up of patients with "superficial" transitional cell carcinoma of the bladder: the case for a change in policy. BRITISH JOURNAL OF UROLOGY 1993; 72:135-42. [PMID: 8402013 DOI: 10.1111/j.1464-410x.1993.tb00674.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P D Abel
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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