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Khadhouri S, Gallagher KM, MacKenzie KR, Shah TT, Gao C, Moore S, Zimmermann EF, Edison E, Jefferies M, Nambiar A, Anbarasan T, Mannas MP, Lee T, Marra G, Gómez Rivas J, Marcq G, Assmus MA, Uçar T, Claps F, Boltri M, La Montagna G, Burnhope T, Nkwam N, Austin T, Boxall NE, Downey AP, Sukhu TA, Antón-Juanilla M, Rai S, Chin YF, Moore M, Drake T, Green JSA, Goulao B, MacLennan G, Nielsen M, McGrath JS, Kasivisvanathan V. Developing a Diagnostic Multivariable Prediction Model for Urinary Tract Cancer in Patients Referred with Haematuria: Results from the IDENTIFY Collaborative Study. Eur Urol Focus 2022; 8:1673-1682. [PMID: 35760722 DOI: 10.1016/j.euf.2022.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 06/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patient factors associated with urinary tract cancer can be used to risk stratify patients referred with haematuria, prioritising those with a higher risk of cancer for prompt investigation. OBJECTIVE To develop a prediction model for urinary tract cancer in patients referred with haematuria. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was conducted in 10 282 patients from 110 hospitals across 26 countries, aged ≥16 yr and referred to secondary care with haematuria. Patients with a known or previous urological malignancy were excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were the presence or absence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC], and renal cancer). Mixed-effect multivariable logistic regression was performed with site and country as random effects and clinically important patient-level candidate predictors, chosen a priori, as fixed effects. Predictors were selected primarily using clinical reasoning, in addition to backward stepwise selection. Calibration and discrimination were calculated, and bootstrap validation was performed to calculate optimism. RESULTS AND LIMITATIONS The unadjusted prevalence was 17.2% (n = 1763) for bladder cancer, 1.20% (n = 123) for UTUC, and 1.00% (n = 103) for renal cancer. The final model included predictors of increased risk (visible haematuria, age, smoking history, male sex, and family history) and reduced risk (previous haematuria investigations, urinary tract infection, dysuria/suprapubic pain, anticoagulation, catheter use, and previous pelvic radiotherapy). The area under the receiver operating characteristic curve of the final model was 0.86 (95% confidence interval 0.85-0.87). The model is limited to patients without previous urological malignancy. CONCLUSIONS This cancer prediction model is the first to consider established and novel urinary tract cancer diagnostic markers. It can be used in secondary care for risk stratifying patients and aid the clinician's decision-making process in prioritising patients for investigation. PATIENT SUMMARY We have developed a tool that uses a person's characteristics to determine the risk of cancer if that person develops blood in the urine (haematuria). This can be used to help prioritise patients for further investigation.
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Affiliation(s)
- Sinan Khadhouri
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Aberdeen Royal Infirmary, Aberdeen, UK; British Urology Researchers in Surgical Training (BURST) Collaborative, UK.
| | - Kevin M Gallagher
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Western General Hospital, Edinburgh, UK; Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Kenneth R MacKenzie
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Freeman Hospital, Newcastle Upon Tyne, UK
| | - Taimur T Shah
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Department of Surgery and Cancer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chuanyu Gao
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Addenbrookes Hospital, Cambridge, UK
| | - Sacha Moore
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Wrexham Maelor Hospital, Wrexham, UK
| | - Eleanor F Zimmermann
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Eric Edison
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Matthew Jefferies
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Morriston Hospital, Swansea, UK; Swansea University, Swansea, UK
| | - Arjun Nambiar
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Freeman Hospital, Newcastle Upon Tyne, UK
| | - Thineskrishna Anbarasan
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Western General Hospital, Edinburgh, UK
| | - Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Giancarlo Marra
- Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy; University of Turin, Turin, Italy
| | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France; CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, University Lille, Lille, France
| | - Mark A Assmus
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Taha Uçar
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe La Montagna
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tara Burnhope
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nkwam Nkwam
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tomas Austin
- Department of Urology, Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - Troy A Sukhu
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | | - Sonpreet Rai
- St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Madeline Moore
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - James S A Green
- Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK; Healthcare and Population Research, Kings College, London, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Matthew Nielsen
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - John S McGrath
- University of Exeter Medical School, Exeter, UK; Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) Collaborative, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Khadhouri S, Gallagher KM, MacKenzie KR, Shah TT, Gao C, Moore S, Zimmermann EF, Edison E, Jefferies M, Nambiar A, Mannas MP, Lee T, Marra G, Lillaz B, Gómez Rivas J, Olivier J, Assmus MA, Uçar T, Claps F, Boltri M, Burnhope T, Nkwam N, Tanasescu G, Boxall NE, Downey AP, Lal AA, Antón-Juanilla M, Clarke H, Lau DHW, Gillams K, Crockett M, Nielsen M, Takwoingi Y, Chuchu N, O'Rourke J, MacLennan G, McGrath JS, Kasivisvanathan V. The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study. BJU Int 2021; 128:440-450. [PMID: 33991045 DOI: 10.1111/bju.15483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. PATIENTS AND METHODS This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. RESULTS Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001). CONCLUSIONS A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.
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Affiliation(s)
- Sinan Khadhouri
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Aberdeen Royal Infirmary, Aberdeen, UK.,British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK
| | - Kevin M Gallagher
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Department of Clinical Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Kenneth R MacKenzie
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Freeman Hospital, Newcastle Upon Tyne, UK
| | - Taimur T Shah
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Dept. of Surgery and Cancer, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chuanyu Gao
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sacha Moore
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Wrexham Maelor Hospital, Wrexham, UK
| | - Eleanor F Zimmermann
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Eric Edison
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Department of Urology, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Matthew Jefferies
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Morriston Hospital, Swansea, UK
| | - Arjun Nambiar
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Freeman Hospital, Newcastle Upon Tyne, UK
| | - Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Giancarlo Marra
- Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy.,University of Turin, Turin, Italy
| | | | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Jonathan Olivier
- Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Mark A Assmus
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Taha Uçar
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Tara Burnhope
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nkwam Nkwam
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | | | - Asim A Lal
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | | | - Holly Clarke
- Bradford Teaching Hospitals, NHS Foundation Trust, Bradford, UK
| | | | | | - Matthew Crockett
- Frimley Renal Cancer Centre, Frimley Hospitals NHS Foundation Trust, Camberley, UK
| | - Matthew Nielsen
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Naomi Chuchu
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - John O'Rourke
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John S McGrath
- University of Exeter Medical School, Exeter, UK.,Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) Collaborative, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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John JB, Coscione A, Acher P, Speakman M. Non-visible haematuria: would discontinuing urgent investigation have a visible impact? Br J Hosp Med (Lond) 2020; 81:1-7. [PMID: 32339006 DOI: 10.12968/hmed.2020.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
National guidance in the UK continues to recommend urgent referral of selected patients with non-visible haematuria for urological assessment. The positive predictive value of non-visible haematuria for urological cancer is low, so it is uncertain whether this is an effective and equitable use of healthcare resources. This article considers rationales for and against continuing this practice, and outlines alternative investigative strategies for patients presenting with non-visible haematuria based on current knowledge and modern technology.
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Affiliation(s)
- Joseph B John
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Alberto Coscione
- Department of Urology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Peter Acher
- Department of Urology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Mark Speakman
- Department of Urology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
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'Urgent suspicion of cancer' referrals to a head and neck clinic - what do patients expect? The Journal of Laryngology & Otology 2019; 133:782-787. [PMID: 31439066 DOI: 10.1017/s0022215119001543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Public awareness of 'red flag' symptoms for head and neck cancer is low. There is a lack of evidence regarding patient concerns and expectations in consultations for cancer assessment. METHOD This prospective questionnaire study examined the symptoms, concerns and expectations of 250 consecutive patients attending an 'urgent suspicion of cancer' clinic at a tertiary referral centre. RESULTS The patients' most frequent responses regarding their concerns were 'no concerns' (n = 72, 29 per cent); 'all symptoms' were a cause for concern (n = 65, 26 per cent) and 'neck lump' was a symptom causing concern (n = 37, 17 per cent). The expectations of patients attending clinic were that they would find out what was wrong with them, followed by having no expectations at all. Overall patient knowledge of red flag symptoms was lacking and their expectations were low. CONCLUSION Patients with non-cancer symptoms are frequently referred with suspected cancer. Patients with red flag symptoms are not aware of their significance and they have low expectations of healthcare.
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Clinical outcome of head and neck cancer patients: a comparison between ENT patients referred via the 2 weeks wait pathway and alternative routes in the UK health system. Eur Arch Otorhinolaryngol 2016; 274:415-420. [DOI: 10.1007/s00405-016-4200-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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Barrass BJ, Wood SJ. The new standard of care in urology outpatients? A one-stop clinic improves efficiency and quality. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415813493417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this article is to determine retrospectively if a one-stop clinic for all new urology referrals improved the efficiency and quality of our outpatient pathway. We considered any improvement in productivity (e.g. waiting times) to indicate improved efficiency as resources were not increased. We considered any improvement in the level and continuity of specialist care to indicate improved quality as these factors have both been associated with measures of quality such as patient satisfaction. Patients and methods Quality and efficiency markers were recorded and compared for 100 consecutive urology referrals from 1 October before (2010) and after (2011) introduction of the clinic. Efficiency markers recorded were waiting times, discharge rate, number of dictated letters and clinic attendance. Quality markers recorded were grade and continuity of specialist care. Results The new appointment wait dropped from seven to two weeks. The commonest tests (flexible cystoscopy and ultrasound) were virtually all completed at first attendance. Median hospital visits before diagnosis dropped from two to one (p < 0.001). The discharge rate rose from 5/100 to 19/100 (p < 0.001). More patients (72/100 versus 42/100) were seen by a consultant and more cystoscopies (23/25 (92%) versus 1/28 (3.3%)) were performed by the urologist requesting them (p < 0.0001). The median number of dictated letters per diagnosis dropped from three to two in the one-stop clinic (p = 0.002). Conclusion The one-stop clinic significantly improved efficiency and quality markers for all new referrals, thereby improving access and reducing inequality. The clinic was inexpensive to introduce, and wider adoption of similar clinics could improve access to urological care.
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Affiliation(s)
- Barnaby Jr Barrass
- Department of Urology, Norfolk and Norwich University Hospital NHS Foundation Trust, UK
| | - Sarah J Wood
- Department of Urology, Norfolk and Norwich University Hospital NHS Foundation Trust, UK
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Rubin GP, Saunders CL, Abel GA, McPhail S, Lyratzopoulos G, Neal RD. Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: analysis of national primary care audit data. Br J Cancer 2015; 112:676-87. [PMID: 25602963 PMCID: PMC4333492 DOI: 10.1038/bjc.2014.634] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/07/2014] [Accepted: 12/01/2014] [Indexed: 01/07/2023] Open
Abstract
Background: For patients with symptoms of possible cancer who do not fulfil the criteria for urgent referral, initial investigation in primary care has been advocated in the United Kingdom and supported by additional resources. The consequence of this strategy for the timeliness of diagnosis is unknown. Methods: We analysed data from the English National Audit of Cancer Diagnosis in Primary Care on patients with lung (1494), colorectal (2111), stomach (246), oesophagus (513), pancreas (327), and ovarian (345) cancer relating to the ordering of investigations by the General Practitioner and their nature. Presenting symptoms were categorised according to National Institute for Health and Care Excellence (NICE) guidance on referral for suspected cancer. We used linear regression to estimate the mean difference in primary-care interval by cancer, after adjustment for age, gender, and the symptomatic presentation category. Results: Primary-care investigations were undertaken in 3198/5036 (64%) of cases. The median primary-care interval was 16 days (IQR 5–45) for patients undergoing investigation and 0 days (IQR 0–10) for those not investigated. Among patients whose symptoms mandated urgent referral to secondary care according to NICE guidelines, between 37% (oesophagus) and 75% (pancreas) were first investigated in primary care. In multivariable linear regression analyses stratified by cancer site, adjustment for age, sex, and NICE referral category explained little of the observed prolongation associated with investigation. Interpretation: For six specified cancers, investigation in primary care was associated with later referral for specialist assessment. This effect was independent of the nature of symptoms. Some patients for whom urgent referral is mandated by NICE guidance are nevertheless investigated before referral. Reducing the intervals between test order, test performance, and reporting can help reduce the prolongation of primary-care intervals associated with investigation use. Alternative models of assessment should be considered.
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Affiliation(s)
- G P Rubin
- Evaluation, Research and Development Unit, School of Medicine, Pharmacy and Health, Wolfson Research Institute, University of Durham, Queen's Campus, University Boulevard, Stockton-on-Tees TS17 6BH, UK
| | - C L Saunders
- Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge CB2 0SR, UK
| | - G A Abel
- Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge CB2 0SR, UK
| | - S McPhail
- National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK
| | - G Lyratzopoulos
- Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Cambridge CB2 0SR, UK
| | - R D Neal
- North Wales Centre for Primary Care Research, College of Health & Behavioural Sciences, Bangor University, Gwenfro Unit 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
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Young SM, Bansal P, Vella ET, Finelli A, Levitt C, Loblaw A. Systematic review of clinical features of suspected prostate cancer in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:e26-e35. [PMID: 25756146 PMCID: PMC4301783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To systematically review the literature and provide an update and integration of existing peer-reviewed guidelines with recent systematic reviews and with primary studies related to the early recognition and management of prostate cancer in primary care. DATA SOURCES We searched MEDLINE and EMBASE for relevant articles. The quality of the evidence to support existing guideline recommendations and the consistency of recommendations with updated evidence were assessed. Applicability in a Canadian primary care setting was also evaluated. STUDY SELECTION All studies conducted in the primary care setting that provided information on clinical features predictive of prostate cancer were included. Also, studies that assessed the accuracy of nomograms to predict prostate cancer were reviewed. SYNTHESIS The findings suggest that lower urinary tract symptoms are not highly predictive of prostate cancer. However, evidence suggests that FPs might be good at discriminating between patients with and without prostate cancer using digital rectal examination and prostate-specific antigen testing. Nomograms might also be useful in assessing patients for aggressive prostate cancers. CONCLUSION The results of this review can be used to inform recommendations for referral for suspected prostate cancer in the primary care setting. They could also inform development of prostate cancer diagnostic assessment programs.
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Audit of rapid access introduction reveals high prevalence of prostate cancer in Western Region. Ir J Med Sci 2013; 183:173-9. [DOI: 10.1007/s11845-013-0986-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/04/2013] [Indexed: 11/25/2022]
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Rimmer J, Watson J, O'Flynn P, Vaz F. A Head and Neck 'Two-Week Wait' Clinic: Cancer Referrals or the Worried Well ? ACTA ACUST UNITED AC 2012. [DOI: 10.1308/147363512x13311314196212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Head and neck cancer affects approximately 8–15 per 100,000 of the UK population, with marked regional variations. There is good evidence that early detection improves prognosis but unfortunately many of the initial symptoms are often non-specific. In 2000 the NHS Cancer Plan introduced the 'two-week wait'(2WW) rule to increase the speed with which patients with suspected cancer are seen by a specialist.
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Affiliation(s)
- J Rimmer
- SpR in Otolaryngology, University College Hospital, London
| | - J Watson
- SHO in Head and Neck Surgery, University College Hospital, London
| | - P O'Flynn
- Consultant Head and Neck Surgeon, University College Hospital, London
| | - F Vaz
- Consultant Head and Neck Surgeon, University College Hospital, London
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Serag H, Banerjee S, Saeb-Parsy K, Irving S, Wright K, Stearn S, Doble A, Gnanapragasam VJ. Risk profiles of prostate cancers identified from UK primary care using national referral guidelines. Br J Cancer 2012; 106:436-9. [PMID: 22240787 PMCID: PMC3273344 DOI: 10.1038/bjc.2011.596] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Prostate cancer in the United Kingdom is mainly diagnosed from primary care referrals based on national guidelines published by the Department of Health. Here we investigated the characteristics of cancers detected through the use of these guidelines. Methods: A prospective two-centre study was established to assess men referred from the primary care based on the UK national guidelines. Results: The overall cancer detection rate was 43% (169 out of 397) with 15% (26 out of 169) of all cancers metastatic at presentation. Amongst 50–69-year-old men these rates were 34% (68 out of 200) and 15% (10 out of 68). Only 21% (25 out of 123) of men with local cancers had low-risk disease. In comparison to a historical cohort from 2001 (n=137) we found no overall differences in rates of metastatic disease, locally advanced tumours, or risk categories. Amongst 50–69-year-old men with local disease, however, we observed an increase in detection of low-risk cancers in a contemporary cohort (P=0.04). This was primarily because of the increased detection of low-stage organ-confined tumours in this group (P=0.02). Conclusion: Use of the UK prostate cancer guidelines detects a high proportion of clinically significant cancers. Use of the guidelines does not seem to have led to an overall change in the clinical characteristics of presenting cancers. There may, however, be a specific benefit in detecting more low-risk disease in younger men.
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Affiliation(s)
- H Serag
- Department of Urology, Addenbrookes Hospital, Hills Road, Cambridge CB2 0XZ, UK
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