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Swann R, Lyratzopoulos G, Rubin G, Elliss-Brookes L, McPhail S. Predictors and consequences of different pathways to emergency diagnosis of cancer in England: Evidence from linked national audit and cancer registration data. Cancer Epidemiol 2024; 92:102607. [PMID: 39167911 DOI: 10.1016/j.canep.2024.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Diagnosis of cancer soon after emergency care use is associated with adverse prognosis. We aimed to more precisely explore different definitions of emergency diagnosis. METHODS For 43,383 patients in the National Cancer Diagnosis Audit and Routes to Diagnosis datasets, we defined two emergency care pathways: emergency referral (Type-A) and emergency hospital admission (Type-B). We examined patient and tumour factors associated with each pathway excluding the other, and in combination (Type-A+B), in particular their concordance and prognostic implications for short-term mortality. RESULTS One in five patients (19 %) were diagnosed following emergency care use: 4 % through Type-A only, 7 % through Type-B only, and 8 % through Type-A+B. Higher co-morbidity, deprivation, advanced stage and certain cancer sites were associated with greater risk of emergency diagnosis. Concordance of emergency diagnosis pathway between Type-A and Type-B increased with age, co-morbidity and certain cancer sites. Patients with non-alarm symptoms were more likely to self-refer (Type-A) to an Emergency Department than patients with alarm symptoms. Associations with higher short-term mortality were strongest for Type-A+B. CONCLUSIONS We profile different pathways to emergency diagnosis and identify opportunities to improve diagnostic processes for these patients.
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Affiliation(s)
- Ruth Swann
- Cancer Intelligence, CRUK, London, United Kingdom; National Disease Registration Service, NHS England, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Greg Rubin
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | - Sean McPhail
- National Disease Registration Service, NHS England, United Kingdom
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Bosch X, Montori-Palacin E, Gomes TM, Naval-Álvarez J, Moreno P, López-Soto A. Clinical characterisation of patients diagnosed with cancer following emergency self-referral. Cancer Epidemiol 2024; 92:102609. [PMID: 38991388 DOI: 10.1016/j.canep.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Despite their frequency and potential impact on prognosis, cancers diagnosed via self-referral to the emergency department are poorly documented. We conducted a detailed analysis of cancer patients diagnosed following emergency self-referral and compared them with those diagnosed following emergency referral from primary care. Given the challenges associated with measuring intervals in the emergency self-referral pathway, we also aimed to provide a definition of the diagnostic interval for these cancers. METHODS A retrospective observational analysis was performed on patients diagnosed with 13 cancers, either following emergency self-referral or emergency referral from primary care. We analysed demographics, tumour stage, clinical data (including 28 presenting symptoms categorised by body systems), and diagnostic intervals by cancer site, then testing for differences between pathways. RESULTS Out of 3624 patients, 37 % were diagnosed following emergency self-referral and 63 % via emergency referral from primary care. Emergency self-referrals were associated with a higher likelihood of being diagnosed with cancers manifesting with localising symptoms (e.g., breast and endometrial cancer), whereas the likelihood of being diagnosed with cancers featuring nonspecific symptoms and abdominal pain (e.g., pancreatic and ovarian cancer) was higher among patients referred from primary care. Diagnostic intervals in self-referred patients were half as long as those in patients referred from primary care, with most significant differences for pancreatic cancer (28 [95 % CI -34 to -23] days shorter, respectively). CONCLUSION These findings enrich the best available evidence on cancer diagnosis through emergency self-referral and showed that, compared with the emergency referral pathway from primary care, these patients had a significantly increased likelihood of presenting with symptoms that are strongly predictive of cancer. Since the starting point for the diagnostic interval in these patients is their emergency presentation, comparing it with that of those referred from primary care as an emergency is likely to result in biased data.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain.
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | | | - José Naval-Álvarez
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
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3
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Odo C, Albutt A, Hardman J, Patterson J, Mcvey L, Rousseau N, Paleri V, Randell R. Technology for fast-tracking high-risk head and neck cancer referrals: Co-designing with patients. Int J Med Inform 2024; 192:105641. [PMID: 39326213 DOI: 10.1016/j.ijmedinf.2024.105641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 09/19/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Head and Neck Cancer (HNC) is the eighth most prevalent global cancer. Timely recognition of symptoms is crucial for reducing mortality rates. The EVolution of a patiEnt-REported symptom-based risk stratification sySTem to redesign the suspected Head and Neck cancer referral pathway (EVEREST-HN) study aims to develop and evaluate a risk stratification tool using patient reported symptoms, which will be populated remotely in the community before the patient is seen by the clinician to hasten HNC diagnosis. EVEREST-HN will design a patient SYmptom iNput Clinical (SYNC) system to gather patient symptom data and calculate a risk score to aid clinicians in identifying high-risk cases. This identification potentially allows for high-risk patients to be seen sooner, thereby improving patient outcomes. METHODS Three workshop sessions were conducted involving a total of 17 unique participants, with several contributing to multiple sessions: nine in the co-design session, six in the validation session, and nine in the evaluation session. The co-design session employed online collaboration with patients' representatives. Thematic analysis was used to identify requirements and concerns informing the development of a low-fidelity prototype. The validation session assessed whether the prototype aligned with patient expectations. In the evaluation session, participants interacted with an online prototype and provided further feedback. RESULTS During the co-design workshop, participants emphasized the need for a concise and clear SYNC system questionnaire for reporting suspected HNC symptoms. Concerns were raised about questionnaire length, language clarity, and the inclusion of probing questions. Participants suggested concise questions using lay language, incorporating visual aids for topics like alcohol and tobacco use, and making the sexual activity question optional. Recommendations included diverse language options, hard copies for non-English speakers, and phone call options for those uncomfortable with screen-based technology. The validation workshop confirmed that the prototype reflected participants' ideas. Feedback highlighted the need for call-back features to help those not confident with technology and the need to present symptom questions first before social background questions. Feedback from the evaluation demonstrated a commitment to efficiency, and continuous improvement. CONCLUSION This study aims to develop the SYNC system to enhance efficiency of suspected HNC referrals. The workshops highlighted the importance of end-user inclusiveness in the system development life cycle, with collaboration with stakeholders and repeated feedback, providing crucial insights for ensuring the SYNC system effectively addresses the needs and concerns of patients in the context of HNC diagnosis.
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Affiliation(s)
- Chinasa Odo
- Centre for Digital Innovations in Health Social Care, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK.
| | - Abigail Albutt
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | | | - Lynn Mcvey
- Centre for Digital Innovations in Health Social Care, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Rebecca Randell
- Centre for Digital Innovations in Health Social Care, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
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4
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Bradford A, Meyer AND, Khan S, Giardina TD, Singh H. Diagnostic error in mental health: a review. BMJ Qual Saf 2024; 33:663-672. [PMID: 38575311 DOI: 10.1136/bmjqs-2023-016996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. We review conceptual considerations for defining and measuring diagnostic error, the application of these concepts to mental health settings, and the methods and subject matter focus of recent studies of diagnostic error in mental health. We found that diagnostic error is well understood to be a problem in mental healthcare. Although few studies used clear definitions or frameworks for understanding diagnostic error in mental health, several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Nevertheless, a lack of clear consensus on how to conceptualise, define and measure errors in diagnosis will pose a barrier to advancement. Further research should focus on identifying preventable missed opportunities in the diagnosis of mental disorders, which may uncover generalisable opportunities for improvement.
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Affiliation(s)
- Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Ashley N D Meyer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Traber D Giardina
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Jensen ABH, Andersen HRP, Jensen ST, Jensen CF, Amstrup J, Mathiasen R, Henriksen KA, Hasle H, Callesen MT, Brix N. Musculoskeletal Symptoms and Misdiagnoses in Children With Acute Myeloid Leukaemia: A Nationwide Cohort Study. Eur J Haematol 2024. [PMID: 39295289 DOI: 10.1111/ejh.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/21/2024]
Abstract
OBJECTIVES Childhood cancer often presents with non-specific signs and symptoms that might mimic non-malignant disorders including musculoskeletal diseases, potentially leading to rheumatic and orthopaedic misdiagnoses. We aimed to compare clinical presentation, diagnostic interval and survival in paediatric acute myeloid leukaemia (AML) with and without initial musculoskeletal symptoms. METHODS This nationwide retrospective, cohort study reviewed medical records of 144 children below 15 years diagnosed with AML in Denmark from 1996 to 2018. RESULTS Musculoskeletal symptoms occurred in 29% (42/144) of children with AML and 8% (11/144) received an initial musculoskeletal misdiagnosis, being mainly non-specific and pain-related. The children with and without musculoskeletal symptoms did not differ markedly up to the diagnosis of AML and blood counts were affected equally in both groups. However, the children with prior musculoskeletal symptoms were more likely to have elevated levels of LDH and ferritin. Furthermore, they revealed a tendency towards a longer total interval (median 53 days vs. 32 days, p = 0.07), but the overall survival did not differ. CONCLUSION AML should be considered as an underlying cause in children with unexplained musculoskeletal symptoms and abnormal blood counts. Concomitant elevation of LDH and ferritin should strengthen the suspicion.
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Affiliation(s)
| | | | - Sarah Thorius Jensen
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Friis Jensen
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Amstrup
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - René Mathiasen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | | | - Henrik Hasle
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Thude Callesen
- Department of Pediatric and Adolescent Medicine, Odense University Hospital, Odense, Denmark
| | - Ninna Brix
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
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Bergin RJ, O'Sullivan D, Dixon-Suen S, Emery JD, English DR, Milne RL, White VM. Time to Diagnosis and Treatment for Ovarian Cancer and Associations with Outcomes: A Systematic Review. J Womens Health (Larchmt) 2024; 33:1185-1197. [PMID: 38976232 DOI: 10.1089/jwh.2023.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: Ovarian cancer is commonly diagnosed symptomatically at an advanced stage. Better survival for early disease suggests improving diagnostic pathways may increase survival. This study examines literature assessing diagnostic intervals and their association with clinical and psychological outcomes. Methods: Medline, EMBASE, and EmCare databases were searched for studies including quantitative measures of at least one interval, published between January 1, 2000 and August 9, 2022. Interval measures and associations (interval, outcomes, analytic strategy) were synthesized. Risk of bias of association studies was assessed using the Aarhus Checklist and ROBINS-E tool. Results: In total, 65 papers (20 association studies) were included and 26 unique intervals were identified. Interval estimates varied widely and were impacted by summary statistic used (mean or median) and group focused on. Of Aarhus-defined intervals, patient (symptom to presentation, n = 23; range [median]: 7-168 days) and diagnostic (presentation to diagnosis, n = 22; range [median]: 7-270 days) were most common. Nineteen association studies examined survival or stage outcomes with most, including five low risk-of-bias studies, finding no association. Conclusions: Studies reporting intervals for ovarian cancer diagnosis are limited by inconsistent definitions and reporting. Greater utilization of the Aarhus statement to define intervals and appropriate analytic methods is needed to strengthen findings from future studies.
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Affiliation(s)
- Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Deirdre O'Sullivan
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Suzanne Dixon-Suen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- School of Exercise & Nutrition Sciences, Deakin University, Burwood, Australia
| | - Jon D Emery
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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He Y, Li F, Guo C, Quaresma M, He Z, Ke Y, Dos-Santos-Silva I. Dissecting the Prediagnostic Journey to Identify Opportunities for Early Detection of Esophageal Cancer: Findings From a High-Risk Area in Rural China. JCO Glob Oncol 2024; 10:e2400209. [PMID: 39303193 DOI: 10.1200/go.24.00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/22/2024] [Accepted: 08/09/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE Survival from esophageal cancer (EC) is poor, partly reflecting the delay in diagnosis. To inform the potential measures for downstaging the disease, we estimated diagnosis delay, that is, the length of interval from symptom-to-diagnosis (STD), and investigated its correlates among patients with EC in a high-risk resource-limited rural area in China. METHODS Patients newly diagnosed with EC (N = 411) were recruited in a secondary hospital in Henan province in China between August 1, 2018, and October 21, 2020. A face-to-face structured questionnaire was used to collect patient-level and health-seeking data from patients and/or proxies. Association between the length of STD interval and stage at diagnosis was examined using logistic regression. Correlates of the length of the STD interval were identified using negative binomial regression. RESULTS The median STD interval was 61 (IQR, 24-155) days, with the time from symptom onset to first health care contact representing 90.1% (IQR, 7.8%-100%) of its length. The odds of being diagnosed at stages III-IV increased by 3% (age- and sex-adjusted odds ratio, 1.03 [95% CI, 0.99 to 1.08]) for every 2-month increase in the STD interval. Higher awareness of EC risk factors was associated with shorter STD intervals (incidence rate ratio [95% CI] for awareness score ≥2 v ≤0: 0.65 [0.46 to 0.93]), whereas patients who first visited secondary or tertiary/cancer hospitals had much longer STD intervals than those who first visited a primary health care facility (1.69 [1.19 to 2.40]; 2.22 [1.24 to 3.97]). CONCLUSION The median length of the STD interval was 2 months, but with considerable interindividual variability. Improving EC awareness, coupled with effective referral pathways, may promote timely diagnosis of this disease.
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Affiliation(s)
- Yu He
- Chinese Preventive Medicine Association, Beijing, People's Republic of China
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fenglei Li
- Hua County People's Hospital, Henan, People's Republic of China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Manuela Quaresma
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zhonghu He
- State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yang Ke
- State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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8
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Lisboa LJ, Pires AL, Silva AM, Freitas VS. Analysis of scientific publications on oral cancer diagnosis delays: a bibliometric study over 22 years. Med Oral Patol Oral Cir Bucal 2024; 29:e682-e689. [PMID: 39088715 PMCID: PMC11365049 DOI: 10.4317/medoral.26719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/24/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND The area of oncology still lacks bibliometric studies that investigate the diagnostic interval of oral cancer. This study proposed to carry out a bibliometric analysis of epidemiological studies that investigated the diagnosis of oral cancer between 2002 to 2024. MATERIAL AND METHODS On April, 2024, the Scopus and Web of Science databases were explored, and the selected articles underwent bibliometric analysis of performance and scientific mapping of journals, authors, institutions, and countries, as well as the predominant topics and trends in research into the diagnosis of oral cancer through an analysis of references and co-occurrence of key words. The analyzes were carried out using the R extension package, Bibliometrix, and the VOSviewer software. RESULTS A total of 532 documents were included. China contributed the highest number of publications (36.71%) and total citations [1,584]. Seoane J was the most prolific author [16 (h-index: 9)], while Warnakulasuriya S had the highest total link strength [282 (h-index: 7)] in co-citations. Oral Oncology was identified as the most prolific [231 (72.64%)], co-cited and impactful journal (h-index: 13). Explosions of citations were found for keywords such as "early diagnosis", "biomarker", "saliva", "precancer" and "prognosis", making it evident that in the field of oral cancer diagnosis there is room for new studies focusing in reducing the diagnostic interval, with the research hotspots being the terms "biomarkers", "imaging diagnosis" and "gene expression". CONCLUSIONS This study provides valuable information that can help researchers and institutions align their research activities according to emerging themes, establish collaborations and allocate resources effectively.
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Affiliation(s)
- L-J Lisboa
- Department of Health, State University of Feira de Santana Av. Transnordestina, s/n. Novo Horizonte Feira de Santana, Bahia, 44036-900, Brazil
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Walsh R, Lofters A, Groome P, Moineddin R, Krzyzanowska M, Griffiths R, Grunfeld E. Wait times and breast cancer survival: a population-based retrospective cohort study using CanIMPACT data. Cancer Causes Control 2024; 35:1245-1257. [PMID: 38748276 DOI: 10.1007/s10552-024-01879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/04/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE The time from breast cancer surgery to chemotherapy has been shown to affect survival outcomes; however, the effect of time from first breast cancer-related healthcare contact to first cancer specialist consultation, or the time from first breast cancer-related healthcare contact to adjuvant chemotherapy on survival has not been well explored. We aimed to determine whether various wait times along the breast cancer treatment pathway (contact-to-consultation, contact-to-chemotherapy, surgery-to-chemotherapy) were associated with overall survival in women within the Canadian province of Ontario. METHODS We performed a population-based retrospective cohort study of women diagnosed with stage I-III breast cancer in Ontario between 2007 and 2011 who received surgery and adjuvant chemotherapy. This was the Ontario cohort of a larger, nationwide study (the Canadian Team to improve Community-Based Cancer Care along the Continuum - CanIMPACT). We used Cox-proportional hazards regression to determine the association between the contact-to-consultation, contact-to-chemotherapy, and surgery-to-chemotherapy intervals and overall survival while adjusting for cancer stage, age, comorbidity, neighborhood income, immigration status, surgery type, and method of cancer detection. RESULTS Among 12,782 breast cancer patients, longer surgery-to-chemotherapy intervals (HR 1.13, 95% CI 1.03-1.18 per 30-day increase), but not the contact-to-consultation (HR 0.979, 95% CI 0.95-1.01 per 30-day increase), nor the more comprehensive contact-to-chemotherapy intervals (HR 1.00, 95% CI 0.98-1.02 per 30-day increase) were associated with decreased survival in our adjusted analyses. CONCLUSION Our findings emphasize the prognostic importance of a shorter surgery-to-chemotherapy interval, whereas the contact-to-consultation and contact-to-chemotherapy intervals have less impact on survival outcomes.
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Affiliation(s)
- Rachel Walsh
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | | | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Monika Krzyzanowska
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Rasmussen LA, Vedsted P, Jensen H, Frederiksen H, El-Galaly TC, Kristensen IB, Virgilsen LF. Multiple myeloma: unplanned diagnostic pathways and association with risk factors and survival - a nationwide register-based cohort study in Denmark. BMC Cancer 2024; 24:998. [PMID: 39134966 PMCID: PMC11320956 DOI: 10.1186/s12885-024-12706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Multiple myeloma often presents with vague and non-specific symptoms. Many patients are diagnosed in unplanned rather than elective (planned) diagnostic pathways. This study investigates the diagnosis of multiple myeloma in unplanned pathways and the association with patient characteristics, disease profile, and survival. METHODS We conducted a nationwide register-based study, including all patients diagnosed with multiple myeloma in Denmark in 2014-2018. Patients were categorised as diagnosed in an unplanned pathway if registered with an acute admission within 30 days prior to the multiple myeloma diagnosis and no other previously registered pathway to this diagnosis. Unplanned pathways were compared to all other pathways combined. RESULTS We included 2,213 patients diagnosed with multiple myeloma, hereof 32% diagnosed in an unplanned pathway. Comorbidity, no prior cancer diagnosis, a history of few visits to the general practitioner (GP), multiple myeloma complications at diagnosis, high-risk cytogenetics, and advanced cancer stage were associated with a higher probability of being diagnosed in an unplanned pathway. For example, 24.4% (95% confidence interval (CI): 21.8-27.0) of patients with low comorbidity (Charlson Comorbidity Index (CCI) score 0) were diagnosed in an unplanned pathway as were 50.9% (95% CI: 45.6-56.1) of patients with high comorbidity (CCI score 3+). For patients with dialysis need at the time of diagnosis the probability was 66.0% (95% CI 54.2-77.8) and 30.9% (95% CI: 28.9-32.9) for patients with no dialysis need. Patients diagnosed in an unplanned pathway had inferior survival (hazard ratio 1.44 (95% CI: 1.26-1.64)). However, this association was not seen in analyses restricted to patients surviving for more than three years. CONCLUSIONS High comorbidity level, few usual GP visits, advanced disease status at diagnosis, and complications were associated with diagnosis in an unplanned pathway. Further, patients diagnosed in an unplanned pathway had inferior survival. Promoting earlier diagnosis and preventing unplanned pathways may help improve survival in multiple myeloma.
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Affiliation(s)
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus, Denmark
- Department of Clinical Medicine, University Clinic for Innovative Patient Pathways, Aarhus University, Aarhus, Denmark
| | - Henry Jensen
- Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Haematology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Ida Bruun Kristensen
- Department of Haematology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Davis LE, Strumpf EC, Patel SV, Mahar AL. Income differences in time to colon cancer diagnosis. Cancer Med 2024; 13:e6999. [PMID: 39096087 PMCID: PMC11297540 DOI: 10.1002/cam4.6999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. METHODS This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. RESULTS A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. CONCLUSION These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
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Affiliation(s)
- Laura E. Davis
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- ICESTorontoCanada
| | - Erin C. Strumpf
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- Department of EconomicsMcGill UniversityMontrealCanada
| | | | - Alyson L. Mahar
- ICESTorontoCanada
- School of NursingQueen's UniversityKingstonCanada
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Weile KS, Helligsoe ASL, von Holstein SL, Winther JF, Mathiasen R, Hasle H, Henriksen LT. Patient- and parent-reported diagnostic delay in children with central nervous system tumors in Denmark. Pediatr Blood Cancer 2024; 71:e31128. [PMID: 38814259 DOI: 10.1002/pbc.31128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/01/2024] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Diagnostic delays in childhood tumors of the central nervous system (CNS) pose a significant challenge. The aim of this study was to map diagnostic delay and presenting symptoms in Denmark. METHODS The study was a retrospective questionnaire study, mapping delay and symptoms in pediatric patients (0-17 years), diagnosed with a CNS tumor from 2015 to 2019. Descriptive analysis was performed to measure delay in days, reported as total diagnostic interval (TDI), patient interval (PI), and diagnostic interval (DI). Analysis of symptoms, contacts to healthcare professionals, and socioeconomic status was also performed. RESULTS We included 89 patients (median age 7.0 years, 54% male). The TDI was median of 106 days (range: 0-2694 days). Low-grade tumors had longer TDI than high-grade tumors (125 vs. 43 days; p ≤ .02). Patients aged 15-17 displayed the longest TDI (median 665 days). Number of symptoms at onset were inversely associated with longer TDI in patients presenting one symptom (247 days) and patients presenting two to three (110 days) or greater than three complaints (66 days). PI was not associated with sex (p = .14), tumor grade (p = .63), location (p = .32), or socioeconomic status (p = .82). Most frequent single complaint at onset was headache (19%), most frequent combination of symptoms was headache and vomiting (60%). CONCLUSION We found TDIs longer than reported in contemporary publications. TDI was longer in patients with low-grade tumors and only few symptoms at the time of onset. The findings support the crucial need of awareness and improved diagnostic tools to recognize and interpret symptoms to promote timely diagnosis.
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Affiliation(s)
- Kathrine Synne Weile
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Anne Sophie Lind Helligsoe
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Sarah Linea von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
- Danish Cancer Institute, Copenhagen, Denmark
| | - René Mathiasen
- Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
| | - Louise Tram Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, HEALTH, Aarhus University, Aarhus, Denmark
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Pradhan P, Wan K(Z, Chan L, Low T(H, Wu R, Lee JH, Palme CE, Clark JR, Venchiarutti RL. A qualitative exploration of the pathway to diagnosis and treatment of cutaneous squamous cell carcinoma of the head and neck with perineural spread. Cancer Med 2024; 13:e70118. [PMID: 39177016 PMCID: PMC11342044 DOI: 10.1002/cam4.70118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Perineural spread (PNS) is associated with a poor prognosis in cutaneous squamous cell carcinoma of the head and neck (cSCCHN). Hence, investigating facilitators and barriers of early diagnosis and treatment of PNS in cSCCHN may improve outcomes. METHODS Patients were recruited from an institutional database. Semi-structured interviews were conducted according to the Model of Pathways to Treatment. Thematic analysis was based on the four main intervals in the framework using a data-driven analytical method. RESULTS Seventeen participants were interviewed. Facilitators included patients' past experiences, symptom progression, trust in healthcare professionals (HCPs), and capacity to leverage relationships. Barriers included difficult diagnoses, limited access to cancer services, lack of care coordination, and lack of awareness of PNS among primary health care providers. CONCLUSION These findings emphasise the complexity early diagnosis and treatment of PNS. Interventions like clinical practice guidelines, education for HCPs, and telehealth could facilitate timely detection and management.
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Affiliation(s)
- Poorva Pradhan
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
| | - Ke (Zoe) Wan
- Sydney School of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - Li Chan
- Department of Radiation OncologySt George HospitalKogarahNew South WalesAustralia
| | - Tsu‐Hui (Hubert) Low
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
- Central Clinical School, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology–Head & Neck SurgeryFaculty of Medicine and Health Sciences, Macquarie UniversitySydneyNew South WalesAustralia
| | - Raymond Wu
- Central Clinical School, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologyChris O'Brien LifehouseCamperdownNew South WalesAustralia
| | - Jenny H. Lee
- Department of Medical OncologyChris O'Brien LifehouseCamperdownNew South WalesAustralia
- Faculty of Medicine and Health SciencesFaculty of Medicine and Health Sciences, Macquarie UniversitySydneyNew South WalesAustralia
| | - Carsten E. Palme
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
- Central Clinical School, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
| | - Jonathan R. Clark
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
- Central Clinical School, Faculty of Medicine and Health, University of SydneySydneyNew South WalesAustralia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health DistrictCamperdownNew South WalesAustralia
| | - Rebecca L. Venchiarutti
- Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia
- Sydney School of Public Health, The University of SydneySydneyNew South WalesAustralia
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Andersen RS, Frumer M, Merrild CH, Offersen SMH, Aarhus R, Tørring ML. How do we avoid polarization of interdisciplinary research on cancer diagnosis? A critical comment to: "Rethinking the Logic of Early Diagnosis in Cancer" by Damhus, Risør, Brodersen, and Jønsson (2024). Health (London) 2024:13634593241258392. [PMID: 39051480 DOI: 10.1177/13634593241258392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Rikke Sand Andersen
- Department of Anthropology, AU, Denmark
- Department of Public Health, Research Unit for General Practice, SDU, Denmark
| | - Michal Frumer
- Research Unit, Horsens Regional Hospital, Horsens, Midtjylland, Denmark
- External Lecturer, Department of Public Health, Faculty of Health, AU, Denmark
| | | | | | - Rikke Aarhus
- VIVE, The Danish Center for Social Science Research, Denmark
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Weile KS, Mathiasen R, Winther JF, Hasle H, Henriksen LT. Hjernetegn.dk-The Danish Central Nervous System Tumor Awareness Initiative Digital Decision Support Tool: Design and Implementation Report. JMIR Med Inform 2024; 12:e58886. [PMID: 39052326 PMCID: PMC11310640 DOI: 10.2196/58886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/22/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Childhood tumors in the central nervous system (CNS) have longer diagnostic delays than other pediatric tumors. Vague presenting symptoms pose a challenge in the diagnostic process; it has been indicated that patients and parents may be hesitant to seek help, and health care professionals (HCPs) may lack awareness and knowledge about clinical presentation. To raise awareness among HCPs, the Danish CNS tumor awareness initiative hjernetegn.dk was launched. OBJECTIVE This study aims to present the learnings from designing and implementing a decision support tool for HCPs to reduce diagnostic delay in childhood CNS tumors. The aims also include decisions regarding strategies for dissemination and use of social media, and an evaluation of the digital impact 6 months after launch. METHODS The phases of developing and implementing the tool include participatory co-creation workshops, designing the website and digital platforms, and implementing a press and media strategy. The digital impact of hjernetegn.dk was evaluated through website analytics and social media engagement. IMPLEMENTATION (RESULTS) hjernetegn.dk was launched in August 2023. The results after 6 months exceeded key performance indicators. The analysis showed a high number of website visitors and engagement, with a plateau reached 3 months after the initial launch. The LinkedIn campaign and Google Search strategy also generated a high number of impressions and clicks. CONCLUSIONS The findings suggest that the initiative has been successfully integrated, raising awareness and providing a valuable tool for HCPs in diagnosing childhood CNS tumors. The study highlights the importance of interdisciplinary collaboration, co-creation, and ongoing community management, as well as broad dissemination strategies when introducing a digital support tool.
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Affiliation(s)
- Kathrine Synne Weile
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - René Mathiasen
- Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Louise Tram Henriksen
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Bosch X, Mota Gomes T, Montori-Palacin E, Moreno P, López-Soto A. Time to Diagnosis and Presenting Symptoms of Patients Diagnosed With Cancer Through Emergency and Nonemergency Routes: A Large Retrospective Study From a High-Volume Center. JCO Oncol Pract 2024; 20:932-942. [PMID: 38457754 DOI: 10.1200/op.23.00567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE The symptoms with which a patient with cancer presents and the route taken to diagnosis (emergency v nonemergency) may affect the speed with which the diagnosis of cancer is made, thereby affecting outcomes. We examined time to diagnosis by symptom for cancers diagnosed through emergency and nonemergency routes (NERs). METHODS We performed a retrospective review of patients diagnosed with 10 solid cancers at Hospital Clínic of Barcelona between March 2013 and June 2023. Cancers were diagnosed through emergency presentation and admission (inpatient emergency route [IER]), emergency presentation and outpatient referral (outpatient emergency route [OER]), and primary care presentation and outpatient referral (NER). We assessed the effect of diagnostic routes on intervals to diagnosis for 19 cancer symptoms. RESULTS A total of 5,174 and 1,607 patients were diagnosed with cancer through emergency routes and NERs, respectively. Over 85% of patients presenting with alarm (localizing) symptoms such as hematuria through emergency routes were diagnosed with the expected cancer, whereas those with nonlocalizing symptoms such as abdominal pain had a more heterogeneous cancer-site composition. Median intervals were shorter for alarm than nonlocalizing symptoms and tended to be shorter in IERs than OERs. However, for most symptoms, intervals in both routes were invariably shorter than in the NER. For example, diagnostic intervals for hematuria and abdominal pain were 3 and 5 days shorter in IERs than OERs, but they were 5-8 and 17-22 days shorter than in the NER, respectively. CONCLUSION For patients with alarm symptoms, intervals were shorter than for those with nonlocalizing symptoms and, for most symptoms, intervals were shorter when patients were evaluated by emergency routes rather than NERs.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Tiago Mota Gomes
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain
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Fenwick A, Black C, Linehan V, Gala-Lopez BL, Costa AF. Resection of colorectal carcinoma liver metastases: A population-based study in outcomes and factors associated with recurrent disease. Curr Probl Diagn Radiol 2024; 53:481-487. [PMID: 38702281 DOI: 10.1067/j.cpradiol.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To assess the hepatic disease-free survival (HDFS) and overall survival (OS) of patients who underwent resection of colorectal cancer liver metastases (CRCLM) in our population, and evaluate what factors are associated with these outcomes. METHODS Patients with resected non-mucinous CRCLM between January 2013-February 2020 were retrospectively identified. Dates of diagnosis, surgery, and, if applicable, death were recorded. HDFS and OS were calculated using a census date of 24 September 2022. Separate Cox multivariate regression analyses were performed to evaluate for association between HDFS and OS and the following factors: pre-operative imaging interval (<4 weeks vs. ≥4 weeks); pre-operative imaging modality (CT only vs. MRI+CT); extrahepatic disease at time of hepatectomy (yes vs. no); tumor burden score (TBS, where TBS2 = (largest axial dimension of CRCLM)2 + (number of CRCLM)2); pT and pN; and neoadjuvant chemotherapy. RESULTS 137 subjects (mean age, 61 ± 11 years, 86 males) were included. Associations with recurrent hepatic disease were found with chemotherapy (HR 2.11[95 % CI = 1.13-3.92]), TBS (HR 1.30[95 % CI = 1.17-1.45]), MRI+CT (HR 2.12[95 % CI = 1.29-3.48]), and extrahepatic disease at hepatectomy (HR 2.16[95 % CI = 1.08-4.35]). For mortality, associations were found with TBS (HR 1.22[95 % CI = 1.09-1.37]), pT (HR 1.45[95 % CI = 1.05-2.00]), and extrahepatic disease at hepatectomy (HR 2.10[95 % CI = 1.31-3.36]). CONCLUSION In our population, non-imaging related factors TBS, neoadjuvant chemotherapy, pT and presence of extrahepatic disease at time of hepatectomy were associated with HDFS and/or OS. The preoperative imaging interval and use of preoperative MRI were not associated with improved patient outcomes.
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Affiliation(s)
- Andrew Fenwick
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9
| | - Curtis Black
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9
| | - Victoria Linehan
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9
| | - Boris L Gala-Lopez
- Department of Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9; Beatrice Hunter Cancer Research Institute. Suite 2L-A2, Tupper Link, 5850 College Street P.O. Box 15000 Halifax, NS B3H 4R2
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9..
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Allende-González J, Gullón-Blanco JA, Sánchez-Vázquez E, García-Coya E, Cascón-Hernández J. Lung Cancer Diagnostic Delay Time and Related Variables. OPEN RESPIRATORY ARCHIVES 2024; 6:100341. [PMID: 39026513 PMCID: PMC11255355 DOI: 10.1016/j.opresp.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
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Mathoma A, Sartorius B, Mahomed S. Evaluation of cancer screening services provided for people living with HIV in Botswana, 2022-2023. Health Promot Int 2024; 39:daae042. [PMID: 38742893 DOI: 10.1093/heapro/daae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
People living with human immunodeficiency virus (PLHIV) have an increased risk of cancers. Currently, Botswana has no screening guidelines for common cancers in PLHIV except cervical cancer. Also, the proportion of PLHIV who are screened for cancer is unknown. This study aimed to evaluate cancer screening services for PLHIV receiving care in the human immunodeficiency virus (HIV) clinics. Resources for cancer screening were assessed and medical records of adults initiating antiretroviral therapy (ART) from 2020 to 2021 in 20 high-volume HIV clinics in Gaborone and Francistown were reviewed. Questionnaires assessing knowledge and practices of cancer screening were administered to health workers. The majority of clinics had the required resources for cancer screening (specifically cervical cancer). Of the 62 health workers working at the HIV clinics, 57 (91.9%) completed the questionnaire: 35 (62.5%) nurses and 22 (37.5%) doctors. Only 26.3% of the health workers were trained in cervical cancer screening. Doctors were more likely to report practicing routine screening of other cancers (e.g. breast) (p = 0.003) while more nurses reported assessing patients for cancer history during follow-up visits (p = 0.036). Most health workers did not perform physical examinations to detect cancer at initial or follow-up visits. Of the 1000 records of PLHIV reviewed, 57.3% were females, and only 38% of these were screened for cervical cancer. Besides cervical cancer, almost all (97.8%) were not screened for any cancer at ART initiation and during follow-up. These findings highlight the need to improve cancer screening services of PLHIV in Botswana through the training of health workers, and the development and enhanced use of screening guidelines.
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Affiliation(s)
- Anikie Mathoma
- Division of Research and Innovation, University of Botswana, Corner of Notwane and Mabuto Road, Plot 4775, Gaborone, Botswana
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
- Faculty of Medicine, UQ Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, St Lucia QLD 4072, Australia
- Centre for Tropical Medicine and Global Health, University of Oxford, New Richards Building, Roosevelt Dr, Headington, Oxford OX3 7LG, UK
- Department of Health Metric Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Saajida Mahomed
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
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Ramli FI, Thokala P, Tong T, Unger-Saldaña K. Understanding breast cancer patient pathways and their impact on survival in Mexico. J Cancer Policy 2024; 40:100482. [PMID: 38663531 DOI: 10.1016/j.jcpo.2024.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Understanding patient pathways from discovery of breast symptoms to treatment start can aid in identifying ways to improve access to timely cancer care. This study aimed to describe the patient pathways experienced by uninsured women from detection to treatment initiation for breast cancer in Mexico City and estimate the potential impact of earlier treatment on patient survival. METHODS We used process mining, a data analytics technique, to create maps of the patient pathways. We then compared the waiting times and pathways between patients who initially consulted a private service versus those who sought care at a public health service. Finally, we conducted scenario modelling to estimate the impact of early diagnosis and treatment on patient survival. RESULTS Our study revealed a common pathway followed by breast cancer patients treated at the two largest public cancer centres in Mexico City. However, patients who initially sought care in private clinics experienced shorter mean wait times for their first medical consultation (66 vs 88 days), and diagnostic confirmation of cancer (57 vs 71 days) compared to those who initially utilized public clinics. Our scenario modelling indicated that improving early diagnosis to achieve at least 60% of patients starting treatment at early stages could increase mean patient survival by up to two years. CONCLUSION Our study highlights the potential of process mining to inform healthcare policy for improvement of breast cancer care in Mexico. Also, our findings indicate that reducing diagnostic and treatment intervals for breast cancer patients could result in substantially better patient outcomes. POLICY SUMMARY This study revealed significant differences in time intervals along the pathways of women with breast cancer according to the type of health service first consulted by the patients: whether public primary care clinics or private doctors. Policies directed to reduce these inequities in access to timely cancer care are desperately needed to reduce socioeconomic disparities in breast cancer survival.
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Affiliation(s)
- Fatin Izzati Ramli
- Health Economics and Decision Science, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Faculty of Industrial Management, University Malaysia Pahang, Gambang, Malaysia
| | - Praveen Thokala
- Health Economics and Decision Science, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Thaison Tong
- Health Economics and Decision Science, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
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Irimia R, Badelita S, Barbu S, Cirlan IL, Zidaru L, Coriu D. Determining diagnostic delays in Romanian multiple myeloma patients using the Aarhus statement. Front Med (Lausanne) 2024; 11:1372907. [PMID: 38854669 PMCID: PMC11157957 DOI: 10.3389/fmed.2024.1372907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Multiple Myeloma (MM) is classified as one of the most challenging cancers to diagnose, and the hematological malignancy is associated with prolonged diagnostic delays. Although major steps have been made in the improvement of MM patient diagnosis and care, Romanian patients still face long diagnostic delays. Thus far, there have been no studies evaluating the factors associated with diagnostic errors in Romanian MM patients. Methods Using the Aarhus statement, we prospectively determined the diagnostic intervals for 103 patients diagnosed with MM at Fundeni Clinical Institute, between January 2022 and March 2023. Results Our data revealed that the main diagnostic delays are experienced during the "patient interval." Patients spend a median of 162 days from the first symptom onset until the first doctor appointment. Bone pain is the most frequently reported symptom by patients (78.64%), but it leads to a medical-seeking behavior in only half of the reporting patients and results in a median delay of 191 days. The changes in routine lab tests are considered most worrisome for patients, leading to a medical appointment after a median of only 25 days. The median primary care interval was 70 days, with patients having an average of 3.7 medical visits until MM suspicion was first raised. The secondary care interval did not contribute to the diagnostic delays. Discussion Overall, the median diagnostic path for MM patients in Romania was more than 6 months, leading to a higher number of emergency presentations and myeloma-related end-organ damage.
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Affiliation(s)
- Ruxandra Irimia
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Sinziana Barbu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | | | - Larisa Zidaru
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniel Coriu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
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Vuorisalo A, Huhtala H, Paavonen T, Kholová I. Insufficient endobronchial ultrasound-guided transbronchial needle aspiration specimens. When and why? The analysis of criteria and reasons behind the insufficient specimens. Diagn Cytopathol 2024; 52:271-287. [PMID: 38348643 DOI: 10.1002/dc.25284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The classification terminology systems for pulmonary cytology specimens have recently emerged. Inadequate samples, classified as "nondiagnostic," raise challenges in determining the threshold of cell numbers and the risk of malignancy (ROM). METHODS The study retrospectively reviewed 248 endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples: 46 insufficient samples, 60 low cellularity samples, and 142 adequate samples. Characteristics as cellularity, number of benign and malignant cells, and background features were assessed. Receiver operating characteristic curve analysis was performed to establish cell sufficiency thresholds for the diagnosis. RESULTS Out of the 248 samples analyzed, 108 were classified as benign, 94 as malignant, and 46 as insufficient. The study found that the cellularity thresholds for diagnosis in cell blocks and cytological samples were ≥50 cells and ≥100 cells, respectively. The thresholds for tumor cell counts were ≥1 - 10 cells for both types of cells, respectively. Considerably, some low cellularity samples were initially classified as insufficient despite meeting the diagnostic thresholds upon revision. The ROM varied across sample categories, with insufficient samples having a ROM of 10.9%, benign samples 15.7%, suspicious samples 92.0%, and malignant samples 100%. CONCLUSION Insufficient EBUS-TBNA samples raise challenges in diagnosis and management. This study identified the root cause of insufficient samples, including factors related to humans, diagnostic methods, sampling, and laboratory processing. By understanding the root causes, diagnostic recommendations can be developed to improve the diagnostic process. The findings emphasize the importance of standardized classification and terminology systems for clear communication among healthcare professionals and institutions, ultimately improving patient care and enabling quality assurance measures.
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Affiliation(s)
- Antti Vuorisalo
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Timo Paavonen
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Tamefusa K, Ochi M, Ishida H, Shiwaku T, Kanamitsu K, Fujiwara K, Tatebe Y, Matsumoto N, Washio K, Tsukahara H. Delayed diagnostic interval and survival outcomes in pediatric leukemia: A single-center, retrospective study. Eur J Haematol 2024; 112:714-722. [PMID: 38152024 DOI: 10.1111/ejh.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE This study primarily focused on the diagnostic interval (DI), defined as the duration from the onset of leukemic symptoms to diagnosis. We investigated whether a prolonged DI is associated with the outcomes of pediatric leukemia. METHODS We retrospectively collected data of children with newly diagnosed pediatric leukemia at Okayama University Hospital from January 2007 to December 2022. Survival analyses were conducted using Kaplan-Meier methods, and an unadjusted analysis to compare differences in survival was performed using the log-rank test. RESULTS In total, 103 children with leukemia were included in the analysis. The median DI was 20 days (interquartile range, 9.5-33.5 days). A prolonged DI (≥30 days) demonstrated no association with either 5-year event-free survival (70.1% for <30 days and 68.3% for ≥30 days, p = .99, log-rank test) or overall survival (84.7% for <30 days and 89.4% for ≥30 days, p = .85, log-rank test). CONCLUSIONS A prolonged DI was not associated with the survival of children with leukemia. If a precise classification of leukemia biology is provided for pediatric patients, a prolonged DI may have little impact on the prognosis of these patients.
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Affiliation(s)
- Kosuke Tamefusa
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Motoharu Ochi
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Hisashi Ishida
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Takahiro Shiwaku
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Kiichiro Kanamitsu
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Kaori Fujiwara
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Yasuhisa Tatebe
- Department of Pharmacy, Okayama University Hospital, Okayama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kana Washio
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
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Mergen M, Welter N, Furtwängler R, Melchior P, Vokuhl C, Gessler M, Meier C, Kager L, Schenk J, Graf N. The impact of the route to diagnosis in nephroblastoma. Cancer Med 2024; 13:e7226. [PMID: 38785181 PMCID: PMC11117195 DOI: 10.1002/cam4.7226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Wilms tumor (WT) is the most common childhood kidney cancer. It is a rapid growing embryonal tumor in young children and can be diagnosed with and without tumor related symptoms. METHODS We retrospectively analyzed the route to diagnosis of WT treated prospectively according to the SIOP 93-01/GPOH and 2001/GPOH in Germany between 1993 and 2022. Four routes were defined: diagnosis due to tumor-related symptoms, incidental diagnosis during another disease, diagnosis by preventive examinations, and diagnosis within a surveillance program. For these groups we compared clinical and tumor characteristics and outcome. RESULTS Of 2549 patients with WT 1822 (71.5%) were diagnosed by tumor-related symptoms, 472 (18.5%) incidentally, 213 (8.4%) by preventive medical examinations, and 42 (1.6%) by surveillance. Age, general health status, tumor volume, and local and overall stage varied significantly between these groups. The youngest patients were those diagnosed by preventive medical examination (mean: 1.70 years). These patients also showed the best general health status. Tumor volume at diagnosis (549 mL) and after preoperative chemotherapy (255 mL) was significantly higher for children with tumor-related symptoms. The highest percentage of local stage I (78.6%) and the lowest percentage of metastatic disease (4.8%) was found in the surveillance group. The outcome of patients was not significantly different, with up to 19.0% relapses in the surveillance group and 3.0% deaths in the group with tumor-related symptoms. CONCLUSION The route to diagnosis of WT correlates with age, general health status, tumor volume, and stage distribution, but does not impact the outcome of patients. Nonetheless, diagnosis without tumor related symptoms results in lower treatment burden and thus improved quality of life.
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Affiliation(s)
- Marvin Mergen
- Department of Pediatric Oncology and HematologySaarland University Medical CenterHomburgGermany
| | - Nils Welter
- Department of Pediatric Oncology and HematologySaarland University Medical CenterHomburgGermany
| | - Rhoikos Furtwängler
- Divison of Paediatric Hematology and Oncology, Department of Paediatrics, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Patrick Melchior
- Department of Radiation OncologySaarland University Medical CenterHomburgGermany
| | - Christian Vokuhl
- Section of Pediatric Pathology, Department of PathologyUniversity Hospital BonnBonnGermany
| | - Manfred Gessler
- Developmental Biochemistry and Comprehensive Cancer Center Mainfranken, Theodor‐Boveri‐Institute/BiocenterUniversity of WürzburgWürzburgGermany
| | - Clemens‐Magnus Meier
- Department of General Surgery, Visceral, Vascular and Pediatric SurgerySaarland University Medical CenterHomburgGermany
| | - Leo Kager
- Department of PediatricsSt. Anna Children's Hospital, Medical University ViennaViennaAustria
- St. Anna Children's Cancer Research InstituteViennaAustria
| | - Jens‐Peter Schenk
- Department of Diagnostic and Interventional Radiology, Division of Pediatric RadiologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Norbert Graf
- Department of Pediatric Oncology and HematologySaarland University Medical CenterHomburgGermany
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Montagnoli DRABS, Leite VF, Godoy YS, Lafetá VM, Junior EAP, Chaurasia A, Aguiar MCF, Abreu MHNG, Martins RC. Can predictive factors determine the time to treatment initiation for oral and oropharyngeal cancer? A classification and regression tree analysis. PLoS One 2024; 19:e0302370. [PMID: 38630775 PMCID: PMC11023193 DOI: 10.1371/journal.pone.0302370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
This ecological study aimed to identify the factors with the greatest power to discriminate the proportion of oral and oropharyngeal cancer (OOC) records with time to treatment initiation (TTI) within 30 days of diagnosis in Brazilian municipalities. A descriptive analysis was performed on the variables grouped into five dimensions related to patient characteristics, access to health services, support for cancer diagnosis, human resources, and socioeconomic characteristics of 3,218 Brazilian municipalities that registered at least one case of OOC in 2019. The Classification and Regression Trees (CART) technique was adopted to identify the explanatory variables with greater discriminatory power for the TTI response variable. There was a higher median percentage of records in the age group of 60 years or older. The median percentage of records with stage III and IV of the disease was 46.97%, and of records with chemotherapy, radiation, or both as the first treatment was 50%. The median percentage of people with private dental and health insurance was low. Up to 75% had no cancer diagnostic support services, and up to 50% of the municipalities had no specialist dentists. Most municipalities (49.4%) started treatment after more than 30 days. In the CART analysis, treatment with chemotherapy, radiotherapy, or both explained the highest TTI in all municipalities, and it was the most relevant for predicting TTI. The final model also included anatomical sites in the oral cavity and oropharynx and the number of computed tomography services per 100,000. There is a need to expand the availability of oncology services and human resources specialized in diagnosing and treating OOC in Brazilian municipalities for a timely TTI of OOC.
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Affiliation(s)
| | | | - Yasmim Silva Godoy
- School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vitória Marçolla Lafetá
- Technical High School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Akhilanand Chaurasia
- Department of Oral Medicine and Radiology, King George´s Medical University, Lucknow, Uttar Pradesh, India
| | - Maria Cássia Ferreira Aguiar
- Department of Clinic, Dental Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Renata Castro Martins
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Lauridsen GB, Jarbøl DE, Thye-Rønn P, Rasmussen S, Balasubramaniam K, Lykkegaard J. Exploring diagnostic events and first referrals in cancer patient pathways in primary care. A questionnaire survey. Fam Pract 2024; 41:67-75. [PMID: 38086552 DOI: 10.1093/fampra/cmad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Cancer diagnostic pathways in general practice are often nonlinear, and several events can delay timely diagnosis. OBJECTIVES To explore cancer diagnostic processes in general practice, examining how patients' symptom presentations, sex, and age are associated with the occurrence of predefined potentially delaying events and the first referrals. METHOD General practices in 3 Danish Regions were invited to participate in a questionnaire survey, addressing patient's symptom presentation, diagnostic process events, and first referral. The general practitioners (GPs) received a list of their incident cancer patients from the preceding 2 years. RESULTS In total 187 general practices participated, including 5,908 patients with the cancer diagnostic pathways initiated in general practice. Presenting with nonspecific symptoms was associated with potentially delaying events, even when the patient also had specific symptoms. Almost half of the patients were referred to a cancer patient pathway (CPP) first, men more often than women, and 10% were referred for acute hospitalization. In 23% of the diagnostic processes, GPs initially treated or referred patients on suspicion of another disease rather than cancer and waited due to normal examinations in 1 out of 20 patients. Excluding sex-specific cancers, these 2 events were more prevalent in women. Men less often complied to the follow-up agreement. Younger patients were less often first referred to a CPP and together with older patients more often first acutely hospitalized. CONCLUSION In cancer diagnostic processes in general practice, first referrals and the occurrence of potentially delaying events are associated with the patient's age, sex, and specificity of symptoms.
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Affiliation(s)
- Gitte B Lauridsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Dorte E Jarbøl
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Peter Thye-Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Diagnostic Center, Svendborg Hospital, OUH, Svendborg, Denmark
| | - Sanne Rasmussen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Kirubakaran Balasubramaniam
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Jesper Lykkegaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Audit Project Odense, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Venchiarutti RL, Clark JR, Palme CE, Dwyer P, Tahir ARM, Hill J, Ch'ng S, Elliott MS, Young JM. Associations between patient-level health literacy and diagnostic time intervals for head and neck cancer: A prospective cohort study. Head Neck 2024; 46:857-870. [PMID: 38213101 DOI: 10.1002/hed.27633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Health literacy (HL) comprises skills and knowledge required to understand, access, and make decisions about healthcare. Our aim was to examine associations between patient HL and time intervals (defined in the Aarhus statement) along the pathway to treatment of head and neck cancer (HNC). METHODS A prospective cohort study was conducted from October 2018 to March 2020. Participants completed the Health Literacy Questionnaire (HLQ®) and described key events and dates along the pathway to treatment using validated questionnaires. Correlations between six diagnostic time intervals and domains of HL were explored, and factors predicting exceeding maximum acceptable timeframes were assessed using logistic regression. RESULTS One hundred patients with a diagnosis of HNC within the preceding 6 months were recruited. HLQ® Domain 2 (sufficient information to manage health) was significantly negatively associated with four intervals: the patient interval (first symptom to first presentation), primary care interval (first presentation to referral to secondary care), diagnostic interval (first presentation to diagnosis), and total interval (first symptom to treatment onset); correlation coefficients -0.25 to -0.27 (P < 0.05). Domain 8 (ability to find good information) was significantly negatively associated with three intervals (primary care interval, diagnostic interval, and total interval; correlation coefficients -0.23 to -0.34; P < 0.05). Higher education, age, and comorbidity levels were associated with shorter patient and diagnostic intervals. CONCLUSIONS HL may be a potential target to improve timeliness of HNC diagnosis and reduce disparities in outcomes.
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Affiliation(s)
- Rebecca L Venchiarutti
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Patrick Dwyer
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Jacques Hill
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Jane M Young
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Camperdown, New South Wales, Australia
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Wheelwright SJ, Russ S, Mold F, Armes J, Harder H. Symptomatic presentation of cancer in primary care: a scoping review of patients' experiences and needs during the cancer diagnostic pathway. BMJ Open 2024; 14:e076527. [PMID: 38508614 PMCID: PMC10961516 DOI: 10.1136/bmjopen-2023-076527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective was to map the experiences and needs of patients presenting with symptoms of suspected cancer in the primary care interval (from when they first present to primary care to their first appointment or referral to a secondary or tertiary level healthcare facility). DESIGN This was a scoping review. INCLUSION CRITERIA Studies or reports written in English which included primary data on the primary care interval experiences and/or needs of adult patients presenting with new symptoms of suspected cancer were eligible. Studies which only included patients with secondary or recurring cancer, conference abstracts and reviews were excluded. No date limits were applied. METHODS The Joanna Briggs Institute method for Scoping Reviews guided screening, report selection and data extraction. At least two independent reviewers contributed to each stage. Medline, CINAHL, PsychInfo, Embase and Web of Science were searched and several grey literature resources. Relevant quantitative findings were qualitised and integrated with qualitative findings. A thematic analysis was carried out. RESULTS Of the 4855 records identified in the database search, 18 were included in the review, along with 13 identified from other sources. The 31 included studies were published between 2002 and 2023 and most (n=17) were conducted in the UK. Twenty subthemes across four themes (patient experience, interpersonal, healthcare professional (HCP) skills, organisational) were identified. No studies included patient-reported outcome measures. Patients wanted (1) to feel heard and understood by HCPs, (2) a plan to establish what was causing their symptoms, and (3) information about the next stages of the diagnostic process. CONCLUSIONS Scoping review findings can contribute to service planning as the cancer diagnostic pathway for symptomatic presentation of cancer evolves. The effectiveness of this pathway should be evaluated not only in terms of clinical outcomes, but also patient-reported outcomes and experience, along with the perspectives of primary care HCPs.
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Affiliation(s)
| | - Stephanie Russ
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Freda Mold
- Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Helena Harder
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Pickwell-Smith B, Greenley S, Lind M, Macleod U. Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis. J Cancer Policy 2024; 39:100458. [PMID: 38013132 DOI: 10.1016/j.jcpo.2023.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare. METHODS We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071]. RESULTS Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24-0.99) and chemotherapy (range of odds ratios 0.70-0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay. POLICY SUMMARY Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.
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Affiliation(s)
- Benjamin Pickwell-Smith
- Hull York Medical School, University of Hull, Hull, United Kingdom; Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals, Hull, United Kingdom.
| | - Sarah Greenley
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Michael Lind
- Hull York Medical School, University of Hull, Hull, United Kingdom; Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, United Kingdom
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Damhus CS, Risør MB, Brodersen JB, Jønsson ABR. Rethinking the logic of early diagnosis in cancer. Health (London) 2024:13634593241234481. [PMID: 38407179 DOI: 10.1177/13634593241234481] [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: 02/27/2024]
Abstract
To reduce morbidity and mortality of cancer, more countries have implemented strategies to detect cancer, based on the logic of 'the sooner the better'. Time is thereby an essential component in how cancer research, policies, and prevention are practiced today. Where the logic of early diagnosis benefits some, the logic also produces harms. In this article, we use a cross-disciplinary case-study design to discuss how different notions of time and linearity are essential in today's research ontology of cancer, describe the individual and societal consequences of such ontology, and invite a rethinking of time in cancer. Drawing on theoretical concepts of time together with cancer epidemiological, historical and ethnographical data, we analyse how the logic of early diagnosis has been established as a stable concept. Although evidence supporting the logic points in different directions, the message 'the sooner the better' is currently not being challenged by research, policy or society. This at least partly, can be explained by a linear perception of time and societal traces of neoliberalism and acceleration in our society together with cancer still being a somewhat enigmatic disease that requires acute action. To support a sustainable healthcare sector, we argue there is a need to nuance the logic of early diagnosis. Continuing the linear perception of symptoms and cancer, risks doing more harm than good by making more people patients unnecessarily and by spending health resources on those with the least need.
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Affiliation(s)
- Christina Sadolin Damhus
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice in Region Zealand, Denmark
| | - Mette Bech Risør
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, General Practice Research Unit, Faculty of Health Sciences, UiT, The Arctic University of Norway, Norway
| | - John Brandt Brodersen
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice in Region Zealand, Denmark
- Department of Community Medicine, General Practice Research Unit, Faculty of Health Sciences, UiT, The Arctic University of Norway, Norway
| | - Alexandra Brandt Ryborg Jønsson
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, General Practice Research Unit, Faculty of Health Sciences, UiT, The Arctic University of Norway, Norway
- Department of People and Technology, Roskilde University, Denmark
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Koo MM, Mounce LTA, Rafiq M, Callister MEJ, Singh H, Abel GA, Lyratzopoulos G. Guideline concordance for timely chest imaging after new presentations of dyspnoea or haemoptysis in primary care: a retrospective cohort study. Thorax 2024; 79:236-244. [PMID: 37620048 DOI: 10.1136/thorax-2022-219509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 07/08/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation. METHODS We analysed linked primary care and hospital imaging data for patients aged 30+ years newly presenting with dyspnoea or haemoptysis in primary care during April 2012 to March 2017. We examined guideline-concordant management, defined as General Practitioner-ordered chest X-ray/CT carried out within 2 weeks of symptomatic presentation, and variation by sociodemographic characteristic and relevant medical history using logistic regression. Additionally, among patients diagnosed with cancer we described time to diagnosis, diagnostic route and stage at diagnosis by guideline-concordant status. RESULTS In total, 22 560/162 161 (13.9%) patients with dyspnoea and 4022/8120 (49.5%) patients with haemoptysis received guideline-concordant imaging within the recommended 2-week period. Patients with recent chest imaging pre-presentation were much less likely to receive imaging (adjusted OR 0.16, 95% CI 0.14-0.18 for dyspnoea, and adjusted OR 0.09, 95% CI 0.06-0.11 for haemoptysis). History of chronic obstructive pulmonary disease/asthma was also associated with lower odds of guideline concordance (dyspnoea: OR 0.234, 95% CI 0.225-0.242 and haemoptysis: 0.88, 0.79-0.97). Guideline-concordant imaging was lower among dyspnoea presenters with prior heart failure; current or ex-smokers; and those in more socioeconomically disadvantaged groups.The likelihood of lung cancer diagnosis within 12 months was greater among the guideline-concordant imaging group (dyspnoea: 1.1% vs 0.6%; haemoptysis: 3.5% vs 2.7%). CONCLUSION The likelihood of receiving urgent imaging concords with the risk of subsequent cancer diagnosis. Nevertheless, large proportions of dyspnoea and haemoptysis presenters do not receive prompt chest imaging despite being eligible, indicating opportunities for earlier lung cancer diagnosis.
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Affiliation(s)
- Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Dept. of Behavioural Science and Health, Institute of Epidemiology & Health Care (IEHC), UCL, London, UK
| | - Luke T A Mounce
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
| | - Meena Rafiq
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Dept. of Behavioural Science and Health, Institute of Epidemiology & Health Care (IEHC), UCL, London, UK
| | | | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
- Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gary A Abel
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Dept. of Behavioural Science and Health, Institute of Epidemiology & Health Care (IEHC), UCL, London, UK
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Brito M, Ramos M, Silva JP, Câmara G, Mayer A, Miranda A, Coelho JLP, Moreira A, Esteves S. Epidemiology, Management, and Survival Outcomes of Germ Cell Cancer in Southern Portugal: A Population-Based Study (2008-2012). Clin Genitourin Cancer 2024; 22:e170-e177.e1. [PMID: 38061978 DOI: 10.1016/j.clgc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Building on previous suboptimal survival results, we aimed to perform a study of the epidemiological status, management, and outcomes of germ cell tumors (GCT) in the Portuguese population. MATERIALS AND METHODS Retrospective populational study of GCT cases diagnosed between 2008 and 2012 in southern Portugal. Joinpoint regression was used to compute average annual percentage change (AAPC) in incidence rate. ESMO/EAU guidelines served as references to evaluate compliance. Association between compliance with guidelines and hospital GCT case load was performed by generalized estimating equation. Survival was calculated by Kaplan-Meier and prognostic factors by Cox models. RESULTS The study included 401 GCT male cases. The AAPC was 5.4% (IC 95% 3.3-7.4, P < .001) from 1999 (an earlier cohort published) to 2012. The median time to diagnosis was 63 days (Q25 = 33 days; Q75 = 114 days; IQR = 81 days). For stage II/III the median time to start chemotherapy was 34 days (Q25 = 22 days; Q75 = 56 days; IQR = 22 days). In 86% cases there was noncompliance with guidelines for the orchiectomy report, 6% for staging, 38% for tumor markers evaluation, 20% for treatment and 25% for chemotherapy dose intensity. The 5-year overall survival was 93.8% (95% CI, 91.3%-96.4%). Hospitals that managed ≤ 3 GCT cases/ year had higher odds for noncompliance with guidelines of blood markers, treatment and dose intensity. None of GCT healthcare access and management factors studied were associated with prognosis. CONCLUSIONS The burden of GCT is rising in Portugal. Although survival has improved, efforts must be made to nationally enhance training and expertise in GCT and support region adapted models of centralization of care.
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Affiliation(s)
- Margarida Brito
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Marco Ramos
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal; Epidemiology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - José Pais Silva
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Gabriela Câmara
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Alexandra Mayer
- Epidemiology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Ana Miranda
- Epidemiology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | | | - António Moreira
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal; Clinical Research Unit of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Susana Esteves
- Clinical Research Unit of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
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Jain S, Sharma SS, Gupta DK. Effect of patient and diagnostic intervals on the risk of advanced stage in Indian patients with seven types of gastrointestinal cancers: A retrospective cohort study. Cancer Epidemiol 2024; 88:102514. [PMID: 38141472 DOI: 10.1016/j.canep.2023.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Advanced stage is linked to prolonged patient and diagnostic interval for gastrointestinal (GI) cancers. However, objective evidence of this fact is not so forthcoming. Our aim was to study the effect of these intervals on the risk of advanced stage for GI cancers. METHODS We performed this retrospective cohort study to analyse the effect of patient and diagnostic intervals on final stage in seven types of GI cancers, during 2013 and 2022. Two groups of stage: early (TNM- 0, I, II) and advanced (TNM- III, IV), were formed. Outcome studied was interdependence between patient and diagnostic intervals and incidence of advanced stage. Binary logistic regression was applied to calculate odds ratio of having an advanced versus early stage as a function of duration of these delays, in the whole cohort. We used restricted cubic splines with five knots to study flexible and non-monotonic pattern of association between these delays and stage. RESULTS In whole cohort of 1859 patients, median patient and diagnostic intervals of early and advanced cancers were 21 and 26 days and 120 and 45 days, respectively. There was a positive association between patient interval and advanced stage (odds ratio [OR], 1.04, confidence interval [CI], 1.035 to 1.045; P < 0.001) and negative association between diagnostic interval and advanced stage (odds ratio, 0.98, CI, 0.976 to 0.998; P-0.017), among all gastrointestinal cancers combined. Increased risk of advanced stage started from day one of patient interval and for diagnostic interval there was an initial decrease followed by subsequent increase in the risk of advanced stage beyond 26 days of diagnostic interval. CONCLUSIONS Longer patient and diagnostic intervals increase the risk of advanced stage in gastrointestinal cancers.
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Affiliation(s)
- Sundeep Jain
- Department of Gastrointestinal & HPB Surgery, Fortis Hospital, Jaipur, India.
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Mavor ME, Hanna TP, Asai Y, Langley H, Look Hong NJ, Wright FC, Nguyen P, Groome PA. Factors associated with the melanoma diagnostic interval in Ontario, Canada: a population-based study. Br J Cancer 2024; 130:483-495. [PMID: 38102225 PMCID: PMC10844321 DOI: 10.1038/s41416-023-02518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Protracted times to diagnosis of cancer can lead to increased patient anxiety, and in some cases, disease progression and worse outcomes. This study assessed the time to diagnosis for melanoma, and its variability, according to patient-, disease-, and system-level factors. METHODS This is a descriptive, cross-sectional study in Ontario, Canada from 2007-2019. We used administrative health data to measure the diagnostic interval (DI)-and its two subintervals-the primary care subinterval (PCI) and specialist care subinterval (SCI). Multivariable quantile regression was used. RESULTS There were 33,371 melanoma patients. The median DI was 36 days (interquartile range [IQR]: 8-85 days), median PCI 22 days (IQR: 6-54 days), and median SCI 6 days (IQR: 1-42 days). Increasing comorbidity was associated with increasing DI. Residents in the most deprived neighbourhoods and those in rural areas experienced shorter DIs and PCIs, but no differences in SCI. There was substantial variation in the DI and SCI across health regions, but limited differences in the PCI. Finally, patients with a history of non-melanoma skin cancer, and those previously established with a dermatologist experienced significantly longer DI, PCI, and SCI. DISCUSSION This study found variability in the melanoma DI, notably by system-level factors.
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Affiliation(s)
- Meaghan E Mavor
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada.
| | - Timothy P Hanna
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- ICES at Queen's University, Kingston, ON, Canada
| | - Yuka Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Hugh Langley
- Department of Oncology, Queen's University, Kingston, ON, Canada
- South East Regional Cancer Program, Kingston, ON, Canada
| | - Nicole J Look Hong
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Surgical Oncology Program, Cancer Care Ontario - Ontario Health, Toronto, ON, Canada
| | - Paul Nguyen
- ICES at Queen's University, Kingston, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
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Wang M, Kono M, Yamaguchi Y, Islam J, Shoji S, Kitagawa Y, Fushimi K, Watanabe S, Matsuba G, Yamamoto A, Tanaka M, Tsuda M, Tanaka S, Hasegawa Y. Structure-changeable luminescent Eu(III) complex as a human cancer grade probing system for brain tumor diagnosis. Sci Rep 2024; 14:778. [PMID: 38253656 PMCID: PMC10803341 DOI: 10.1038/s41598-023-50138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Accurate determination of human tumor malignancy is important for choosing efficient and safe therapies. Bioimaging technologies based on luminescent molecules are widely used to localize and distinguish active tumor cells. Here, we report a human cancer grade probing system (GPS) using a water-soluble and structure-changeable Eu(III) complex for the continuous detection of early human brain tumors of different malignancy grades. Time-dependent emission spectra of the Eu(III) complexes in various types of tumor cells were recorded. The radiative rate constants (kr), which depend on the geometry of the Eu(III) complex, were calculated from the emission spectra. The tendency of the kr values to vary depended on the tumor cells at different malignancy grades. Between T = 0 and T = 3 h of invasion, the kr values exhibited an increase of 4% in NHA/TS (benign grade II gliomas), 7% in NHA/TSR (malignant grade III gliomas), and 27% in NHA/TSRA (malignant grade IV gliomas). Tumor cells with high-grade malignancy exhibited a rapid upward trend in kr values. The cancer GPS employs Eu(III) emissions to provide a new diagnostic method for determining human brain tumor malignancy.
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Affiliation(s)
- Mengfei Wang
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan.
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan.
| | - Masaya Kono
- Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan
| | - Yusaku Yamaguchi
- Graduate School of Chemical Sciences and Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan
| | - Jahidul Islam
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan
| | - Sunao Shoji
- Department of Engineering, Nara Women's University, Nara, 630-8506, Japan
| | - Yuichi Kitagawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan
| | - Koji Fushimi
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan
| | - Sora Watanabe
- Graduate School of Organic Material Engineering, Yamagata University, Yonezawa, Yamagata, 992-8510, Japan
| | - Go Matsuba
- Graduate School of Organic Material Engineering, Yamagata University, Yonezawa, Yamagata, 992-8510, Japan
| | - Akihisa Yamamoto
- Center for Integrative Medicine and Physics, Institute for Advanced Study, Kyoto University, Kyoto, 606-8501, Japan
| | - Motomu Tanaka
- Center for Integrative Medicine and Physics, Institute for Advanced Study, Kyoto University, Kyoto, 606-8501, Japan
- Physical Chemistry of Biosystems, Institute of Physical Chemistry, Heidelberg University, 69120, Heidelberg, Germany
| | - Masumi Tsuda
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Shinya Tanaka
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasuchika Hasegawa
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Hokkaido, 001-0021, Japan.
- Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, 060-8628, Japan.
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Pickwell-Smith BA, Spencer K, Sadeghi MH, Greenley S, Lind M, Macleod U. Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis. BMJ Open 2024; 14:e080467. [PMID: 38171631 PMCID: PMC10773363 DOI: 10.1136/bmjopen-2023-080467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Patients diagnosed with colorectal cancer living in more deprived areas experience worse survival than those in more affluent areas. Those living in more deprived areas face barriers to accessing timely, quality healthcare. These barriers may contribute to socioeconomic inequalities in survival. We evaluated the literature for any association between socioeconomic group, hospital delay and treatments received among patients with colorectal cancer in the UK, a country with universal healthcare. DESIGN MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED and PsycINFO were searched from inception to January 2023. Grey literature, including HMIC, BASE and Google Advanced Search, and forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts and full-text articles. Observational UK-based studies were included if they reported socioeconomic measures and an association with either hospital delay or treatments received. The QUIPS tool assessed bias risk, and a narrative synthesis was conducted. The review is reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. RESULTS 41 of the 7209 identified references were included. 12 studies evaluated 7 different hospital intervals. There was a significant association between area-level deprivation and a longer time from first presentation in primary care to diagnosis. 32 studies evaluated treatments received. There were socioeconomic inequalities in surgery and chemotherapy but not radiotherapy. CONCLUSION Patients with colorectal cancer face inequalities across the cancer care continuum. Further research is needed to understand why and what evidence-based actions can reduce these inequalities in treatment. Qualitative research of patients and clinicians conducted across various settings would provide a rich understanding of the complex factors that drive these inequalities. Further research should also consider using a causal approach to future studies to considerably strengthen the interpretation. Clinicians can try and mitigate some potential causes of colorectal cancer inequalities, including signposting to financial advice and patient transport schemes. PROSPERO REGISTRATION NUMBER CRD42022347652.
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Affiliation(s)
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Michael Lind
- University of Hull, Hull, UK
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Lee A, McCarthy D, Bergin RJ, Drosdowsky A, Martinez Gutierrez J, Kearney C, Philip S, Rafiq M, Venning B, Wawryk O, Zhang J, Emery J. Data Resource Profile: Victorian Comprehensive Cancer Centre Data Connect. Int J Epidemiol 2023; 52:e292-e300. [PMID: 37889594 PMCID: PMC10749758 DOI: 10.1093/ije/dyad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Affiliation(s)
- Alex Lee
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Damien McCarthy
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Rebecca J Bergin
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Allison Drosdowsky
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Javiera Martinez Gutierrez
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Chris Kearney
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Sally Philip
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Meena Rafiq
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
- Epidemiology of Cancer and Healthcare Outcomes (ECHO) Group, UCL, London, UK
| | - Brent Venning
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Olivia Wawryk
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Jianrong Zhang
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
| | - Jon Emery
- Department of General Practice, Faculty of Medicine, University of Melbourne and Centre for Cancer Research, Parkville, VIC, Australia
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Jovanović A, Tošić N, Marjanović I, Komazec J, Zukić B, Nikitović M, Ilić R, Grujičić D, Janić D, Pavlović S. Germline Variants in Cancer Predisposition Genes in Pediatric Patients with Central Nervous System Tumors. Int J Mol Sci 2023; 24:17387. [PMID: 38139220 PMCID: PMC10744041 DOI: 10.3390/ijms242417387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Central nervous system (CNS) tumors comprise around 20% of childhood malignancies. Germline variants in cancer predisposition genes (CPGs) are found in approximately 10% of pediatric patients with CNS tumors. This study aimed to characterize variants in CPGs in pediatric patients with CNS tumors and correlate these findings with clinically relevant data. Genomic DNA was isolated from the peripheral blood of 51 pediatric patients and further analyzed by the next-generation sequencing approach. Bioinformatic analysis was done using an "in-house" gene list panel, which included 144 genes related to pediatric brain tumors, and the gene list panel Neoplasm (HP:0002664). Our study found that 27% of pediatric patients with CNS tumors have a germline variant in some of the known CPGs, like ALK, APC, CHEK2, ELP1, MLH1, MSH2, NF1, NF2 and TP53. This study represents the first comprehensive evaluation of germline variants in pediatric patients with CNS tumors in the Western Balkans region. Our results indicate the necessity of genomic research to reveal the genetic basis of pediatric CNS tumors, as well as to define targets for the application and development of innovative therapeutics that form the basis of the upcoming era of personalized medicine.
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Affiliation(s)
- Aleksa Jovanović
- Pediatric Oncology Department, National Cancer Research Center, 11000 Belgrade, Serbia; (A.J.); (D.J.)
| | - Nataša Tošić
- Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (N.T.); (I.M.); (J.K.); (B.Z.)
| | - Irena Marjanović
- Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (N.T.); (I.M.); (J.K.); (B.Z.)
| | - Jovana Komazec
- Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (N.T.); (I.M.); (J.K.); (B.Z.)
| | - Branka Zukić
- Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (N.T.); (I.M.); (J.K.); (B.Z.)
| | - Marina Nikitović
- Pediatric Radiation Oncology Department, National Cancer Research Center, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (R.I.); (D.G.)
| | - Rosanda Ilić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (R.I.); (D.G.)
- Neurooncology Department, Neurosurgery Clinic, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Danica Grujičić
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (R.I.); (D.G.)
- Neurooncology Department, Neurosurgery Clinic, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Dragana Janić
- Pediatric Oncology Department, National Cancer Research Center, 11000 Belgrade, Serbia; (A.J.); (D.J.)
| | - Sonja Pavlović
- Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (N.T.); (I.M.); (J.K.); (B.Z.)
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Lauridsen GB, Jarbøl DE, Thye-Rønn P, Rasmussen S, Balasubramaniam K, Lykkegaard J. Exploring GPs' assessments of their patients' cancer diagnostic processes: a questionnaire study. Br J Gen Pract 2023; 73:e941-e948. [PMID: 37903641 PMCID: PMC10633666 DOI: 10.3399/bjgp.2022.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/16/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Most cancer diagnostic pathways start from primary care and several factors affect the diagnostic processes. AIM To analyse the associations between patient characteristics, symptom presentation, and cancer type and the GP's assessment of the diagnostic processes. DESIGN AND SETTING General practices in the North, Central, and Southern regions of Denmark were invited to participate in a questionnaire survey. METHOD Participating GPs received a list of patients with incident cases of cancer in the period between 1 March 2019 and 28 February 2021 based on administrative hospital data. A questionnaire was completed for each patient, addressing symptom presentation and the GP's assessment of the diagnostic process both overall and in four subcategories (the patient's role, the GP's role, the transition between primary and secondary care, and the secondary sector's role). RESULTS A total of 187 general practices informed on 8240 patients. For 5868 patients, diagnostic pathways started in general practice. Almost half (48.3%, 2837/5868) presented with specific cancer symptoms. GPs assessed 55.6% (3263) and 32.3% (1897) of the diagnostic processes as 'very good' and 'predominantly good', respectively; 11.9% (700) were 'predominantly poor' or 'very poor' for these 5868 patients. Long symptom duration of ≥2 months prior to GP contact and presenting with non-specific or a combination of non-specific and specific symptoms were associated with a poor overall assessment of the diagnostic process. Assessment in the four subcategories showed that the patient's role was assessed less positively than the other three categories. CONCLUSION A longer symptom duration and presenting without cancer-specific symptoms were associated with GPs assessing the diagnostic process as poor.
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Affiliation(s)
- Gitte Bruun Lauridsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Peter Thye-Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, and Diagnostic Center, Svendborg Hospital, Svendborg
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | | | - Jesper Lykkegaard
- Department of Public Health and Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense
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Lacika JL, Wabinga H, Kagaayi J, Opito R, Orach CG, Mwaka AD. Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study. BMC Womens Health 2023; 23:633. [PMID: 38012615 PMCID: PMC10683271 DOI: 10.1186/s12905-023-02785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. METHODS This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. RESULTS The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4-8.2) months and 2.4 (IQR: 1.2-4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo-radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60-3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07-2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60-0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61-0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55-0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18-5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41-0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). CONCLUSION Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.
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Affiliation(s)
- Jackie Lalam Lacika
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Kagaayi
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Ronald Opito
- Department of Public Health, School of Health Sciences, Soroti University, P.O Box 211, Soroti, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
- Department of Medicine, Faculty of Medicine, Gulu University, P.O Box 166, Gulu, Uganda.
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LeBlanc M, Kang J, Costa AF. Can we rely on contrast-enhanced CT to identify pancreatic ductal adenocarcinoma? A population-based study in sensitivity and factors associated with false negatives. Eur Radiol 2023; 33:7656-7664. [PMID: 37266655 DOI: 10.1007/s00330-023-09758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the sensitivity of contrast-enhanced computed tomography (CECT) in detecting pancreatic ductal adenocarcinoma (PDAC) and identify factors associated with false negatives (FNs). METHODS Patients diagnosed with PDAC in 2014-2015 were retrospectively identified by a cancer registry. CECTs performed during the diagnostic interval were retrospectively classified as true positive (TP), indeterminate, or FN. Sensitivity TP/(TP+FN) was calculated for all CECTs and the following subgroups: protocol (uniphasic vs. biphasic); tumor size (≤ 2 cm vs. > 2 cm); and resectability (potentially resectable vs. unresectable). Multivariate logistic regression was performed to assess which of the following factors were associated with FN: clinical suspicion of PDAC; size >2 cm; presence of metastases; protocol; isoattenuating tumor; and potentially resectable disease on imaging. RESULTS In total, 176 CECTs (127 uniphasic; 49 biphasic) in 154 patients (90 men, mean age 72 ± 11 years) were included. Sensitivity was 125/149 (83.9%) overall and 87/106 (82.1%) and 38/43 (88.4%) for uniphasic and biphasic protocols, respectively. Sensitivity was decreased for tumors ≤ 2 cm (45.4% vs. 90.6%), no liver metastases (78.0% vs. 95.9%), and potentially resectable disease (65.3% vs. 93.0%). Factors significantly associated with FN were clinical suspicion (OR, 0.24, 95% CI: 0.07-0.75), size>2 cm (OR, 0.10, 95% CI: 0.02-0.44), absence of liver metastases (OR, 4.94, 95% CI: 1.29-22.99), and potentially resectable disease (OR, 4.13, 95% CI: 1.07-16.65). CONCLUSIONS In our population, the overall sensitivity of CECT to detect PDAC is 83.9%; however, this is substantially lower in several scenarios, including patients with potentially resectable disease. This finding has important implications for patient outcomes and efforts to maximize CECT sensitivity should be sought. CLINICAL RELEVANCE STATEMENT The sensitivity of CECT to detect PDAC is significantly decreased in the setting of sub-2 cm tumors and potentially resectable disease. A dedicated biphasic pancreatic CECT protocol has higher sensitivity and should be applied in patients with suspected pancreatic disease. KEY POINTS • The sensitivities of contrast-enhanced CT for the detection of PDAC were 87/106 (82.1%) and 38/43 (88.4%) for uniphasic and biphasic protocols, respectively. • The sensitivity of contrast-enhanced CT was decreased for small tumors ≤ 2 cm (45.4% vs. 90.6%), if there were no liver metastases (78.0% vs. 95.9%), and with potentially resectable disease (65.3% vs. 93.0%). • Absence of liver metastases (OR, 4.94, 95% CI: 1.29-22.99) and potentially resectable disease (OR, 4.13, 95% CI: 1.07-16.65) were associated with a false--negative (FN) CT result; suspicion of malignancy on the imaging requisition (OR, 0.24, 95% CI: 0.07-0.75) and size > 2 cm (OR, 0.10, 95% CI: 0.02-0.44) were negatively associated with FN.
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Affiliation(s)
- Max LeBlanc
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Jessie Kang
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
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Jovanović A, Ilić R, Pudrlja Slović M, Paripović L, Janić D, Nikitović M, Grujičić D, Ilić V. Total diagnostic interval in children with brain tumours in a middle-income country: national experience from Serbia. Childs Nerv Syst 2023; 39:3169-3177. [PMID: 37097460 PMCID: PMC10127958 DOI: 10.1007/s00381-023-05958-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The aim was to evaluate the total diagnostic interval (TDI) and presenting complaints in children with brain tumours in Serbia. METHODS This study retrospectively analysed 212 children aged 0-18 years newly diagnosed with brain tumours in two tertiary centres from mid-March 2015 to mid-March 2020 covering virtually all children with brain tumours in Serbia. TDI was calculated as the difference between the date of diagnosis and the date of symptom onset presented as a median in weeks. This variable has been evaluable for 184 patients. RESULTS Overall TDI was 6 weeks. TDI was significantly longer in patients with low-grade tumours (11 weeks) than in patients with high-grade tumours (4 weeks). Children with the most frequent complaints (headache, nausea/vomiting and gait disturbance) were more likely to be diagnosed sooner. Patients with a single complaint had significantly longer TDI (12.5 weeks) contrasted to patients with multiple complaints (5 weeks). CONCLUSION TDI with a median of 6 weeks is similar to other developed countries. Our study supports the view that low-grade tumours will present later than high-grade tumours. Children with the commonest complaints and children with multiple complaints were more likely to be diagnosed sooner.
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Affiliation(s)
- Aleksa Jovanović
- Paediatric Oncology Department, National Cancer Research Centre, Belgrade, Serbia
| | - Rosanda Ilić
- Neurooncology Department, Neurosurgery Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Lejla Paripović
- Paediatric Oncology Department, National Cancer Research Centre, Belgrade, Serbia
| | - Dragana Janić
- Paediatric Oncology Department, National Cancer Research Centre, Belgrade, Serbia
| | - Marina Nikitović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Paediatric Radiation Oncology Department, National Cancer Research Centre, Belgrade, Serbia
| | - Danica Grujičić
- Neurooncology Department, Neurosurgery Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Ilić
- Paediatric Oncology Department, National Cancer Research Centre, Belgrade, Serbia.
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Whitfield E, White B, Denaxas S, Barclay ME, Renzi C, Lyratzopoulos G. A taxonomy of early diagnosis research to guide study design and funding prioritisation. Br J Cancer 2023; 129:1527-1534. [PMID: 37794179 PMCID: PMC10645731 DOI: 10.1038/s41416-023-02450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
Researchers and research funders aiming to improve diagnosis seek to identify if, when, where, and how earlier diagnosis is possible. This has led to the propagation of research studies using a wide range of methodologies and data sources to explore diagnostic processes. Many such studies use electronic health record data and focus on cancer diagnosis. Based on this literature, we propose a taxonomy to guide the design and support the synthesis of early diagnosis research, focusing on five key questions: Do healthcare use patterns suggest earlier diagnosis could be possible? How does the diagnostic process begin? How do patients progress from presentation to diagnosis? How long does the diagnostic process take? Could anything have been done differently to reach the correct diagnosis sooner? We define families of diagnostic research study designs addressing each of these questions and appraise their unique or complementary contributions and limitations. We identify three further questions on relationships between the families and their relevance for examining patient group inequalities, supported with examples from the cancer literature. Although exemplified through cancer as a disease model, we recognise the framework is also applicable to non-neoplastic disease. The proposed framework can guide future study design and research funding prioritisation.
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Affiliation(s)
- Emma Whitfield
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK.
- Institute of Health Informatics, UCL, London, UK.
| | - Becky White
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Spiros Denaxas
- Institute of Health Informatics, UCL, London, UK
- British Heart Foundation Data Science Centre, London, UK
- Health Data Research UK, London, UK
- UCL Hospitals Biomedical Research Centre, London, UK
| | - Matthew E Barclay
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Cristina Renzi
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Georgios Lyratzopoulos
- ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), 1-19 Torrington Place, London, WC1E 7HB, UK
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Halgren Olsen M, Maltesen T, Lassen P, Kjaer TK, Johansen J, Primdahl H, Andersen E, Kristensen CA, Andersen M, Farhadi M, Overgaard J, Dalton SO. Socioeconomic position and the pre-diagnostic interval among patients diagnosed with head and neck squamous cell carcinoma - a population-based study from DAHANCA. Acta Oncol 2023; 62:1394-1402. [PMID: 37672036 DOI: 10.1080/0284186x.2023.2254478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The socioeconomic differences in survival are pronounced for patients diagnosed with head and neck cancer; disease stage at diagnosis is suggested to be a main driver of this association. This nationwide, population-based study investigates socioeconomic differences in the pre-diagnostic interval and disease stage at diagnosis. MATERIAL AND METHODS Information on patient-reported symptoms, symptom onset and disease-specific factors was obtained from the nationwide population-based Danish Head and Neck Cancer Group (DAHANCA) database for patients diagnosed with head and neck squamous cell carcinoma between 2008 and 2019 in Denmark. Socioeconomic position (SEP) was measured by individual-level education, income and cohabitation status obtained from administrative registers. Socioeconomic differences in the interval from symptom onset to diagnosis were investigated in general linear models with 95% confidence intervals (CIs); overall and by subsite, symptom and comorbidity score. Consultation patterns prior to diagnosis were examined using methods for change-point detection. Associations with advanced-stage disease were estimated in logistic regression models. RESULTS Patients with low, medium and high SEP had a similar interval from patient-reported symptom onset to diagnosis of 10 weeks. Although this interval varied according to primary symptom and anatomical subsite, no apparent socioeconomic differences were observed within these subgroups. Aligned with the patient-reported symptom onset, a distinct increase in consultation rates was observed at 9 weeks (95% CI [7.3; 10.7]) for patients with low SEP and 7 weeks (95% CI [4.8; 9.2]) for patients with high SEP, with overlapping CIs. Patients with low compared to high SEP had increased odds for advanced-stage glottic and oral cavity squamous cell carcinoma. For the remaining subsites the association varied according to SEP-indicator and TNM-edition. CONCLUSION The interval from symptom onset to diagnosis and consultation patterns were similar across SEP groups. Still, socioeconomic differences in stage at diagnosis were observed for some - but not all - subsites.
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Affiliation(s)
- Maja Halgren Olsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Thomas Maltesen
- Statistics and Data Analysis, Danish Cancer Institute, Copenhagen, Denmark
| | - Pernille Lassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Elo Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev, Herlev, Denmark
| | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mohammad Farhadi
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Elyes M, Heesen P, Schelling G, Bode-Lesniewska B, Studer G, Fuchs B. Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis. Cancers (Basel) 2023; 15:4892. [PMID: 37835586 PMCID: PMC10571532 DOI: 10.3390/cancers15194892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).
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Affiliation(s)
- Maria Elyes
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | - Philip Heesen
- University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland
| | - Georg Schelling
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | | | - Gabriela Studer
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
| | - Bruno Fuchs
- University Teaching Hospital LUKS, Lucerne, Sarcoma Service, University of Lucerne, 6000 Lucerne, Switzerland
- University Hospital USZ, Sarcoma Servuce, University of Zurich, 8000 Zurich, Switzerland
- Kantonsspital Winterthur, Sarcoma Service, 8400 Winterthur, Switzerland
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McCarty RD, Barnard ME, Lawson-Michod KA, Owens M, Green SE, Derzon S, Karabegovic L, Akerley WL, Watt MH, Doherty JA, Grieshober L. Pathways to lung cancer diagnosis among individuals who did not receive lung cancer screening: a qualitative study. BMC PRIMARY CARE 2023; 24:203. [PMID: 37789288 PMCID: PMC10548694 DOI: 10.1186/s12875-023-02158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Although early detection of lung cancer through screening is associated with better prognosis, most lung cancers are diagnosed among unscreened individuals. We therefore sought to characterize pathways to lung cancer diagnosis among unscreened individuals. METHODS Participants were individuals with lung cancer who did not undergo asymptomatic lung cancer screening (n = 13) and healthcare providers who may be involved in the pathway to lung cancer diagnosis (n = 13). We conducted semi-structured interviews to identify themes in lung cancer patients' narratives of their cancer diagnoses and providers' personal and/or professional experiences of various pathways to lung cancer diagnoses, to identify delays in diagnosis. We audio-recorded, transcribed, and coded interviews in two stages. First, we conducted deductive coding using three time-period intervals from the Models of Pathways to Treatment framework: appraisal, help-seeking, and diagnostic (i.e., excluding pre-treatment). Second, we conducted inductive coding to identify themes within each time-period interval, and classified these themes as either barriers or facilitators to diagnosis. Coding and thematic summarization were completed independently by two separate analysts who discussed for consensus. RESULTS Eight of the patient participants had formerly smoked, and five had never smoked. We identified eight barrier/facilitator themes within the three time-period intervals. Within the appraisal interval, the barrier theme was (1) minimization or misattribution of symptoms, and the facilitator theme was (2) acknowledgment of symptoms. Within the help-seeking interval, the barrier theme was (3) hesitancy to seek care, and the facilitator theme was (4) routine care. Within the diagnosis interval, barrier themes were (5) health system challenges, and (6) social determinants of health; and facilitator themes were (7) severe symptoms and known risk factors, and (8) self-advocacy. Many themes were interrelated, including minimization or misattribution of symptoms and hesitancy to seek care, which may collectively contribute to care and imaging delays. CONCLUSIONS Interventions to reduce hesitancy to seek care may facilitate timely lung cancer diagnoses. More prompt referral to imaging-especially computed tomography (CT)-among symptomatic patients, along with patient self-advocacy for imaging, may reduce delays in diagnosis.
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Affiliation(s)
- Rachel D McCarty
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT, 84112, USA.
- Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Mollie E Barnard
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Katherine A Lawson-Michod
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Makelle Owens
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
- San Antonio Military Medical Center Internal Medicine Residency, Brooke Army Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - Sarah E Green
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
- Danbury Hospital Department of Surgery, Danbury Hospital, 24 Hospital Ave, Danbury, CT, 06810, USA
| | - Samantha Derzon
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
- Intermountain Healthcare, Utah Valley Hospital, Utah Valley Family Medicine Residency, 475 W 940 N, Provo, Provo, UT, 84604, USA
| | - Lea Karabegovic
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Wallace L Akerley
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT, 84112, USA
- Division of Oncology, Spencer Fox Eccles School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Melissa H Watt
- Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jennifer A Doherty
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Laurie Grieshober
- Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences Spencer Fox Eccles School of Medicine, University of Utah Intermountain Healthcare, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Achan J, Kasujja FX, Opito R, Wabinga H, Orach CG, Mwaka AD. Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute: A cross-sectional study. Cancer Med 2023; 12:19701-19713. [PMID: 37787090 PMCID: PMC10587984 DOI: 10.1002/cam4.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/09/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Most breast cancer (BC) patients in Uganda are diagnosed with advanced-stage disease and experience poor outcomes. This study examined the diagnostic and pre-treatment intervals and factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI). METHODS This was a cross-sectional, facility-based study. Data were collected using structured questionnaire administered by trained research assistants and analyzed using STATA version 14.0. Modified Poisson regressions models were used to determine the strength of associations between independent variables and diagnostic and pre-treatment intervals. RESULTS The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140) stage IV cancers. The median interval from first consultation to diagnosis, i.e. diagnostic interval (DI) was 5.6 months (IQR: 1.5-17.0), while the median interval from histological diagnosis to start of chemotherapy, i.e. pre-treatment interval (PTI) was 1.7 months (IQR: 0.7-4.5). Majority (85%, n = 341) of participants were diagnosed at ≥3 months from first consultation with clinicians. Participants with tertiary education and those who lived within 100-199 km from the UCI were about four times and twice more likely to be diagnosed early (DI <3 months from first consultation) ([aPR = 3.88; 95% CI: 1.15-13.0] and [aPR = 2.19; 95% CI: 1.06-4.55]), respectively. About half (48.3%; n = 176) of participants started chemotherapy within 1 month of cancer diagnosis. Patients who lived more than 300 km from the UCI were less likely to start chemotherapy within 1 month of histology diagnosis of cancer. [Correction added on October 17, 2023 after first online publication. The term ', i.e.' has been included in the results section in this version.] CONCLUSION: Majority of breast cancer patients are diagnosed late and in advanced stages. There is need to promote all efforts toward timely diagnosis when cancers are still in early stages by identifying factors responsible for prolonged diagnostic intervals among breast cancer patients.
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Affiliation(s)
- Jennifer Achan
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Francis Xavier Kasujja
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Ronald Opito
- Department of Public Health, School of Health SciencesSoroti UniversitySorotiUganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical SciencesCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of MedicineCollege of Health Sciences, Makerere UniversityKampalaUganda
- Department of Medicine, Faculty of MedicineGulu UniversityGuluUganda
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Bosch X, Montori-Palacin E, Calvo J, Carbonell I, Naval-Álvarez J, Moreno P, López-Soto A. Time intervals and previous primary care consultations in the pathway to emergency cancer diagnosis. Cancer Epidemiol 2023; 86:102445. [PMID: 37651939 DOI: 10.1016/j.canep.2023.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Time intervals and number of prior consultations in primary care (PC) are recognised metrics of diagnostic timeliness of cancer and are interrelated. However, whether and how the two measures correlate with each other in the emergency diagnostic pathway is unknown. We investigated the association between the number of prereferral consultations and the length of intervals from PC presentation to cancer diagnosis following emergency referral to hospital. METHODS Patients were eligible if they first consulted in PC and were diagnosed with cancer following emergency or nonemergency referral to hospital. We analysed for differences in PC and diagnostic intervals and number of consultations between emergency and nonemergency presenters and determined their associations by cancer type. Differences in presenting symptoms and stage at diagnosis between populations and according to number of consultations were also examined. RESULTS There were 796 emergency and 865 nonemergency presenters with comparable sociodemographic and comorbidity data. Correlation analysis in emergency presenters revealed a strong positive association between number of consultations and intervals for seven of 13 different cancers, including cancers characterised by high proportions of > 3 consultations and long intervals (pancreatic, lung, and colorectal cancer) and vice versa for others (e.g., endometrial, cervical, or oesophageal cancer). Additionally, emergency presenters with > 3 consultations were more likely than those with 1-2 to report nonspecific symptoms (60 vs. 40%, respectively) and to be diagnosed at a later stage. CONCLUSION System level interventions are needed to reduce unnecessary delays in the emergency diagnostic pathway, particularly in cancer patients with multiple prereferral consultations. The findings also suggest opportunities to reduce the proportion of emergency diagnoses by targeting symptomatic individuals pre-presentation.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Julia Calvo
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Irene Carbonell
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - José Naval-Álvarez
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Drosdowsky A, Lamb KE, Karahalios A, Bergin RJ, Milley K, Boyd L, IJzerman MJ, Emery JD. The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose-response meta-analysis. Br J Cancer 2023; 129:993-1006. [PMID: 37528204 PMCID: PMC10491798 DOI: 10.1038/s41416-023-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate existing evidence on the relationship between diagnostic and treatment intervals and outcomes for colorectal cancer. METHODS Four databases were searched for English language articles assessing the role of time before initial treatment in colorectal cancer on any outcome, including stage and survival. Two reviewers independently screened articles for inclusion and data were synthesised narratively. A dose-response meta-analysis was performed to examine the association between treatment interval and survival. RESULTS One hundred and thirty papers were included in the systematic review, eight were included in the meta-analysis. Forty-five different intervals were considered in the time from first symptom to treatment. The most common finding was of no association between the length of intervals on any outcome. The dose-response meta-analysis showed a U-shaped association between the treatment interval and overall survival with the nadir at 45 days. CONCLUSION The review found inconsistent, but mostly a lack of, association between interval length and colorectal cancer outcomes, but study design and quality were heterogeneous. Meta-analysis suggests survival becomes increasingly poorer for those commencing treatment more than 45 days after diagnosis. REGISTRATION This review was registered, and the protocol is available, in PROSPERO, the international database of systematic reviews, with the registration ID CRD42021255864.
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Affiliation(s)
- Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia.
| | - Karen E Lamb
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Amalia Karahalios
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rebecca J Bergin
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Kristi Milley
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
| | - Lucy Boyd
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Maarten J IJzerman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
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50
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Canova T, McNinch N, Judd A, Rush S, Wright E. The effects of educational interventions and the COVID-19 pandemic on the time to diagnosis in pediatric patients with primary central nervous system tumors. Neurooncol Pract 2023; 10:437-445. [PMID: 37720393 PMCID: PMC10502781 DOI: 10.1093/nop/npad024] [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: 09/19/2023] Open
Abstract
Background Primary central nervous system tumors are a leading cause of death and disability amongst pediatric cancer patients. Akron Children's Hospital published data in 2018 on response time for brain tumor diagnosis and implemented components of an established program to decrease diagnostic delays and thereby reduce tumor- and treatment-related morbidities. This study evaluates if there was an improvement in the total diagnostic interval (TDI, time from symptom onset to diagnosis) after provider education. During the study, the COVID-19 pandemic forced alterations in care delivery. The impact this had on the TDI was also assessed. Methods A retrospective chart review was performed, and patients were separated into 2008-2017 (historical) and 2018-2021 (posteducation) groups to assess the effect of educational interventions on TDI. The posteducation cohort was analyzed separately to assess the impact of COVID-19 pandemic. Results The 85 patients studied in the post-education group showed a median TDI of 31 days. Though not statistically significant (P = .939), this represents an 11-day decrease in median TDI compared to the historical group (42 days). In addition, the posteducation group showed an increase in the average number of healthcare provider visits (HCP, 2.4 historical to 3.2 posteducation, P = .009). The pre-COVID-19 group (median TDI 43.5 days) did not differ statistically from the post-COVID-19 group (30-day median TDI). Conclusion The nonsignificant decrease in TDI and concurrent increase in HCP visits after implementation of education suggests a potential gap amongst providers in working-up primary CNS tumors. These results will influence expansion of education to further improve TDI.
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Affiliation(s)
- Tyler Canova
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
- College of Medicine and Life Sciences, The University of Toledo, USA
| | - Neil McNinch
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
| | - Alexis Judd
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
| | - Sarah Rush
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
| | - Erin Wright
- Department of Hematology and Oncology, Akron Children’s Hospital, USA
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