1
|
Hinnen C, Mols F. Fluctuations in core depressive symptoms in colorectal cancer patients. A prospective, population-based PROFILES-registry study. Psychol Health 2024; 39:1411-1427. [PMID: 36511583 DOI: 10.1080/08870446.2022.2155670] [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: 07/12/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Research investigating depressive symptoms among cancer patients rarely distinguish between core symptoms of depression (motivational and consummatory anhedonia, and negative affect). This distinction is important as these symptoms may show different trajectories during the course of the illness and require different treatment approaches. The aim of the present study is to investigate fluctuations in core depressive symptoms in patients with colorectal cancer (CRC). It is hypothesized that these core depressive symptoms fluctuate differently during the course of the illness and depend on the phase of the illness (diagnostic, treatment, recovery and palliative phase). METHOD This study is based on data from the PROCORE study. PROCORE is a prospective, population-based study aimed to examine the longitudinal impact of CRC and its treatment on patient-reported outcomes. Eligible patients completed self-report questionnaires (i.e. Multifactorial Fatigue Index, Hospital Anxiety and Depression scale, EORTC-C30) after diagnosis, after surgery and at one and two years after diagnosis. RESULTS In total, 539 patients participated of whom 68 have died until March 1ste 2021. Core depressive symptoms fluctuated differently during the course of the illness with higher levels of motivational anhedonia during treatment and palliative phase (P<.001), consummatory anhedonia at the palliative phase (p < .001) and negative affect at the diagnostic and palliative phase (P<.001). CONCLUSION It is important to distinguish between different core depressive symptoms as they fluctuate differently during the course of an illness like CRC. The various depressive symptoms may require a different treatment approach at specific moments during the illness process.
Collapse
Affiliation(s)
- Chris Hinnen
- Department of Psycho-Oncology, LUMC Oncology Center, Leiden, the Netherlands
| | - Floortje Mols
- CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| |
Collapse
|
2
|
Miglioretti DL, Abraham L, Sprague BL, Lee CI, Bissell MCS, Ho TQH, Bowles EJA, Henderson LM, Hubbard RA, Tosteson ANA, Kerlikowske K. Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort. Ann Intern Med 2024. [PMID: 39222505 DOI: 10.7326/m24-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND False-positive results on screening mammography may affect women's willingness to return for future screening. OBJECTIVE To evaluate the association between screening mammography results and the probability of subsequent screening. DESIGN Cohort study. SETTING 177 facilities participating in the Breast Cancer Surveillance Consortium (BCSC). PATIENTS 3 529 825 screening mammograms (3 184 482 true negatives and 345 343 false positives) performed from 2005 to 2017 among 1 053 672 women aged 40 to 73 years without a breast cancer diagnosis. MEASUREMENTS Mammography results (true-negative result or false-positive recall with a recommendation for immediate additional imaging only, short-interval follow-up, or biopsy) from 1 or 2 screening mammograms. Absolute differences in the probability of returning for screening within 9 to 30 months of false-positive versus true-negative screening results were estimated, adjusting for race, ethnicity, age, time since last mammogram, BCSC registry, and clustering within women and facilities. RESULTS Women were more likely to return after a true-negative result (76.9% [95% CI, 75.1% to 78.6%]) than after a false-positive recall for additional imaging only (adjusted absolute difference, -1.9 percentage points [CI, -3.1 to -0.7 percentage points]), short-interval follow-up (-15.9 percentage points [CI, -19.7 to -12.0 percentage points]), or biopsy (-10.0 percentage points [CI, -14.2 to -5.9 percentage points]). Asian and Hispanic/Latinx women had the largest decreases in the probability of returning after a false positive with a recommendation for short-interval follow-up (-20 to -25 percentage points) or biopsy (-13 to -14 percentage points) versus a true negative. Among women with 2 screening mammograms within 5 years, a false-positive result on the second was associated with a decreased probability of returning for a third regardless of the first screening result. LIMITATION Women could receive care at non-BCSC facilities. CONCLUSION Women were less likely to return to screening after false-positive mammography results, especially with recommendations for short-interval follow-up or biopsy, raising concerns about continued participation in routine screening among these women at increased breast cancer risk. PRIMARY FUNDING SOURCE National Cancer Institute.
Collapse
Affiliation(s)
- Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California, and Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (D.L.M.)
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (L.A., E.J.A.B.)
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vermont (B.L.S.)
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine; Department of Health Systems and Population Health, University of Washington School of Public Health; and Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington (C.I.L.)
| | | | - Thao-Quyen H Ho
- Department of Training and Scientific Research, University Medical Center, and Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam (T.H.H.)
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (L.A., E.J.A.B.)
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina (L.M.H.)
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (R.A.H.)
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Dartmouth Cancer Center, Lebanon, New Hampshire (A.N.A.T.)
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans Affairs, and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (K.K.)
| |
Collapse
|
3
|
Ginzberg SP, Grady CB, Fayanju OM, Edmonds CE. Disparities in the Use of Preoperative Breast Magnetic Resonance Imaging After Breast Cancer Diagnosis. JCO Oncol Pract 2024:OP2300831. [PMID: 38950325 DOI: 10.1200/op.23.00831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 04/22/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE Preoperative magnetic resonance imaging (MRI) after breast cancer diagnosis is increasingly used to improve locoregional staging, particularly among women with dense breasts, extensive ductal carcinoma in situ, and lobular histology. The goals of this study were to (1) assess whether use of preoperative MRI varies by race and insurance type; and (2) determine whether preoperative MRI is associated with downstream surgical management. MATERIALS AND METHODS We performed a retrospective cohort study of women with stage 0-III breast cancer who were treated with surgical resection within our academic health system (2016-2019). Patients were categorized by race and insurance type. The primary outcome was receipt of preoperative MRI. Secondary outcomes included surgery extent (lumpectomy v mastectomy) and receipt of a second operation. RESULTS A total of 1,410 women (27% Black, 73% White; 67% private insurance, 26% Medicare, 6% Medicaid) were included. Black patients were significantly less likely to undergo preoperative MRI than White patients (odds ratio [OR], 0.54 [95% CI, 0.38 to 0.76]; P < .001). There was no association between insurance type and preoperative MRI (Medicare v private: OR, 0.77 [95% CI, 0.52 to 1.15]; P = .208; Medicaid v private: OR, 0.67 [95% CI, 0.36 to 1.25]; P = .210). White patients who underwent preoperative MRI were less likely to undergo lumpectomy versus those who did not (OR, 0.53 [95% CI, 0.37 to 0.76]; P < .001). Likelihood of re-excision was lower for Black women who had undergone MRI versus those who had not (OR, 0.43 [95% CI, 0.20 to 0.93]; P = .031). CONCLUSION Black patients were less likely than White patients to undergo preoperative MRI, yet Black women who underwent MRI were less likely to require re-excision. Standardizing preoperative MRI use may mitigate provider- and system-level biases and promote more equitable care.
Collapse
Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Connor B Grady
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Oluwadamilola M Fayanju
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Rena Rowan Breast Center, Penn Medicine, Philadelphia, PA
| | - Christine E Edmonds
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA
| |
Collapse
|
4
|
Monroy-Iglesias MJ, Russell B, Martin S, Fox L, Moss C, Bruno F, Millwaters J, Steward L, Murtagh C, Cargaleiro C, Bater D, Lavelle G, Simpson A, Onih J, Haire A, Reeder C, Jones G, Smith S, Santaolalla A, Van Hemelrijck M, Dolly S. Anxiety and depression in patients with non-site-specific cancer symptoms: data from a rapid diagnostic clinic. Front Oncol 2024; 14:1358888. [PMID: 38887232 PMCID: PMC11180766 DOI: 10.3389/fonc.2024.1358888] [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: 02/08/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024] Open
Abstract
Background Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression. Methods Patients seen at GSTT RDC between June 2019 and January 2023 completed the General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-8) questionnaires, at baseline. We used logistic regression (LR) and 2 machine learning (ML) algorithms (random forest (RF), support vector machine (SVM)) to predict risk of severe anxiety and severe depression. The models were constructed using a set of sociodemographic and clinical variables. Results A total of 1734 patients completed GAD-7 and PHQ-8 questionnaires. Of these, the mean age was 59 years (Standard Deviation: 15.5), and 61.5% (n:1067) were female. Prevalence of severe anxiety (GAD-7 score ≥15) was 13.8% and severe depression (PHQ-8 score≥20) was 9.3%. LR showed that a combination of previous mental health condition (PMH, Adjusted Odds Rario (AOR) 3.28; 95% confidence interval (CI) 2.36-4.56), symptom duration >6 months (AOR 2.20; 95%CI 1.28-3.77), weight loss (AOR 1.88; 95% CI 1.36-2.61), progressive pain (AOR 1.71; 95%CI 1.26-2.32), and fatigue (AOR 1.36; 95%CI 1.01-1.84), was positively associated with severe anxiety. Likewise, a combination PMH condition (AOR 3.95; 95%CI 2.17-5.75), fatigue (AOR 2.11; 95%CI 1.47-3.01), symptom duration >6 months (AOR 1.98; 95%CI 1.06-3.68), weight loss (AOR 1.66; 95%CI 1.13-2.44), and progressive pain (AOR 1.50; 95%CI 1.04-2.16), was positively associated with severe depression. LR and SVM had highest accuracy levels for severe anxiety (LR: 86%, SVM: 85%) and severe depression (SVM: 89%, LR: 86%). Conclusion High prevalence of severe anxiety and severe depression was found. PMH, fatigue, weight loss, progressive pain, and symptoms >6 months emerged as combined risk factors for both these psychological comorbidities. RDCs offer an opportunity to alleviate distress in patients with concerning symptoms by expediting diagnostic evaluations.
Collapse
Affiliation(s)
- Maria J. Monroy-Iglesias
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Beth Russell
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Sabine Martin
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Louis Fox
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Charlotte Moss
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Flaminia Bruno
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Juliet Millwaters
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Lindsay Steward
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Colette Murtagh
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Carlos Cargaleiro
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Darren Bater
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Grace Lavelle
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
| | - Anna Simpson
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
| | - Jemima Onih
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
| | - Anna Haire
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Clare Reeder
- Macmillan Psychological Support (MAPS) Team, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Geraint Jones
- South East London Cancer Alliance, London, United Kingdom
| | - Sue Smith
- Dimbleby Cancer Care, Guy’s Cancer Centre, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| | - Aida Santaolalla
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King’s College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ National Health System (NHS) Foundation Trust, London, United Kingdom
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Duckham RL, Webster T, See K. The development and implementation of the Northern Health lung cancer digital care pathway: a case study in service change. AUST HEALTH REV 2024; 48:148-153. [PMID: 38432683 DOI: 10.1071/ah23279] [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: 12/29/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
This case study details the approach utilised to establish an easy to use, accessible and sustainable method for routine collection of Patient Reported Outcome Measures for patients newly diagnosed with lung cancer. We sought to enhance communication with patients and their families, particularly around shared decision making, their quality of life and symptoms, as well as the impacts of their care or treatment. We detail the co-design methodology utilised with consumers and healthcare providers to develop and implement a multi-lingual, fully automated digital care pathway which has been proven to be highly impactful and powerful for both healthcare providers working within the service and consumers enrolled within the digital pathway. This innovative initiative has changed the practice of the lung cancer service across a health service. Furthermore, its success has evolved the organisational strategy, to embed 'Outcomes for Impact' across the health service.
Collapse
Affiliation(s)
- Rachel L Duckham
- Clinical Leadership Effectiveness and Outcomes (CLEO), Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia; and Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Vic. 3021, Australia; and Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Vic. 3125, Australia
| | - Tracey Webster
- Clinical Leadership Effectiveness and Outcomes (CLEO), Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia
| | - Katharine See
- Clinical Leadership Effectiveness and Outcomes (CLEO), Northern Health, 185 Cooper Street, Epping, Vic. 3076, Australia; and Department of Respiratory Medicine, Northern Health, Epping, Vic. 3076, Australia
| |
Collapse
|
7
|
Suciu V, El Chamieh C, Soufan R, Mathieu MC, Balleyguier C, Delaloge S, Balogh Z, Scoazec JY, Chevret S, Vielh P. Real-World Diagnostic Accuracy of the On-Site Cytopathology Advance Report (OSCAR) Procedure Performed in a Multidisciplinary One-Stop Breast Clinic. Cancers (Basel) 2023; 15:4967. [PMID: 37894334 PMCID: PMC10605571 DOI: 10.3390/cancers15204967] [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: 07/09/2023] [Revised: 08/19/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
Fine-needle aspiration (FNA) cytology has been widely used for the diagnosis of breast cancer lesions with the objective of differentiating benign from malignant masses. However, the occurrence of unsatisfactory samples and false-negative rates remains a matter of concern. Major improvements have been made thanks to the implementation of rapid on-site evaluation (ROSE) in multidisciplinary and integrated medical settings such as one-stop clinics (OSCs). In these settings, clinical and radiological examinations are combined with a morphological study performed by interventional pathologists. The aim of our study was to assess the diagnostic accuracy of the on-site cytopathology advance report (OSCAR) procedure on breast FNA cytologic samples in our breast OSC during the first three years (April 2004 till March 2007) of its implementation. To this goal, we retrospectively analyzed a series of 1820 breast masses (1740 patients) radiologically classified according to the American College of Radiology (ACR) BI-RADS lexicon (67.6% being either BI-RADS 4 or 5), sampled by FNA and immediately diagnosed by cytomorphology. The clinicoradiological, cytomorphological, and histological characteristics of all consecutive patients were retrieved from the hospital computerized medical records prospectively registered in the central information system. Histopathological analysis and ultrasound (US) follow-up (FU) were the reference diagnostic tests of the study design. In brief, we carried out either a histopathological verification or an 18-month US evaluation when a benign cytology was concordant with the components of the triple test. Overall, histology was available for 1138 masses, whereas 491 masses were analyzed at the 18-month US-FU. FNA specimens were morphologically nondiagnostic in 3.1%, false negatives were observed in 1.5%, and there was only one false positive (0.06%). The breast cancer prevalence was 62%. Diagnostic accuracy measures of the OSCAR procedure with their 95% confidence intervals (95% CI) were the following: sensitivity (Se) = 97.4% (96.19-98.31); specificity (Sp) = 94.98% (92.94-96.56); positive predictive value (PPV) = 96.80% (95.48-97.81); negative predictive value (NPV) = 95.91% (94.02-97.33); positive likelihood ratio (LR+) = 19.39 (13.75-27.32); negative predictive ratio (LR-) = 0.03 (0.02-0.04), and; accuracy = 96.45% (95.42-97.31). The respective positive likelihood ratio (LR+) for each of the four categories of cytopathological diagnoses (with their 95% CI) which are malignant, suspicious, benign, and nondiagnostic were 540 (76-3827); 2.69 (1.8-3.96); 0.03 (0.02-0.04); and 0.37 (0.2-0.66), respectively. In conclusion, our study demonstrates that the OSCAR procedure is a highly reliable diagnostic approach and a perfect test to select patients requiring core-needle biopsy (CNB) when performed by interventional cytopathologists in a multidisciplinary and integrated OSC setting. Besides drastically limiting the rate of nondiagnostic specimens and diagnostic turn-around time, OSCAR is an efficient and powerful first-line diagnostic approach for patient-centered care.
Collapse
Affiliation(s)
- Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Ranya Soufan
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | | | - Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | - Zsofia Balogh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
| | | | - Sylvie Chevret
- Department of Biostatistics and Medical Information, INSERM UMR1153 ECSTRRA Team, Hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France
- Medipath and American Hospital of Paris, 92200 Paris, France
| |
Collapse
|
8
|
Holm S, Mussmann BR, Olesen F. Patient involvement and expectations during CT scans. Tinkering to involve patients and offer care in radiographic practice. Radiography (Lond) 2023; 29:935-940. [PMID: 37524036 DOI: 10.1016/j.radi.2023.07.005] [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: 01/06/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION This study investigated how patients expected and experienced to be put first and cared for in diagnostic imaging settings and how putting the patient first was operationalized in practice. METHODS A qualitative field study was conducted in two Danish hospitals to investigate patients' expectations and experiences of care and involvement during CT examinations. Data collection methods included semi-structured interviews and participant observations of five examination cases. Three Computed Tomography (CT) guided lung biopsy intervention studies and two conventional CT studies of the chest of patients being investigated for lung cancer in Fast Track Cancer Referral Programs (FTCRP) were included. RESULTS Patients reported low expectations of receiving care and being involved during examinations. Perceptions of receiving care predominantly consisted of being received in a kind, personalized manner. Expectations of involvement in the procedure were reported in terms of readiness to do as they were told, complying with requests put to each patient. Concepts of care and involvement were challenged in their formal meanings and found to be entangled in complex interactions within sociotechnical boundaries. CONCLUSION Patient's expectations of receiving care and being involved in the diagnostic imaging procedures, were expressed in noncommittal terms, and were overshadowed by patients' focus on getting through the examination, in order to get an answer to their tentative diagnose. The concepts of care and patient involvement were negotiated and reconceptualized within the sociotechnical framework of the diagnostic imaging situation of the individual patient. The concept of "tinkering" is suggested as a means of understanding how patientcare is performed during diagnostic imaging procedures. IMPLICATIONS FOR PRACTICE Issues were identified that may help professionals to put "the patient first", thus, improving patient centered care.
Collapse
Affiliation(s)
- S Holm
- UCL University College, Radiography Education, Denmark.
| | - B R Mussmann
- Department of Radiology, Odense University Hospital, Denmark. Research and Innovation Unit of Radiology, University of Southern Denmark, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - F Olesen
- School of Communication and Culture - Information Studies, Aarhus University, Denmark.
| |
Collapse
|
9
|
Rak O, Urban D, Perlman S, Ziv-Baran T, Katorza E. Fast vs. Regular Track for Lung and Pancreatic Cancer Diagnosis-Time from Initial Finding to Final Diagnosis and Patient Survival. J Med Syst 2023; 47:48. [PMID: 37060494 DOI: 10.1007/s10916-023-01939-y] [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: 08/09/2022] [Accepted: 03/16/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Health systems around the world have begun implementing unique tracks to expedite diagnosis and improve survival of patients with suspected cancers. This study aimed to compare characteristics and survival between patients diagnosed by way of fast and regular diagnostic tracks. METHODS A historical cohort study of patients (age ≥ 18) diagnosed with lung or pancreatic cancers between 09/2017 and 03/2020 on a fast diagnostic track and treated in a tertiary hospital versus a random sample of patients with the same cancer types who began treatment in the hospital over the same period of time after being diagnosed utilizing the regular track in the community. RESULTS The study included 336 patients (108 fast-track diagnostics, 228 regular track diagnostics). Advanced stages III-IV at diagnosis were more likely in the fast-track group (94.4% vs. 81.1%, p = 0.001). The median time from initial cancer suspicion to diagnosis was 21 days (IQR 14-37) for the fast-track vs. 31 days (IQR 18-51) for the regular track (p < 0.001). During the follow-up period, 56 patients from the fast-track and 131 patients from the regular track died. No significant difference was found in the median survival time between the fast and regular tracks, whether from the onset of symptoms, diagnosis, or treatment initiation. CONCLUSION Patients referred to the fast-track were more likely to be diagnosed at a further advanced stage of their cancer. The fast-track shortened the time until diagnosis and treatment but no difference was found in median survival between the tracks, perhaps due to late referral and high fatality rates.
Collapse
Affiliation(s)
- Orit Rak
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Center for Fast Diagnosis of Cancer, Sheba Medical Center, Ramat Gan, Israel
| | - Damien Urban
- Center for Fast Diagnosis of Cancer, Sheba Medical Center, Ramat Gan, Israel
| | - Saritte Perlman
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eldad Katorza
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
10
|
Cerezo MV, Soria-Reyes LM, Pajares B, Gómez-Millán J, Blanca MJ. Development and psychometric properties of the Stressors in Breast Cancer Scale. Front Psychol 2023; 14:1102169. [PMID: 37057161 PMCID: PMC10086352 DOI: 10.3389/fpsyg.2023.1102169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundA diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient’s daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer.AimsThe aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS).MethodA panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed.ResultsValidity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald’s omega and Cronbach’s alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life.DiscussionThe results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.
Collapse
Affiliation(s)
- M. Victoria Cerezo
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Málaga, Spain
- *Correspondence: M. Victoria Cerezo,
| | - Lorena M. Soria-Reyes
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Málaga, Spain
| | - Bella Pajares
- Instituto de Investigaciones Biomédicas de Málaga, University of Malaga, Málaga, Spain
| | - Jaime Gómez-Millán
- Instituto de Investigaciones Biomédicas de Málaga, University of Malaga, Málaga, Spain
| | - María J. Blanca
- Department of Psychobiology and Methodology of Behavioural Sciences, University of Malaga, Málaga, Spain
| |
Collapse
|
11
|
Ho TQH, Bissell MCS, Lee CI, Lee JM, Sprague BL, Tosteson ANA, Wernli KJ, Henderson LM, Kerlikowske K, Miglioretti DL. Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall. J Am Coll Radiol 2023; 20:299-310. [PMID: 36273501 PMCID: PMC10044471 DOI: 10.1016/j.jacr.2022.09.030] [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: 06/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. METHODS A population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. RESULTS The study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. CONCLUSIONS Prioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.
Collapse
Affiliation(s)
- Thao-Quyen H Ho
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam; Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Michael C S Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California
| | - Christoph I Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, Seattle, Washington; Deputy Editor, JACR
| | - Janie M Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Breast Imaging, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and Co-Leader, Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, Burlington, Vermont
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Associate Director for Population Sciences, Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Karen J Wernli
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; Cancer Epidemiology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, California; Women's Health Comprehensive Clinic, and Director, Advanced Postdoctoral Fellowship in Women's Health, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington; Biostatistics and Population Sciences and Health Disparities Program, University of California, Davis, Comprehensive Cancer Center, Davis, California.
| |
Collapse
|
12
|
Factors Associated with the Breast Cancer Diagnostic Interval across Five Canadian Provinces: A CanIMPACT Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15020404. [PMID: 36672357 PMCID: PMC9857089 DOI: 10.3390/cancers15020404] [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: 11/04/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The cancer diagnostic process can be protracted, and it is a time of great anxiety for patients. The objective of this study was to examine inter- and intra-provincial variation in diagnostic intervals and explore factors related to the variation. This was a multi-province retrospective cohort study using linked administrative health databases. All females with a diagnosis of histologically confirmed invasive breast cancer in British Columbia (2007-2010), Manitoba (2007-2011), Ontario (2007-2010), Nova Scotia (2007-2012), and Alberta (2004-2010) were included. The start of the diagnostic interval was determined using algorithms specific to whether the patient's cancer was detected through screening. We used multivariable quantile regression analyses to assess the association between demographic, clinical and healthcare utilization factors with the diagnostic interval outcome. We found significant inter- and intra-provincial variation in the breast cancer diagnostic interval and by screen-detection status; patients who presented symptomatically had longer intervals than screen-detected patients. Interprovincial diagnostic interval variation was 17 and 16 days for screen- and symptom-detected patients, respectively, at the median, and 14 and 41 days, respectively, at the 90th percentile. There was an association of longer diagnostic intervals with increasing comorbid disease in all provinces in non-screen-detected patients but not screen-detected. Longer intervals were observed across most provinces in screen-detected patients living in rural areas. Having a regular primary care provider was not associated with a shorter diagnostic interval. Our results highlight important findings regarding the length of the breast cancer diagnostic interval, its variation within and across provinces, and its association with comorbid disease and rurality. We conclude that diagnostic processes can be context specific, and more attention should be paid to developing tailored processes so that equitable access to a timely diagnosis can be achieved.
Collapse
|
13
|
Marcus D, Phelps DL, Savage A, Balog J, Kudo H, Dina R, Bodai Z, Rosini F, Ip J, Amgheib A, Abda J, Manoli E, McKenzie J, Yazbek J, Takats Z, Ghaem-Maghami S. Point-of-Care Diagnosis of Endometrial Cancer Using the Surgical Intelligent Knife (iKnife)-A Prospective Pilot Study of Diagnostic Accuracy. Cancers (Basel) 2022; 14:5892. [PMID: 36497372 PMCID: PMC9736036 DOI: 10.3390/cancers14235892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Delays in the diagnosis and treatment of endometrial cancer negatively impact patient survival. The aim of this study was to establish whether rapid evaporative ionisation mass spectrometry using the iKnife can accurately distinguish between normal and malignant endometrial biopsy tissue samples in real time, enabling point-of-care (POC) diagnoses. Methods: Pipelle biopsy samples were obtained from consecutive women needing biopsies for clinical reasons. A Waters G2-XS Xevo Q-Tof mass spectrometer was used in conjunction with a modified handheld diathermy (collectively called the 'iKnife'). Each tissue sample was processed with diathermy, and the resultant surgical aerosol containing ionic lipid species was then analysed, producing spectra. Principal component analyses and linear discriminant analyses were performed to determine variance in spectral signatures. Leave-one-patient-out cross-validation was used to test the diagnostic accuracy. Results: One hundred and fifty patients provided Pipelle biopsy samples (85 normal, 59 malignant, 4 hyperplasia and 2 insufficient), yielding 453 spectra. The iKnife differentiated between normal and malignant endometrial tissues on the basis of differential phospholipid spectra. Cross-validation revealed a diagnostic accuracy of 89% with sensitivity, specificity, positive predictive value and negative predictive value of 85%, 93%, 94% and 85%, respectively. Conclusions: This study is the first to use the iKnife to identify cancer in endometrial Pipelle biopsy samples. These results are highly encouraging and suggest that the iKnife could be used in the clinic to provide a POC diagnosis.
Collapse
Affiliation(s)
- Diana Marcus
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - David L. Phelps
- Department of Gynaecological Oncology, University Hospital Southampton, Coxford Road, Southampton SO16 5YA, UK
| | - Adele Savage
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Julia Balog
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Hiromi Kudo
- Centre for Pathology, Imperial College London, 4th Floor Clarence Wing, St Mary’s Hospital, London W2 1NY, UK
| | - Roberto Dina
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Zsolt Bodai
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Francesca Rosini
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Jacey Ip
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Ala Amgheib
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Julia Abda
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Eftychios Manoli
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - James McKenzie
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Joseph Yazbek
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| |
Collapse
|
14
|
Brual J, Abdelmutti N, Agarwal A, Arisz A, Benea A, Lord B, Massey C, Giuliani M, Stuart-McEwan T, Papadakos J. Developing an Education Pathway for Breast Cancer Patients Receiving Rapid Diagnostic Testing: Investigating Informational and Supportive Care Needs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:568-577. [PMID: 32737830 DOI: 10.1007/s13187-020-01847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several studies have examined the informational needs of patients undergoing the breast diagnostic process where needs are highest during testing and prior to receiving a diagnosis. To aid in the development of an education pathway, we identified patient information needs. A multi-method approach to identify areas of need and to understand when and how information should be provided to patients was undertaken. The methods included an environmental scan of consumer health information, ethnographic observation of the patient clinical experience, key informant interviews, and a needs assessment survey. The data collected from the environmental scan, ethnography, and interviews were used to develop the items in the survey. The survey was developed around four domains: (1) Medical Procedures and Tests, (2) Understanding the Rapid Diagnostic Process, (3) Breast Cancer and Other Breast Conditions, and (4) Support and Coping. A total of 101 patients completed the survey. Mean importance scores were significantly different between domains of information need (p < .0001) and significantly higher for the 'Medical Procedures and Tests' domain compared with all others. Multivariate analysis suggested that participants with higher levels of education (p = .02) and a preference to speak English at home (p = .009) tended to rate the importance of 'Support and Coping' information lower than other participants. Information about medical procedures and tests are most important for the patients undergoing rapid diagnostic testing in our sample. Education materials that are tailored to patient needs should be provided to patients during this stage of the cancer journey to help meet informational needs.
Collapse
Affiliation(s)
- Janette Brual
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nazek Abdelmutti
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Arisz
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Internal Medicine Residency Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, Canada
| | - Bridgette Lord
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, Canada
- Gattuso Rapid Diagnostic Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christine Massey
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Radiation Oncology Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Terri Stuart-McEwan
- Gattuso Rapid Diagnostic Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
15
|
Forster AS, Herbert A, Koo MM, Taylor RM, Gibson F, Whelan JS, Lyratzopoulos G, Fern LA. Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: cross-sectional analysis of the BRIGHTLIGHT cohort. Br J Cancer 2022; 126:1725-1734. [PMID: 35190694 PMCID: PMC9174449 DOI: 10.1038/s41416-022-01698-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The association of diagnostic intervals and outcomes is poorly understood in adolescents and young adults with cancer (AYA). We investigated associations between diagnostic intervals and health-related quality of life (HRQoL), anxiety and depression in a large AYA cohort. METHODS Participants aged 12-24 completed interviews post-diagnosis, providing data on diagnostic experiences and the patient-reported outcomes (PROs) HRQoL, anxiety and depression. Demographic and cancer information were obtained from clinical and national records. Six diagnostic intervals were considered. Relationships between intervals and PROs were examined using regression models. RESULTS Eight hundred and thirty participants completed interviews. In adjusted models, across 28 of 30 associations, longer intervals were associated with poorer PROs. Patient intervals (symptom onset to first seeing a GP) of ≥1 month were associated with greater depression (adjusted odds ratio (aOR):1.7, 95% Confidence Interval (CI):1.1-2.5) compared to <1 month. ≥3 pre-referral GP consultations were associated with greater anxiety (aOR:1.6, CI:1.1-2.3) compared to 1-2 consultations. Symptom onset to first oncology appointment intervals of ≥2 months was associated with impaired HRQoL (aOR:1.8, CI:1.2-2.5) compared to <2 months. CONCLUSIONS Prolonged diagnostic intervals in AYA are associated with an increased risk of impaired HRQoL, anxiety and depression. Identifying and delivering interventions for this high-risk group is a priority.
Collapse
Affiliation(s)
- Alice S Forster
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Annie Herbert
- Medical Research Council, Integrative Epidemiology Unit at University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, University of Bristol, Bristol, BS8 2BN, UK
| | - Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7YH, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Jeremy S Whelan
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK.
| |
Collapse
|
16
|
MacLeod C, Hudson J, Brogan M, Cotton S, Treweek S, MacLennan G, Watson AJM. ScotCap - A large observational cohort study. Colorectal Dis 2022; 24:411-421. [PMID: 34935278 PMCID: PMC9305214 DOI: 10.1111/codi.16029] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/28/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
AIM The aim of this work was to evaluate the performance of colon capsule endoscopy (CCE) in a lower gastrointestinal diagnostic care pathway. METHOD This large multicentre prospective clinical evaluation recruited symptomatic patients (patients requiring investigation of symptoms suggestive of colorectal pathology) and surveillance patients (patients due to undergo surveillance colonoscopy). Patients aged 18 years or over were invited to participate and undergo CCE by a secondary-care clinician if they met the referral criteria for a colonoscopy. The primary outcome was the test completion rate (visualization of the whole colon and rectum). We also measured the need for further tests after CCE. RESULTS A total of 733 patients were invited to take part in this evaluation, with 509 patients undergoing CCE. Of these, 316 were symptomatic patients and 193 were surveillance patients. Two hundred and twenty-eight of the 316 symptomatic patients (72%) and 137 of the 193 surveillance patients (71%) had a complete test. It was found that 118/316 (37%) of symptomatic patients required no further test following CCE, while 103/316 (33%) and 81/316 (26%) required a colonoscopy and flexible sigmoidoscopy, respectively. Fifty-three of the 193 surveillance patients (28%) required no further test following CCE, while 104/193 (54%) and 30/193 (16%) required a colonoscopy and flexible sigmoidoscopy, respectively. No patient in this evaluation was diagnosed with colorectal cancer. Two patients experienced serious adverse events - one capsule retention with obstruction and one hospital admission with dehydration due to the bowel preparation. CONCLUSION CCE is a safe, well-tolerated diagnostic test which can reduce the proportion of patients requiring colonoscopy, but the test completion rate needs to be improved to match that of lower gastrointestinal endoscopy.
Collapse
Affiliation(s)
| | - Jemma Hudson
- Health Services Research UnitUniversity of AberdeenAberdeenUK
| | | | - Seonaidh Cotton
- Health Services Research UnitThe Centre for Healthcare Randomised TrialsUniversity of AberdeenAberdeenUK
| | - Shaun Treweek
- Health Services Research UnitUniversity of AberdeenAberdeenUK
| | - Graeme MacLennan
- Health Services Research UnitThe Centre for Healthcare Randomised TrialsUniversity of AberdeenAberdeenUK
| | | |
Collapse
|
17
|
Wang GX, Hwong AR, Mercaldo SF, Lehman CD, Dontchos BN. Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy for Patients With Serious Mental Illness. J Am Coll Radiol 2022; 19:146-154. [PMID: 35033303 DOI: 10.1016/j.jacr.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to investigate disparities in time between breast biopsy recommendation and completion and the impact of a same-day biopsy (SDB) program for patients with serious mental illness (SMI), with a focus on more vulnerable individuals with public payer insurance. METHODS In August 2017, the authors' academic breast imaging center started routinely offering needle biopsies on the day of recommendation. Primary outcomes were the proportion of biopsies performed as SDBs and days from biopsy recommendation to completion over a 2.5-year pre- versus postintervention period, comparing all patients with SMI versus those without, and public payer-insured patients <65 years of age with SMI (SMI-PP) versus without SMI (non-SMI-PP). Multivariable proportional odds and logistic regression models were fit to assess association of SMI status, age, race/ethnicity, language, and insurance with days to biopsy and SDB within each period. RESULTS There were 2,026 biopsies preintervention and 2,361 biopsies postintervention. Preintervention, 8.43% of patients with SMI (7 of 83) underwent SDB compared with 15.59% of those without SMI (303 of 1,943) (P = .076), and 2.7% of the SMI-PP subgroup (1 of 37) underwent SDB compared with 15.88% of the non-SMI-PP subgroup (47 of 296) (P = .031). Adjusted for age, race/ethnicity, and language, disparities persisted in odds for undergoing SDB (adjusted odds ratio, 0.13; 95% confidence interval, 0.02-0.92; P = .04) and having longer days to biopsy (adjusted odds ratio, 2.35; 95% confidence interval, 1.26-4.37; P = .01) for the SMI-PP subgroup compared with the non-SMI-PP subgroup in the preintervention period. There was no evidence of these disparities postintervention for the SMI-PP subgroup. SDB proportion increased from 15.3% (310 of 2,026) to 36.09% (852 of 2,361) (P < .001) across all patients. CONCLUSIONS A same-day breast biopsy program mitigates disparities in time to biopsy for patients with SMI and helps improve breast cancer care equity for this vulnerable population.
Collapse
Affiliation(s)
- Gary X Wang
- Co-Chair, Diversity, Equity, and Inclusion Patient Experience Subcommittee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Alison R Hwong
- Department of Psychiatry, University of California, San Francisco, and University of California, San Francisco, Weill Institute for Neurosciences, San Francisco, California
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Chief, Breast Imaging Division, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
18
|
Ashmore AA, Gnanachandran C, Luqman I, Horrocks K. One-stop clinic for patients with suspected ovarian cancer: results from a retrospective outcome study of the referral pathway. BMC Womens Health 2021; 21:429. [PMID: 34961545 PMCID: PMC8712104 DOI: 10.1186/s12905-021-01540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background Women with abdominal pain and bloating frequently have their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service. Methods This was a retrospective observational outcome study. Data were collected from electronic documents of patients’ referrals, assessments, and clinical correspondences over 48 months. The study was conducted in a secondary gynaecology cancer centre with direct referrals from primary care. The pelvic mass clinic was set up to include a consultation and an ultrasound scan with support available for patients if required. All patients included were referred directly from primary care for suspected ovarian cancer with Ca-125 result over a period of 2 years. Results 286 were referred from primary care according to the NICE guidelines of ‘2-week wait for ovarian cancer’. Only 223 patients who had a Ca-125 result reported at the time of their referral were included in the analysis. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. 18 patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. The malignancy rate in women under 50 years of age was 22% (4/18) and 78% (14/18) in women aged 50 or above. Conclusion One-stop focused gynaecology ultrasound clinics where clinicians may assess patients and perform ultrasound scans for suspected cancer, may be better for managing this patient population due to improved efficiencies in waiting times, same day diagnosis and a reduction in waiting times to first appointment. Secondly, the majority of the patients with Ca-125 of more than 35 U/mL, who were referred through this pathway, did not have cancer. This review queries the future value of using Ca-125 as the basis for referrals from primary care for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for premenopausal women.
Collapse
|
19
|
Piai V, Jansen F, Dahlslätt K, Verdonck-de Leeuw IM, Prins J, Leemans R, Terhaard CHJ, Langendijk JA, Baatenburg de Jong RJ, Smit JH, Takes R, P C Kessels R. Prevalence of neurocognitive and perceived speech deficits in patients with head and neck cancer before treatment: Associations with demographic, behavioral, and disease-related factors. Head Neck 2021; 44:332-344. [PMID: 34799885 PMCID: PMC9299022 DOI: 10.1002/hed.26930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Neurocognition and speech, relevant domains in head and neck cancer (HNC), may be affected pretreatment. However, the prevalence of pretreatment deficits and their possible concurrent predictors are poorly understood. Methods Using an HNC prospective cohort (Netherlands Quality of Life and Biomedical Cohort Study, N ≥ 444) with a cross‐sectional design, we investigated the estimated prevalence of pretreatment deficits and their relationship with selected demographic, behavioral, and disease‐related factors. Results Using objective assessments, rates of moderate‐to‐severe neurocognitive deficit ranged between 4% and 8%. From patient‐reported outcomes, 6.5% of patients reported high levels of cognitive failures and 46.1% reported speech deficits. Patient‐reported speech functioning was worse in larynx compared to other subsites. Other nonspeech outcomes were unrelated to any variable. Patient‐reported neurocognitive and speech functioning were modestly correlated, especially in the larynx group. Conclusions These findings indicate that a subgroup of patients with HNC shows pretreatment deficits, possibly accentuated in the case of larynx tumors.
Collapse
Affiliation(s)
- Vitória Piai
- Department of Medical Psychology, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, Nijmegen, the Netherlands
| | - Femke Jansen
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Chris H J Terhaard
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands.,Department of Radiotherapy, University Medical Center, Utrecht, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otolaryngology - Head and Neck Surgery, Erasmus Cancer Institute, Erasmus MC, Rotterdam, the Netherlands
| | - Johannes H Smit
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robert Takes
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University, Nijmegen, the Netherlands.,Vincent van Gogh Institute for Psychiatry, Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Venray, the Netherlands
| | -
- Project Kubus, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
20
|
de Swart ME, Kouwenhoven MCM, Hellingman T, Kuiper BI, Gorter de Vries C, Leembruggen-Vellinga M, Maliepaard NK, Wouda EJ, Moraal B, Noske DP, Postma TJ, Sanchez Aliaga E, Uitdehaag BMJ, Vandertop WP, Zonderhuis BM, Kazemier G, de Witt Hamer PC, Schuur M. A multidisciplinary neuro-oncological triage panel reduces the time to referral and treatment for patients with a brain tumor. Neurooncol Pract 2021; 8:559-568. [PMID: 34589232 PMCID: PMC8475234 DOI: 10.1093/nop/npab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Regional collaboration and appropriate referral management are crucial in neuro-oncological care. Lack of electronic access to medical records across health care organizations impedes interhospital consultation and may lead to incomplete and delayed referrals. To improve referral management, we have established a multidisciplinary neuro-oncological triage panel (NOTP) with digital image exchange and determined the effects on lead times, costs, and time investment. Methods A prospective cohort study was conducted from February 2019 to March 2020. All newly diagnosed patients referred to Brain Tumor Center Amsterdam were analyzed according to referral pathway: (1) standard referral (SR), (2) NOTP. The primary outcome was lead time, defined as time-to-referral, time-to-treatment, and total time (median days [interquartile range]). Secondary outcomes were costs and time investment. Results In total, 225 patients were included, of whom 153 had SR and 72 NOTP referral. Patients discussed in the NOTP were referred more frequently for first neurosurgical consultation (44.7% vs 28.8%) or combined neurological and neurosurgical consultation (12.8% vs 2.5%, P = .002). Time-to-referral was reduced for NOTP referral compared to SR (1 [0.25-4] vs 6 [1.5-10] days, P < .001). Total time decreased from 27 [14-48] days for the standard group to 15 [12-38.25] days for the NOTP group (P = .040). Costs and time investment were comparable for both groups. Conclusion Implementation of digital referral to a multidisciplinary NOTP is feasible and leads to more swift patient-tailored referrals at comparable costs and time investment as SR. This quality improvement initiative has the potential to improve collaboration and coordination of multidisciplinary care in the field of neuro-oncology.
Collapse
Affiliation(s)
- Merijn E de Swart
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mathilde C M Kouwenhoven
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tessa Hellingman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Babette I Kuiper
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Niels K Maliepaard
- Department of Neurology, Dijklander Ziekenhuis, Purmerend, the Netherlands
| | - Ernest J Wouda
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David P Noske
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tjeerd J Postma
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Esther Sanchez Aliaga
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - William P Vandertop
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Barbara M Zonderhuis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Philip C de Witt Hamer
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maaike Schuur
- Department of Neurology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
21
|
Waiting Times for Prostate Cancer Diagnosis in a Nigerian Population. J Cancer Epidemiol 2021; 2021:5534683. [PMID: 34447434 PMCID: PMC8384527 DOI: 10.1155/2021/5534683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Prostate biopsy remains an important surgical procedure in the diagnostic pathway for prostate cancer, but access to prostate biopsy service is poorly studied in the Nigerian population. While there has been a well-documented delay in patient presentation with prostate cancer in Nigeria, little is however known about how long patients wait to have a histological diagnosis of prostate cancer and start treatment after presenting at Nigerian hospitals. Method This was a descriptive retrospective study to document the specific duration of the various timelines in getting a diagnosis of prostate cancer at the Lagos State University Teaching Hospital, Ikeja, Nigeria. Results There were 270 patients. The mean age was 69.50 ± 8.03 years (range 45-90). The mean PSA at presentation was 563.2 ± 1879.2 ng/ml (range 2.05-15400), and the median PSA was 49.3 ng/ml. The median waiting times were (i) 10 days from referral to presentation; (ii) 30 days from presentation to biopsy; (iii) 24 days from biopsy to review of histology; (iv) 1 day from histology review to discussion/planning of treatment. The median overall waiting time from referral to treatment was 103 days. The mean time from presentation to biopsy was significantly shorter for patients with PSA of ≥50 ng/ml compared to those with PSA < 50 ng/ml. p = 0.048. Overall, the median time from biopsy to histology was significantly shorter for patients whose specimens were processed in private laboratories (17 days) compared to those whose specimens were processed at the teaching hospital laboratory (30 days), p ≤ 0.001. Conclusion There is a significant delay within the health care system in getting a prostate cancer diagnosis in the Nigerian population studied. The major points of the identified delay were the waiting time from patient presentation to having a biopsy done and the histology report waiting time.
Collapse
|
22
|
Prevalence of depression, trait anxiety, and social support during the diagnostic phases of breast cancer. J Taibah Univ Med Sci 2021; 16:497-503. [PMID: 34408606 PMCID: PMC8348272 DOI: 10.1016/j.jtumed.2021.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/20/2020] [Accepted: 01/23/2021] [Indexed: 01/04/2023] Open
Abstract
Objective This study aims to determine the prevalence of depression, trait anxiety, and social support among women suspected of breast cancer (BC) and to investigate the association of these factors with the diagnosis of BC. Methods A cross-sectional study was conducted on 745 women who presented with breast symptoms in a university breast clinic in Malaysia. Participants were instructed to respond to self-report questionnaires on depression, trait anxiety, and social support while they were waiting for assessment of their suspected BC. The final diagnoses of these patients were traced one month after examining their medical records. Descriptive statistics were performed to examine the socio-demographic and clinical characteristics of all participants. A multiple regression analysis was carried out to determine the association of the abovementioned factors with the diagnosis of BC. Results The analysis showed that BC was diagnosed in 109 (14.6%), benign breast disease (BBD) in 550 (73.8%), and healthy breast (HB) in 86 (11.5%) women. The prevalence of depression was 53.2% in women with BC, 53.6% in women with BBD, and 60.5% in women with HB prior to diagnosis. The prevalence of trait anxiety was 33%. Mean scores for trait anxiety were 42.2 ± 9.0 and 41.8 ± 9.1 for the BC group and BBD group, respectively. The level of perceived social support was similar in all three groups. Conclusion We found no significant difference in depression, trait anxiety, and social support among women with newly diagnosed BC, BBD, and HB in women with breast symptoms while undergoing diagnostic evaluation. A longitudinal study is essential to establish the association between chronic mental stress and BC.
Collapse
|
23
|
Mazza D, Lin X, Walter FM, Young JM, Barnes DJ, Mitchell PL, Brijnath B, Martin A, O'Byrne KJ, Emery JD. Do ethnic patients report longer lung cancer intervals than Anglo-Australian patients?: Findings from a prospective, observational cohort study. Eur J Cancer Care (Engl) 2021; 30:e13492. [PMID: 34312918 DOI: 10.1111/ecc.13492] [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: 07/06/2020] [Revised: 05/14/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Lung cancer patients from ethnic minorities have poorer outcomes than their Caucasian counterparts. We compared lung cancer intervals between culturally and linguistically diverse (CALD) and Anglo-Australian patients to identify ethnic disparities. METHODS This was a prospective, observational cohort study comprising a patient survey and reviews of patients' hospital and general practice records. Across three states, 577 (407 Anglo-Australian and 170 CALD) patients were recruited and their hospital records reviewed. The survey was returned by 189 (135 Anglo-Australian and 54 CALD) patients, and a review was completed by general practitioners (GPs) of 99 (76 Anglo-Australian and 23 CALD) patients. Survival and Cox regression analyses were conducted. RESULTS CALD patients had longer hospital diagnostic interval [median 30 days, 95% confidence interval (CI) 26-34] than Anglo-Australian patients (median 17, 95% CI 14-20), p = 0.005, hazard ratio (HR) = 1.32 (95% CI 1.09-1.60). This difference persisted after relevant factors were taken into consideration, adjusted HR = 1.26 (95% CI 1.03-1.54, p = 0.022). CALD patients also reported longer prehospital intervals; however, these differences were not statistically significant. CONCLUSION Target interventions need to be developed to address ethnic disparity in hospital diagnostic interval.
Collapse
Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- Department of General Practice & Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jane M Young
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - David J Barnes
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul L Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Health &University of Melbourne, Melbourne, Victoria, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kenneth J O'Byrne
- Princess Alexandra Hospital & Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
The chain mediating role of social support and stigma in the relationship between mindfulness and psychological distress among Chinese lung cancer patients. Support Care Cancer 2021; 29:6761-6770. [PMID: 33990878 DOI: 10.1007/s00520-021-06278-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Psychological distress greatly impaired the psychological and physical well-being of lung cancer patients. Identification of protective and risk factors is a prerequisite of developing effective psychological treatment protocol. The study aims to determine the relationship of mindfulness and psychological distress and further clarify the mechanism of mindfulness against psychological distress through perceived stigma and social support among Chinese lung cancer patients. METHOD A cross-sectional survey study involving 441 valid Chinese lung cancer patients was conducted from September 2018 to August 2019. After all validated questionnaires that measured psychological distress, level of mindfulness, social support, and perceived stigma were returned by patients, we firstly performed correlation analysis to assess the associations between mindfulness, social support, perceived stigma, and psychological distress. Then structural equation modelling analysis was conducted to further clarify the mediating effects of perceived stigma and social support on the relationship between mindfulness and psychological distress. RESULTS According to our hypothesis and further modification, our revised model adequately fits to data. Mindfulness (β = - 0.107, p = 0.008) and social support (β = - 0.513, p < 0.001) had a direct effect on psychological distress. Meanwhile, mindfulness had a direct effect on perceived stigma (β = - 0.185, p < 0.001), and perceived stigma had a direct effect on social support (β = - 0.373, p < 0.001). Furthermore, mindfulness had also the indirect effect on psychological distress through the chain mediating role of stigma and social support among lung cancer patients. CONCLUSIONS Mindfulness has direct negative effect on psychological distress and has also indirectly negative psychological distress through impacting social support and perceived stigma.
Collapse
|
25
|
Marcus D, King A, Yazbek J, Hughes C, Ghaem-Maghami S. Anxiety and stress in women with suspected endometrial cancer: Survey and paired observational study. Psychooncology 2021; 30:1393-1400. [PMID: 33855785 DOI: 10.1002/pon.5697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the anxiety and stress levels of women with suspected endometrial cancer and factors affecting this. METHODS Prospective survey and paired observational study of consecutive women with suspected endometrial cancer in a rapid access gynaecology clinic. Structured questionnaire including a GAD-7 anxiety test and a modified stress thermometer were used. Patients ranked their perception of a cancer diagnosis on 0-5 Likert scale (0 = confident not cancer and 5 = cancer). Patients requiring an endometrial tissue biopsy were asked to rank their pain on a visual analogue scale (VAS), this was paired with the survey results. RESULTS 250 patients completed the study and 23 of which underwent an endometrial tissue biopsy. The median age was 50-59 years old and 59% of women spoke English as their first language. 32% of patients had significant levels of anxiety with GAD-7 score ≥10. The median stress score was three out of five on Likert scale. GAD-7 anxiety scores were higher in women who perceived that they received insufficient information prior to clinic (sufficient information 5 vs. insufficient information 9.5, P = 0.00036) or had a disability (disability 9 vs. no disability 5.5, P = 0.00374). The median VAS score from the biopsies was seven out of 10 (range 1-10). Patients with higher anxiety levels (GAD-7 scores) were more likely to believe they had cancer P <0.00001. CONCLUSIONS These findings confirm high levels of anxiety and stress in women with suspected endometrial cancer. Adequate pre-clinic information is essential, particularly for minority groups.
Collapse
Affiliation(s)
- Diana Marcus
- Department of Surgery and Cancer, Imperial College London, London, UK.,Gynaecological Cancer Services, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alex King
- Gynaecological Cancer Services, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Yazbek
- Gynaecological Cancer Services, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Cathy Hughes
- Gynaecological Cancer Services, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, UK.,Gynaecological Cancer Services, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
26
|
Vasilakis C, Forte P. Setting up a rapid diagnostic clinic for patients with vague symptoms of cancer: a mixed method process evaluation study. BMC Health Serv Res 2021; 21:357. [PMID: 33865373 PMCID: PMC8052708 DOI: 10.1186/s12913-021-06360-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background The study sought to evaluate the impact of a Rapid Diagnostic Clinic (RDC) service designed to improve general practitioner (GP) referral processes for patients who do not meet existing referral criteria yet present with vague - but potentially concerning - symptoms of cancer. We sought to investigate how well the RDC has performed in the views of local GPs and patients, and through analysis of its activity and performance in the first two years of operation. Methods The study setting was a single, hospital-based RDC clinic in a University Health Board in South Wales. We used a mixed-method process evaluation study, including routinely collected activity and diagnosis data. All GPs were invited to participate in an online survey (34/165 responded), and a smaller group (n = 8) were interviewed individually. Two focus groups with patients and their carers (n = 7) provided in-depth personal accounts of their experiences. Results The focus groups revealed high rates of patient satisfaction with the RDC. GPs were also overwhelmingly positive about the value of the RDC to their practice. There were 574 clinic attendances between July 2017 and March 2019; the mean age of attendees was 68, 57% were female, and approximately 30% had three or more vague symptoms. Of those attending, we estimated between 42 to 71 (7.3 and 12.3%) received preliminary cancer diagnoses. Median time from GP referral to RDC appointment was 12 days; from GP referral to cancer diagnosis was 34 days. Overall, 73% of RDC patients received either a new diagnosis (suspected cancer 23.2%, non-cancer 35.9%) or an onward referral to secondary care for further investigation with no new diagnosis (13.9%), and 27% were referred to primary care with no new diagnosis. Conclusions The RDC appears to enable a good patient experience in cancer diagnosis. Patients are seen in timely fashion, and the service is highly regarded by them, their carers, and referring GPs. Although too early to draw conclusions about long-term patient outcomes, there are strong indications to suggest that this model of service provision can set higher standards for a strongly patient-centred service. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06360-0.
Collapse
Affiliation(s)
- Christos Vasilakis
- Centre for Healthcare Innovation and Improvement (CHI2), School of Management, University of Bath, Bath, UK.
| | - Paul Forte
- Centre for Healthcare Innovation and Improvement (CHI2), School of Management, University of Bath, Bath, UK
| |
Collapse
|
27
|
Donegan D, Gowan T, Gruber R, Cottingham A, Flanagan M, Erickson D, Imperiale TF. The Need for Patient-centered Education Among Patients Newly Diagnosed With a Pituitary Tumor. J Endocr Soc 2021; 5:bvab061. [PMID: 34056501 PMCID: PMC8143658 DOI: 10.1210/jendso/bvab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Brain tumors, including pituitary adenomas (PA), cause anxiety and distress, with a high unmet need for information correlating with increased anxiety. Condition-specific education may alleviate anxiety. We explored patients’ experience around the diagnosis of a PA and piloted a patient education intervention to address peridiagnostic anxiety in adults diagnosed with PA. Methods Anxiety, patient satisfaction, patient knowledge, and need for information were measured prior to, immediately after, and 1 month following the appointment in this multimethods study. A phone interview to explore patient diagnostic and intervention experiences was analyzed using qualitative methods. Results A total of 17 patients participated in the study; 15 completed the interview. The baseline need for information was high. Disease-specific anxiety decreased, and patient knowledge and satisfaction increased significantly after the initial visit. Interview analysis identified 3 main themes: (1) the importance of communication; (2) the need for information; and (3) the impact of the diagnosis on patient experience. Conclusions For patients with newly diagnosed PA, the diagnostic experience was associated with high levels of anxiety. Patients expressed a need for information. Information delivery reduced anxiety and had a positive impact on patient satisfaction. Practice Implications The study findings suggest a need for a streamlined diagnostic process with readily accessible information.
Collapse
Affiliation(s)
- Diane Donegan
- Division of Endocrinology Diabetes and Metabolism, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Mayo Clinic, Division of Endocrinology, Diabetes and Metabolism, Rochester, MN 55905, USA
| | - Tayler Gowan
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Rachel Gruber
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Ann Cottingham
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Mindy Flanagan
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Dana Erickson
- Mayo Clinic, Division of Endocrinology, Diabetes and Metabolism, Rochester, MN 55905, USA
| | - Thomas F Imperiale
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| |
Collapse
|
28
|
Pitt SC, Saucke MC, Wendt EM, Schneider DF, Orne J, Macdonald CL, Connor NP, Sippel RS. Patients' Reaction to Diagnosis with Thyroid Cancer or an Indeterminate Thyroid Nodule. Thyroid 2021; 31:580-588. [PMID: 33012267 PMCID: PMC8195875 DOI: 10.1089/thy.2020.0233] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Little is known about the experiences and concerns of patients recently diagnosed with thyroid cancer or an indeterminate thyroid nodule. This study sought to explore patients' reactions to diagnosis with papillary thyroid cancer (PTC) or indeterminate cytology on fine needle aspiration. Methods: We conducted semistructured interviews with 85 patients with recently diagnosed PTC or an indeterminate thyroid nodule before undergoing thyroidectomy. We included adults with nodules ≥1 cm and Bethesda III, IV, V, and VI cytology. The analysis utilized grounded theory methodology to create a conceptual model of patient reactions. Results: After diagnosis, participants experienced shock, anxiety, fear, and a strong need to "get it out" because "it's cancer!" This response was frequently followed by a sense of urgency to "get it done," which made waiting for surgery difficult. These reactions occurred regardless of whether participants had confirmed PTC or indeterminate cytology. Participants described the wait between diagnosis and surgery as difficult, because the cancer or nodule was "still sitting there" and "could be spreading." Participants often viewed surgery and getting the cancer out as a "fix" that would resolve their fears and worries, returning them to normalcy. The need to "get it out" also led some participants to minimize the risk of complications or adverse outcomes. Education about the slow-growing nature of PTC reassured some, but not all patients. Conclusions: After diagnosis with PTC or an indeterminate thyroid nodule, many patients have strong emotional reactions and an impulse to "get it out" elicited by the word "cancer." This reaction can persist even after receiving education about the excellent prognosis. Understanding patients' response to diagnosis is critical, because their emotional reactions likely pose a barrier to implementing guidelines recommending less extensive management for PTC.
Collapse
Affiliation(s)
- Susan C. Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Address correspondence to: Susan C. Pitt, MD, MPHS, Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC K4/738, Madison, WI 53792-7375, USA
| | - Megan C. Saucke
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - David F. Schneider
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jason Orne
- Department of Sociology, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Nadine P. Connor
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
29
|
Guldager R, Hansen PV, Ziebell M. Past, present and future, the experience of time during examination for malignant brain tumor: a qualitative observational study. Acta Neurochir (Wien) 2021; 163:959-967. [PMID: 33389116 DOI: 10.1007/s00701-020-04693-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/21/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary malignant brain tumor is a severe disease with a poor prognosis causing reduced life expectancy and possible alteration in the perception of time. The aim of this study was to gain deeper insight into the perception of time from the perspective of patients with brain cancer as they pass through the Danish Integrated Brain Cancer Pathway at a university hospital in Denmark. METHODS Data were generated by shadowing six patients and relatives during their visit to and hospitalisation in a neurosurgical department. RESULTS Through one constructed case, three perspectives of time were identified. The patient's perception of time during his illness, the healthcare system's perception of time and, finally, an ethical time perspective. The analysis showed a discrepancy between patients' and healthcare professionals' perception of time. Furthermore, the results revealed an ethical time dimension. CONCLUSIONS The findings contribute to a better understanding of the perception of time among seriously ill patients and may further healthcare professionals' awareness of how to support patients in achieving a more meaningful use of their remaining lifetime.
Collapse
|
30
|
Clinical and FDG-PET/CT Suspicion of Malignant Disease: Is Biopsy Confirmation Still Necessary? Diagnostics (Basel) 2021; 11:diagnostics11030559. [PMID: 33804753 PMCID: PMC8003997 DOI: 10.3390/diagnostics11030559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Biopsy of 18F-fluoro-2-deoxy-D-glucose (FDG)-avid lesions suspected for malignancy remains an invasive procedure associated with a variety of risks. It is still unclear if the positive predictive value (PPV) of positron emission tomography (PET)/computed tomography (CT) is sufficiently high to avoid tissue sampling. Therefore, the purpose of this study was to determine the PPV of 18F-FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease. METHODS This single-center retrospective study included 83 patients who had undergone FDG-PET/CT within 60 days before CT- or ultrasonography-guided tissue sampling and whose request form for CT- or US-guided tissue sampling requested mutation analyses. The latter implies a high clinical suspicion of active malignant disease. The nature of each biopsied lesion was determined based on the results of the pathological analysis and/or clinical and imaging follow-up of at least 12 months. RESULTS In total, eighty-eight FDG-avid lesions were biopsied. The PPV of FDG-PET/CT for malignancy was 98.9% (95% CI: 93.8-99.8%). For patients with an oncological history, the PPV was 98.7% (95% CI: 92.9-99.8%), and for patients with no oncological history, the PPV was 100% (95% CI: 74.1-100.0%). There was no significant difference between the PPV of the group with and without an oncological history (p = 0.71). In two cases, an unsuspected malignancy was diagnosed. CONCLUSION Although the PPV of FDG-PET/CT for malignancy in patients with a clinical suspicion of active malignant disease is high, biopsy remains recommended to avoid inappropriate patient management due the non-negligible chance of dealing with FDG-avid benign disease or unexpected malignancies.
Collapse
|
31
|
Webber C, Whitehead M, Eisen A, Holloway CMB, Groome PA. Factors associated with waiting time to breast cancer diagnosis among symptomatic breast cancer patients: a population-based study from Ontario, Canada. Breast Cancer Res Treat 2021; 187:225-235. [PMID: 33486544 DOI: 10.1007/s10549-020-06051-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE A prolonged time from first presentation to cancer diagnosis has been associated with worse disease-related outcomes. This study evaluated potential determinants of a long diagnostic interval among symptomatic breast cancer patients. METHODS This was a population-based, cross-sectional study of symptomatic breast cancer patients diagnosed in Ontario, Canada from 2007 to 2015 using administrative health data. The diagnostic interval was defined as the time from the earliest breast cancer-related healthcare encounter before diagnosis to the diagnosis date. Potential determinants of the diagnostic interval included patient, disease and usual healthcare utilization characteristics. We used multivariable quantile regression to evaluate their relationship with the diagnostic interval. We also examined differences in diagnostic interval by the frequency of encounters within the interval. RESULTS Among 45,967 symptomatic breast cancer patients, the median diagnostic interval was 41 days (interquartile range 20-92). Longer diagnostic intervals were observed in younger patients, patients with higher burden of comorbid disease, recent immigrants to Canada, and patients with higher healthcare utilization prior to their diagnostic interval. Shorter intervals were observed in patients residing in long-term care facilities, patients with late stage disease, and patients who initially presented in an emergency department. Longer diagnostic intervals were characterized by an increased number of physician visits and breast procedures. CONCLUSIONS The identification of groups at risk of longer diagnostic intervals provides direction for future research aimed at better understanding and improving breast cancer diagnostic pathways. Ensuring that all women receive a timely breast cancer diagnosis could improve breast cancer outcomes.
Collapse
Affiliation(s)
- Colleen Webber
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | | | - Andrea Eisen
- Cancer Care Ontario, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Claire M B Holloway
- Cancer Care Ontario, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada. .,ICES Queen's, Kingston, ON, Canada. .,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| |
Collapse
|
32
|
Hartley LJ, Evans S, Davies MA, Kelly S, Gregory JJ. A Daily Diagnostic Multidisciplinary Meeting to Reduce Time to Definitive Diagnosis in the Context of Primary Bone and Soft Tissue Sarcoma. J Multidiscip Healthc 2021; 14:115-123. [PMID: 33488087 PMCID: PMC7816218 DOI: 10.2147/jmdh.s266014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives Cancer services are under increasing pressure to deliver waiting time targets. Our service has seen referral numbers increase to over 3000 per annum, with more than 80% coming from secondary care. In order to deliver a responsive service, the department has introduced a daily diagnostic multidisciplinary meeting (DMDT) with the aim being stratification of resources by directing rapid access to clinics and diagnostics to those felt to be at greatest risk of malignancy at the start of the pathway. It also aimed to improve communication with patients and referrers, consistency in decision making and deliver improved diagnostic turn-around times in a sustainable manner. An evaluation was undertaken to assess whether the introduction of the DMDT has improved the pathway, the primary endpoint being a reduction in time to definitive diagnosis (TTDD). Secondary endpoints included measurements of efficiency and whether there has been a reduction in variation in practice. Methods Retrospective access to a prospective database over a 1-month period before (2015) and after (2018) the intervention. Results The introduction of the DMDT has led to a reduction in TTDD (7 days). The service also has an added benefit in reducing average total patient miles travelled over the course of diagnosis by 22.68 miles. Conclusion The introduction of a diagnostic MDT at the start of the pathway does lead to an improvement in service efficiency and a reduction in TTDD.
Collapse
Affiliation(s)
- Laura J Hartley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Mark A Davies
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Suzanne Kelly
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | |
Collapse
|
33
|
Warps AK, de Neree tot Babberich MPM, Dekker E, Wouters MWJM, Dekker JWT, Tollenaar RAEM, Tanis PJ. Interhospital referral of colorectal cancer patients: a Dutch population-based study. Int J Colorectal Dis 2021; 36:1443-1453. [PMID: 33743051 PMCID: PMC8195929 DOI: 10.1007/s00384-021-03881-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. METHODS Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. RESULTS In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. CONCLUSION A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.
Collapse
Affiliation(s)
- A. K. Warps
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands
| | - M. P. M. de Neree tot Babberich
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - E. Dekker
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - M. W. J. M. Wouters
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands ,grid.430814.aDepartment of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, Netherlands
| | - J. W. T. Dekker
- grid.415868.60000 0004 0624 5690Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625AD Delft, Netherlands
| | - R. A. E. M. Tollenaar
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands
| | - P. J. Tanis
- grid.7177.60000000084992262Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | | |
Collapse
|
34
|
Miles A, Evans REC, Taylor SA. Predictors of distress among patients undergoing staging investigations for suspected colorectal and lung cancer. PSYCHOL HEALTH MED 2020; 26:887-898. [PMID: 33232621 DOI: 10.1080/13548506.2020.1852477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
People undergoing investigations for suspected cancer have to undergo a number of investigations before they know their full diagnosis and treatment plan. We examined predictors of distress among patients undergoing staging investigations for suspected colorectal or lung cancer. Patients were prospectively recruited to two multi-centre trials comparing WB-MRI with standard scans. Patients completed a questionnaire, administered at trial recruitment, measuring demographic and psychological variables (n = 129, 66 colorectal, 63 lung; median age 66.4, range: 31-89). Predictors of distress were analysed using logistic regression. Forty percent of patients reported high distress (a score of 4 or higher on the GHQ-12). Higher deprivation and greater intolerance of uncertainty (IU) predicted high distress in both unadjusted (low deprivation: OR 0.352, 95% CIs 0.144 to 0.860, p = 0.022; IU: OR 1.972, 95% CIs: 1.357 to 2.865, p < 0.001) and adjusted analyses (low deprivation: OR 0.243, 95% CIs 0.083 to 0.714, p = 0.010; IU: OR 2.231, 95% CIs 1.429 to 3.485, p < 0.001). Age, gender, presence of comorbid illness, cancer type, probable knowledge of cancer diagnosis, and a final diagnosis of cancer did not predict high distress. Future research should examine how to reduce distress in patients undergoing investigations for cancer, particularly among those who find uncertainty difficult to manage.
Collapse
Affiliation(s)
- Anne Miles
- Psychological Sciences, Birkbeck University of London, London, UK
| | - Ruth E C Evans
- Psychological Sciences, Birkbeck University of London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
35
|
Pujadas Botey A, Robson PJ, Hardwicke-Brown AM, Rodehutskors DM, O’Neill BM, Stewart DA. From symptom to cancer diagnosis: Perspectives of patients and family members in Alberta, Canada. PLoS One 2020; 15:e0239374. [PMID: 32970713 PMCID: PMC7514000 DOI: 10.1371/journal.pone.0239374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Significant intervals from the identification of suspicious symptoms to a definitive diagnosis of cancer are common. Streamlining pathways to diagnosis may increase survival, quality of life post-treatment, and patient experience. Discussions of pathways to diagnosis from the perspective of patients and family members are crucial to advancing cancer diagnosis. AIM To examine the perspectives of a group of patients with cancer and family members in Alberta, Canada, on factors associated with timelines to diagnosis and overall experience. METHODS A qualitative approach was used. In-depth, semi-structured interviews with patients with cancer (n = 18) and patient relatives (n = 5) were conducted and subjected to a thematic analysis. FINDINGS Participants struggled emotionally in the diagnostic period. Relevant to their experience were: potentially avoidable delays, concerns about health status, and misunderstood investigation process. Participants emphasized the importance of their active involvement in the care process, and had unmet supportive care needs. CONCLUSION Psychosocial supports available to potential cancer patients and their families are minimal, and may be important for improved experiences before diagnosis. Access to other patients' lived experiences with the diagnostic process and with cancer, and an enhanced supportive role of family doctors might help improve experiences for patients and families in the interval before receiving a diagnosis of cancer, which may have a significant impact on wellbeing.
Collapse
Affiliation(s)
- Anna Pujadas Botey
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Paula J. Robson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | | | | | - Barbara M. O’Neill
- Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Douglas A. Stewart
- Cancer Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Oncology and Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
36
|
Webber C, Whitehead M, Eisen A, Holloway CMB, Groome PA. Breast cancer diagnosis and treatment wait times in specialized diagnostic units compared with usual care: a population-based study. Curr Oncol 2020; 27:e377-e385. [PMID: 32905256 PMCID: PMC7467790 DOI: 10.3747/co.27.6115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Breast assessment sites (bass) were developed to provide expedited and coordinated care for patients being evaluated for breast cancer (bca) in Ontario. We compared the diagnostic and treatment intervals for patients diagnosed at a bas and for those diagnosed through a usual care (uc) route. Methods This population-based, cross-sectional study of patients diagnosed with bca in Ontario during 2007-2015 used linked administrative data. "Diagnostic interval" was the time from the earliest cancer-related health care encounter before diagnosis to diagnosis; "treatment interval" was the time from diagnosis to treatment. Diagnosis at a bas was determined from the patient's biopsy and mammography institutions. Interval lengths for the bas and uc groups were compared using multivariable quantile regression, stratified by detection method. Results The diagnostic interval was shorter for patients who were bas-diagnosed than for those who were uc-diagnosed, with adjusted median differences of -4.0 days [95% confidence interval (ci): -3.2 days to -4.9 days] for symptomatic patients and -5.4 days (95% ci: -4.7 days to -6.1 days) for screen-detected patients. That association was modified by stage at diagnosis, with larger differences in patients with early-stage cancers. In contrast, the treatment interval was longer in patients who were bas-diagnosed than in those who were uc-diagnosed, with adjusted median differences of 4.2 days (95% ci: 3.8 days to 4.7 days) for symptomatic patients and 4.2 days (95% ci: 3.7 days to 4.8 days) for screen-detected patients. Conclusions Diagnosis of bca through a bas was associated with a shorter diagnostic interval, but a longer treatment interval. Although efficiencies in the diagnostic interval might help to reduce distress experienced by patients, the longer treatment intervals for patients who are bas-diagnosed remain a cause for concern.
Collapse
Affiliation(s)
- C Webber
- The Ottawa Hospital Research Institute and Bruyère Research Institute, Ottawa
| | | | - A Eisen
- Ontario Health (Cancer Care Ontario), Toronto
| | - C M B Holloway
- Ontario Health (Cancer Care Ontario), Toronto
- Department of Surgery, University of Toronto, Toronto
| | - P A Groome
- ices Queen's, Kingston
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Department of Public Health Sciences, Queen's University, Kingston, ON
| |
Collapse
|
37
|
Mullin MLL, Tran A, Golemiec B, Stone CJL, Noseworthy C, O'Callaghan N, Parker CM, Digby GC. Improving Timeliness of Lung Cancer Diagnosis and Staging Investigations Through Implementation of Standardized Triage Pathways. JCO Oncol Pract 2020; 16:e1202-e1208. [PMID: 32639927 DOI: 10.1200/jop.19.00807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Timely care for patients with lung cancer (LC) is associated with improved clinical outcomes. In Southeastern Ontario, Canada, we identified delays in the diagnostic process for patients undergoing evaluation for suspected LC through a rapid assessment clinic. We developed improvement initiatives with an aim of reducing the time from referral to diagnosis. METHODS A Standardized Triage Process (STP) was implemented for patients referred with suspected LC, including routine interdisciplinary triage, standardized pathways with preordered staging tests, and a new Small Nodule Clinic. We retrospectively analyzed all patients referred pre-STP (January to April 2018) and prospectively for improvement (May 2018 to March 2019). Process measures included STP compliance and time to completion of staging investigations (positron emission tomography [PET] and computed tomography/magnetic resonance imaging of brain). Data are reported as means; significance was determined by special-cause variation using Statistical Process Control charts; unpaired t tests were compared between groups. RESULTS We reviewed 833 referrals (207 baseline and 626 post-STP). STP compliance improved monthly to 99.4%. Post-STP, time from referral to PET decreased (from 38.5 to 15.7 days), time from referral to brain imaging decreased (from 33.4 to 13.1 days), and time from referral to diagnosis decreased (from 38.0 to 22.7 days), all demonstrating special-cause variation. Patients completing preordered staging tests experienced significantly faster care than those without preordered tests, including time to PET (23.0 v 35.9 days), computed tomography/magnetic resonance imaging of brain (16.2 v 29.9 days), and diagnosis (39.9 v 28.1 days), all P < .001. CONCLUSION An STP significantly improved timeliness of diagnosis and staging for patients with suspected LC undergoing evaluation in a rapid assessment clinic.
Collapse
Affiliation(s)
| | - Audrey Tran
- Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
38
|
Mesurolle B, Sun S, Zhang M. Utilization of breast MRI and breast MRI-guided biopsy in clinical practice: results of a survey in Québec and France. Insights Imaging 2020; 11:81. [PMID: 32613348 PMCID: PMC7329973 DOI: 10.1186/s13244-020-00886-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/29/2020] [Indexed: 11/12/2022] Open
Abstract
Background To investigate the practice regarding breast MRI exams and breast MRI-guided biopsies in two countries with different health care systems, France and Québec. A 12-item questionnaire was distributed online among radiologists from France and Québec, attempting to determine: demographic characteristics and breast MRI diagnostic and MRI-guided practices (indications, workload, availability, and waiting time assessment). Results One hundred and seventy radiologists (France, 132 respondents (28.5%); Quebec, 38 respondents (35.2%)) participated in the survey, most of them based in non-academic centers. Thirty-eight percent of Quebec and 2.3% of French radiologists did not perform breast MRI in their daily practice. Nearly 50% of French and Quebec respondents interpreted 1–10 breast MRI exams per week. Decision-making factors of preoperative MRI were similar in both countries (pathology, age, and breast density), with a heavier emphasis placed on the surgeon’s opinion in Quebec (47.8% versus 21.8% (p = 0.009)). Quebec demonstrated a higher waiting time than France (1–2 weeks in 40% versus less than 1 week in 40%). MRI-guided breast biopsies (less than 5 MRI-guided biopsies per week) were being performed by a minority of the respondents (36% in France and 43% in Québec). Conclusion Most of radiologists performing breast MRIs work in non-academic institutions in both countries. Waiting time is higher in Quebec, but most of preoperative breast MRIs are performed within 3 weeks in both countries. The surgeon plays an important role in recommending preoperative MRI in Quebec. MRI-guided breast biopsies are not widely available in both countries.
Collapse
Affiliation(s)
- Benoît Mesurolle
- Centre République, ELSAN, 99 avenue de la République, BP 304, 63023, Clermont-Ferrand Cedex 2, France.
| | - Simon Sun
- Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, QC, H4A 3 J1, Canada
| | - Michelle Zhang
- Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 1001 Decarie Boulevard, Montreal, QC, H4A 3 J1, Canada
| |
Collapse
|
39
|
Faruqui N, Joshi R, Martiniuk A, Lowe J, Arora R, Anis H, Kalra M, Bakhshi S, Mishra A, Santa A, Sinha S, Siddaiahgari S, Seth R, Bernays S. A health care labyrinth: perspectives of caregivers on the journey to accessing timely cancer diagnosis and treatment for children in India. BMC Public Health 2019; 19:1613. [PMID: 31791308 PMCID: PMC6889559 DOI: 10.1186/s12889-019-7911-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cure rates for children with cancer in India lag behind that of high-income countries. Various disease, treatment and socio-economic related factors contribute to this gap including barriers in timely access of diagnostic and therapeutic care. This study investigated barriers to accessing care from symptom onset to beginning of treatment, from perspectives of caregivers of children with cancer in India. Methods Semi-structured in-depth interviews were conducted with caregivers of children (< 18 years) diagnosed with cancer in seven tertiary care hospitals across New Delhi and Hyderabad. Purposive sampling to saturation was used to ensure adequate representation of the child’s gender, age, cancer type, geographical location and socioeconomic status. Interviews were audio recorded after obtaining informed consent. Thematic content analysis was conducted and organised using NVivo 11. Results Thirty-nine caregivers were interviewed, where three key themes emerged from the narratives: time intervals to definitive diagnosis and treatment, the importance of social supportive care and the overall accumulative impacts of the journey. There were two phases encapsulating the experiences of the family: referral pathways taken to reach the hospital and after reaching the hospital. Most caregivers, especially those from distant geographical areas had variable and inconsistent referral pathways partly due to poor availability of specialist doctors and diagnostic facilities outside major cities, influence from family or friends, and long travel times. Upon reaching the hospital, families mostly from public hospitals faced challenges navigating the hospital facilities, finding accommodation, and comprehending the diagnosis and treatment pathway. Throughout both phases, financial constraint was a recurring issue amongst low-income families. The caregiver’s knowledge and awareness of the disease and health system, religious and social factors were also common barriers. Conclusion This qualitative study highlights and explores some of the barriers to childhood cancer care in India. Our findings show that referral pathways are intrinsically linked to the treatment experience and there should be better recognition of the financial and emotional challenges faced by the family that occur prior to definitive diagnosis and treatment. This information would help inform various stakeholders and contribute to improved interventions addressing these barriers.
Collapse
Affiliation(s)
- Neha Faruqui
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. .,George Institute for Global Health, Sydney, NSW, Australia.
| | - Rohina Joshi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alexandra Martiniuk
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,George Institute for Global Health, Sydney, NSW, Australia.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ramandeep Arora
- Cankids…Kidscan, New Delhi, India.,Max Super Speciality Hospital, New Delhi, India
| | | | - Manas Kalra
- Indraprastha Apollo Hospital, New Delhi, India
| | | | | | - Ayyagari Santa
- Basavatarakam Indo American Cancer Hospital, Hyderabad, India
| | | | | | | | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
40
|
Taylor SA, Mallett S, Miles A, Morris S, Quinn L, Clarke CS, Beare S, Bridgewater J, Goh V, Janes S, Koh DM, Morton A, Navani N, Oliver A, Padhani A, Punwani S, Rockall A, Halligan S. Whole-body MRI compared with standard pathways for staging metastatic disease in lung and colorectal cancer: the Streamline diagnostic accuracy studies. Health Technol Assess 2019; 23:1-270. [PMID: 31855148 PMCID: PMC6936168 DOI: 10.3310/hta23660] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whole-body magnetic resonance imaging is advocated as an alternative to standard pathways for staging cancer. OBJECTIVES The objectives were to compare diagnostic accuracy, efficiency, patient acceptability, observer variability and cost-effectiveness of whole-body magnetic resonance imaging and standard pathways in staging newly diagnosed non-small-cell lung cancer (Streamline L) and colorectal cancer (Streamline C). DESIGN The design was a prospective multicentre cohort study. SETTING The setting was 16 NHS hospitals. PARTICIPANTS Consecutive patients aged ≥ 18 years with histologically proven or suspected colorectal (Streamline C) or non-small-cell lung cancer (Streamline L). INTERVENTIONS Whole-body magnetic resonance imaging. Standard staging investigations (e.g. computed tomography and positron emission tomography-computed tomography). REFERENCE STANDARD Consensus panel decision using 12-month follow-up data. MAIN OUTCOME MEASURES The primary outcome was per-patient sensitivity difference between whole-body magnetic resonance imaging and standard staging pathways for metastasis. Secondary outcomes included differences in specificity, the nature of the first major treatment decision, time and number of tests to complete staging, patient experience and cost-effectiveness. RESULTS Streamline C - 299 participants were included. Per-patient sensitivity for metastatic disease was 67% (95% confidence interval 56% to 78%) and 63% (95% confidence interval 51% to 74%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -5% to 13%; p = 0.51). Specificity was 95% (95% confidence interval 92% to 97%) and 93% (95% confidence interval 90% to 96%) respectively, a difference of 2% (95% confidence interval -2% to 6%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 96% and 95% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 8 days (95% confidence interval 6 to 9 days) and 13 days (95% confidence interval 11 to 15 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 5 days (95% confidence interval 3 to 7 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £216 (95% confidence interval £211 to £221) versus £285 (95% confidence interval £260 to £310). Streamline L - 187 participants were included. Per-patient sensitivity for metastatic disease was 50% (95% confidence interval 37% to 63%) and 54% (95% confidence interval 41% to 67%) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference in sensitivity of 4% (95% confidence interval -7% to 15%; p = 0.73). Specificity was 93% (95% confidence interval 88% to 96%) and 95% (95% confidence interval 91% to 98%), respectively, a difference of 2% (95% confidence interval -2% to 7%). Pathway treatment decisions agreed with the multidisciplinary team treatment decision in 98% and 99% of cases, respectively, a difference of 1% (95% confidence interval -2% to 4%). Time for staging was 13 days (95% confidence interval 12 to 14 days) and 19 days (95% confidence interval 17 to 21 days) for whole-body magnetic resonance imaging and standard pathways, respectively, a difference of 6 days (95% confidence interval 4 to 8 days). The whole-body magnetic resonance imaging pathway was cheaper than the standard staging pathway: £317 (95% confidence interval £273 to £361) versus £620 (95% confidence interval £574 to £666). Participants generally found whole-body magnetic resonance imaging more burdensome than standard imaging but most participants preferred the whole-body magnetic resonance imaging staging pathway if it reduced time to staging and/or number of tests. LIMITATIONS Whole-body magnetic resonance imaging was interpreted by practitioners blinded to other clinical data, which may not fully reflect how it is used in clinical practice. CONCLUSIONS In colorectal and non-small-cell lung cancer, the whole-body magnetic resonance imaging staging pathway has similar accuracy to standard staging pathways, is generally preferred by patients, improves staging efficiency and has lower staging costs. Future work should address the utility of whole-body magnetic resonance imaging for treatment response assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN43958015 and ISRCTN50436483. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 66. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Susan Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Caroline S Clarke
- Research Department of Primary Care and Population Health, and Priment Clinical Trials Unit, University College London, London, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Sutton, UK
| | - Alison Morton
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Alfred Oliver
- c/o Centre for Medical Imaging, University College London, London, UK
| | - Anwar Padhani
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Andrea Rockall
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
41
|
Gulak MA, Bornais C, Shin S, Murphy L, Smylie J, Pantarotto JR, Fung-Kee-Fung M, Maziak DE. Implementing a one-day testing model improves timeliness of workup for patients with lung cancer. ACTA ACUST UNITED AC 2019; 26:e651-e657. [PMID: 31708658 DOI: 10.3747/co.26.4927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patients with lung cancer often experience stressful delays throughout the diagnostic phase of care. To address that situation, our multidisciplinary team created a "Navigation Day," during which patients partake in a single-day visit that comprises nurse-led teaching, social work, smoking cessation counselling, symptom control, and dedicated test slots for integrated positron-emission tomography and computed tomography (pet/ct), pulmonary function tests (pfts), and magnetic resonance imaging (mri) of the brain. We evaluated the effects of that program on wait times and patient satisfaction. Methods Patients with a suspicion of lung cancer on chest ct imaging referred during 3 time periods were reviewed: 1 year before launch of the Navigation Day, 1 year post-launch, and 2 years post-launch. Patients were further stratified according to concordance of their test date with a Navigation Day date. Mean wait times for pet/ct, pfts, and mri brain were calculated for each group. Patient satisfaction was measured using a standardized provincial survey. The Student t-test and analysis of variance were used to assess for significance. Results After implementation, mean wait times in the first year improved to 9.2 days from 15.5 days for pet/ct (p < 0.0001), to 9.6 days from 15.7 days for pfts (p < 0.0001), and to 10.2 days from 16.0 days for mri brain (p < 0.0001). Patients who used a dedicated test slot experienced the shortest wait times, at 5.8 days for pet/ct, 5.8 days for pfts, and 6.3 days for mri brain (p < 0.0001). Those improvements were sustained at 2 years post-launch. Patient satisfaction in the categories of assistance, emotional support, and clarity remained high post-launch. Conclusions Navigation Day significantly improved the timeliness of diagnostic testing services in patients with suspected lung cancer.
Collapse
Affiliation(s)
- M A Gulak
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - C Bornais
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - S Shin
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - L Murphy
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - J Smylie
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
| | - J R Pantarotto
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON.,Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON
| | - M Fung-Kee-Fung
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON.,Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, ON
| | - D E Maziak
- Faculty of Medicine, University of Ottawa, Ottawa, ON.,The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON.,Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, ON
| |
Collapse
|
42
|
Jeyakumar HS, Wright A. Improving regional lung cancer optimal care pathway compliance through a rapid-access respiratory clinic. Intern Med J 2019; 50:805-810. [PMID: 31403752 DOI: 10.1111/imj.14465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related morbidity and mortality in Australia and delays in diagnosis and management increase the potential for disease progression. Incidence and mortality from lung cancer in our region, Gippsland, are higher than the national average, yet there is no known standard referral pathway for diagnosis in the region. AIM To identify the current standard of care for lung cancer diagnosis and the impact a rapid access clinic, led by a respiratory physician, has on optimal care pathway (OCP) compliance. METHODS A retrospective audit of patients with lung cancer managed through our regional hospital between January and December 2018 (Standard Care group), and a prospective audit of a new rapid access, respiratory-physician led, lung lesion assessment clinic over the same period, were conducted. The primary outcomes were compliance with the OCP target for time from initial computed tomography scan identification of a lung lesion to tissue diagnosis and treatment commencement (target 42 days) when malignancy was confirmed. RESULTS There were 25 cases audited in the Standard Care group and 21 cases seen through the Rapid Access Clinic. The Standard Care group met the target for treatment commencement in 33.3% of cases whereas the Rapid Access Clinic group achieved this in 77%. CONCLUSIONS Our project highlights the disjointed and delayed lung cancer care in our region and the improvements a dedicated rapid access clinic can have on diagnosis and treatment commencement timeframes.
Collapse
Affiliation(s)
- Harshan S Jeyakumar
- General Medicine Department, Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Alistair Wright
- General Medicine Department, Latrobe Regional Hospital, Traralgon, Victoria, Australia.,School of Rural Health, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
43
|
Taylor SA, Mallett S, Beare S, Bhatnagar G, Blunt D, Boavida P, Bridgewater J, Clarke CS, Duggan M, Ellis S, Glynne-Jones R, Goh V, Groves AM, Hameeduddin A, Janes SM, Johnston EW, Koh DM, Miles A, Morris S, Morton A, Navani N, O'Donohue J, Oliver A, Padhani AR, Pardoe H, Patel U, Punwani S, Quinn L, Rafiee H, Reczko K, Rockall AG, Shahabuddin K, Sidhu HS, Teague J, Thaha MA, Train M, van Ree K, Wijeyekoon S, Halligan S. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial. Lancet Gastroenterol Hepatol 2019; 4:529-537. [PMID: 31080095 PMCID: PMC6547166 DOI: 10.1016/s2468-1253(19)30056-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer. METHODS The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete. FINDINGS Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (-5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92-97]) and standard pathways (93% [90-96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6-9]) than for the standard pathway (13 days [11-15]); a 5-day (3-7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211-221) for WB-MRI and £285 (260-310) for standard pathways. INTERPRETATION WB-MRI staging pathways have similar accuracy to standard pathways and reduce the number of tests needed, staging time, and cost. FUNDING UK National Institute for Health Research.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.
| | - Sue Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Dominic Blunt
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Boavida
- Department of Radiology, Homerton Hospital, London, UK
| | | | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Marian Duggan
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Steve Ellis
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Robert Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Alison Morton
- Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | - John O'Donohue
- Department of Gastroenterology, Lewisham Hospital, London, UK
| | - Alfred Oliver
- Centre for Medical Imaging, University College London, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Helen Pardoe
- Department of Surgery, Homerton Hospital, London, UK
| | - Uday Patel
- Intestinal Imaging Centre, St Mark's Hospital, LNWUH NHS Trust, Harrow, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hameed Rafiee
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Krystyna Reczko
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Andrea G Rockall
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Cancer and Surgery, Imperial College London, London, UK
| | | | - Harbir S Sidhu
- Centre for Medical Imaging, University College London, London, UK
| | - Jonathan Teague
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Mohamed A Thaha
- Blizard Institute, National Bowel Research Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Surgery, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Matthew Train
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Katherine van Ree
- Imaging Department, Imperial College Healthcare NHS Trust, London, UK
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
44
|
Taylor SA, Mallett S, Ball S, Beare S, Bhatnagar G, Bhowmik A, Boavida P, Bridgewater J, Clarke CS, Duggan M, Ellis S, Glynne-Jones R, Goh V, Groves AM, Hameeduddin A, Janes SM, Johnston EW, Koh DM, Lock S, Miles A, Morris S, Morton A, Navani N, Oliver A, O'Shaughnessy T, Padhani AR, Prezzi D, Punwani S, Quinn L, Rafiee H, Reczko K, Rockall AG, Russell P, Sidhu HS, Strickland N, Tarver K, Teague J, Halligan S. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed non-small-cell lung cancer: the prospective Streamline L trial. THE LANCET. RESPIRATORY MEDICINE 2019; 7:523-532. [PMID: 31080129 PMCID: PMC6529610 DOI: 10.1016/s2213-2600(19)30090-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC. METHODS The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete. FINDINGS Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%) had metastasis at baseline. Pathway sensitivity was 50% (95% CI 37-63) for WB-MRI and 54% (41-67) for standard pathways, a difference of 4% (-7 to 15, p=0·73). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (93% [88-96]) and standard pathways (95% [91-98], p=0·45). Agreement with the multidisciplinary team's final treatment decision was 98% for WB-MRI and 99% for the standard pathway. Time to complete staging was shorter for WB-MRI (13 days [12-14]) than for the standard pathway (19 days [17-21]); a 6-day (4-8) difference. The number of tests required was similar WB-MRI (one [1-1]) and standard pathways (one [1-2]). Mean per-patient costs were £317 (273-361) for WBI-MRI and £620 (574-666) for standard pathways. INTERPRETATION WB-MRI staging pathways have similar accuracy to standard pathways, and reduce the staging time and costs. FUNDING UK National Institute for Health Research.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.
| | - Sue Mallett
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Simon Ball
- Barking, Havering, and Redbridge NHS Trust, Romford, UK
| | - Sandy Beare
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Angshu Bhowmik
- Department of Respiratory Medicine, Homerton University Hospital, London, UK
| | - Peter Boavida
- Department of Radiology, Homerton University Hospital, London, UK
| | | | - Caroline S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Marian Duggan
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Steve Ellis
- Department of Radiology, Barts Health NHS Trust, London, UK
| | - Robert Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Sara Lock
- Department of Respiratory Medicine, Whittington Hospital, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Alison Morton
- Centre for Medical Imaging, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospitals, UK
| | - Alfred Oliver
- Centre for Medical Imaging, University College London, London, UK
| | | | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - David Prezzi
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Centre for Medical Imaging, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hameed Rafiee
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Krystyna Reczko
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Andrea G Rockall
- Department of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Cancer and Surgery, Imperial College London, London, UK
| | - Peter Russell
- Department of Respiratory Medicine, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Harbir S Sidhu
- Centre for Medical Imaging, University College London, London, UK
| | - Nicola Strickland
- Department of Imaging, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Jonathan Teague
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
45
|
Barker SJ, Anderson E, Mullen R. Magnetic resonance imaging for invasive lobular carcinoma: is it worth it? Gland Surg 2019; 8:237-241. [PMID: 31328102 DOI: 10.21037/gs.2018.10.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Invasive lobular cancer (ILC) of the breast can provide diagnostic and therapeutic challenges due to its often mammographically occult and multifocal nature. UK guidelines recommend magnetic resonance imaging (MRI) when considering breast conserving surgery (BCS) in women with a diagnosis of ILC. A small number of studies have shown that due to its low specificity, MRI can lead to additional invasive investigations whilst rarely identifying additional tumour foci that affect management. We carried out a retrospective study of patients diagnosed with ILC to assess the impact of MRI on management and to evaluate if breast density on mammography could indicate likelihood of additional disease being found on MRI. Methods A retrospective analysis of the electronic patient records for all cases of ILC diagnosed between January 2013 and December 2016 was carried out. Results A total of 110 cases of ILC were identified of which 69 women were considered for BCS and 58 (84.1%) women underwent MRI. A further abnormality was seen in 22 (37.9%) patients of whom 13 (59.1%) had a further core biopsy with 4 cases being positive for malignancy. Overall MRI changed the surgical plan from BCS to mastectomy in 7 (10.1%). Breast density did not predict the presence of additional findings on MRI. Conclusions MRI assessment of ILC rarely affects the management when BCS is considered. Having radiologically denser breasts did not correlate with increased reoperation rate. Larger prospective studies may provide further guidance on MRI specificity and breast density.
Collapse
Affiliation(s)
| | - Eileen Anderson
- The Highland Breast Centre, Raigmore Hospital, Inverness, Scotland, UK
| | - Russell Mullen
- The Highland Breast Centre, Raigmore Hospital, Inverness, Scotland, UK
| |
Collapse
|
46
|
Dontchos BN, Narayan AK, Seidler M, Mercaldo SF, Miles RC, Ebert E, Lehman CD. Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy. J Am Coll Radiol 2019; 16:1554-1560. [PMID: 31152690 DOI: 10.1016/j.jacr.2019.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Disparities in breast cancer diagnosis are established. In usual practice, biopsies are performed days or weeks after recommendation. Our aim was to measure the impact of a same-day biopsy program on disparities in time from biopsy recommendation to performance. METHODS After Institutional Review Board approval, we identified all diagnostic examinations leading to biopsy pre- (September 2016 to March 2017) and post- (September 2017 to March 2018) implementation of our same-day biopsy program. We compared demographic characteristics (age, race, language, and insurance) and biopsy information (days from biopsy recommendation to biopsy, and proportion of same-day biopsies in all biopsies) in pre- versus postimplementation groups. Multivariable linear and logistic models in pre- and postimplementation groups assessed if days from biopsy recommendation to biopsy and having a same-day biopsy were associated with patient subgroups. RESULTS In all, 663 and 482 patients underwent biopsy during pre- and postimplementation periods, respectively. Patient subgroups were similar between periods. For all patients, the same-day biopsy program decreased median time from diagnostic examination to biopsy from 8 (interquartile range: 4-13) to 0 (interquartile range: 0-4) days (P < .001). During the pre-implementation period, nonwhite patients and having Medicare insurance were associated with longer days to biopsy (nonwhite Adjusted Coefficient: 2.31, 95% confidence interval [CI]: 0.58-4.03; insurance Adjusted Coefficient: 2.47, 95% CI: 0.58-4.37; P < .05), after adjustment. During the postimplementation period, the previously seen disparities did not persist (nonwhite Adjusted Coefficient: -0.416, 95% CI: -2.16-1.33; insurance Adjusted Coefficient: 0.812, 95% CI: -1.18-2.80; P > .05). CONCLUSION There was no evidence of racial/ethnic or insurance disparities in time from biopsy recommendation to performance after implementation of a same-day biopsy program.
Collapse
Affiliation(s)
| | | | | | | | - Randy C Miles
- Massachusetts General Hospital, Boston, Massachusetts
| | - Emily Ebert
- Massachusetts General Hospital, Boston, Massachusetts
| | | |
Collapse
|
47
|
Friedemann Smith C, Tompson A, Holtman GA, Bankhead C, Gleeson F, Lasserson D, Nicholson BD. General practitioner referrals to one-stop clinics for symptoms that could be indicative of cancer: a systematic review of use and clinical outcomes. Fam Pract 2019; 36:255-261. [PMID: 30052877 PMCID: PMC6531891 DOI: 10.1093/fampra/cmy069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One-stop clinics provide comprehensive diagnostic testing in one outpatient appointment. They could benefit patients with conditions, such as cancer, whose outcomes are improved by early diagnosis, and bring efficiency savings for health systems. OBJECTIVE To assess the use and outcomes of one-stop clinics for symptoms where cancer is a possible diagnosis. DESIGN AND SETTING Systematic review of studies reporting use and outcomes of one-stop clinics in primary care patients. METHOD We searched MEDLINE, Embase, and Cochrane Library for studies assessing one-stop clinics for adults referred after presenting to primary care with any symptom that could be indicative of cancer. Study selection was carried out independently in duplicate with disagreements resolved through discussion. RESULTS Twenty-nine studies were identified, most were conducted in the UK and observational in design. Few included a comparison arm. A pooled comparison of the cancer conversion rate of one-stop and multi-stop clinics was only possible for breast symptoms, and we found no significant difference. One-stop clinics were associated with significant reductions in the interval from referral to testing (15 versus 75 days) and more patients diagnosed on the same day (79% versus 25%) compared to multi-stop pathways. The majority of patients and GPs found one-stop clinics to be acceptable. CONCLUSION This review found one-stop clinics were associated with reduced time from referral to testing, increased same day diagnoses, and were acceptable to patients and GPs. Our conclusions are limited by high levels of heterogeneity, scarcity of comparator groups, and the overwhelmingly observational nature of included studies.
Collapse
Affiliation(s)
| | - Alice Tompson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gea A Holtman
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fergus Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel Lasserson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
48
|
Groome PA, Webber C, Whitehead M, Moineddin R, Grunfeld E, Eisen A, Gilbert J, Holloway C, Irish JC, Langley H. Determining the Cancer Diagnostic Interval Using Administrative Health Care Data in a Breast Cancer Cohort. JCO Clin Cancer Inform 2019; 3:1-10. [PMID: 31112418 PMCID: PMC6874005 DOI: 10.1200/cci.18.00131] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Population-based administrative health care data could be a valuable resource with which to study the cancer diagnostic interval. The objective of the current study was to determine the first encounter in the diagnostic interval and compute that interval in a cohort of patients with breast cancer using an empirical approach. METHODS This is a retrospective cohort study of patients with breast cancer diagnosed in Ontario, Canada, between 2007 and 2015. We used cancer registry, physician claims, hospital discharge, and emergency department visit data to identify and categorize cancer-related encounters that were more common in the three months before diagnosis. We used statistical control charts to define lookback periods for each encounter category. We identified the earliest cancer-related encounter that marked the start of the diagnostic interval. The end of the interval was the cancer diagnosis date. RESULTS The final cohort included 69,717 patients with breast cancer. We identified an initial encounter in 97.8% of patients. Median diagnostic interval was 36 days (interquartile range [IQR], 19 to 71 days). Median interval decreased with increasing stage at diagnosis and varied across initial encounter categories, from 9 days (IQR, 1 to 35 days) for encounters with other cancer as the diagnosis to 231 days (IQR 77 to 311 days) for encounters with cyst aspiration or drainage as the procedure. CONCLUSION Diagnostic interval research can inform early detection guidelines and assess the success of diagnostic assessment programs. Use of administrative data for this purpose is a powerful tool for improving diagnostic processes at the population level.
Collapse
Affiliation(s)
- Patti A. Groome
- Queen’s University, Kingston, Ontario, Canada
- ICES Queen’s, Kingston, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Eva Grunfeld
- University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrea Eisen
- University of Toronto, Toronto, Ontario, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Gilbert
- University of Toronto, Toronto, Ontario, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Hugh Langley
- Queen’s University, Kingston, Ontario, Canada
- South East Regional Cancer Program, Kingston, Ontario, Canada
| |
Collapse
|
49
|
du Rouchet E, Dendoncker C. Accès au premier traitement : apport d’un centre de prise en charge rapide. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pour une patiente porteuse d’un cancer du sein, l’accès au premier traitement comprend plusieurs étapes : établissement d’un diagnostic anatomopathologique, annonce et établissement du plan personnalisé de soins, bilans préthérapeutiques, accès au plateau technique. La durée du délai global de ce parcours intervient dans le pronostic de la maladie pour les stades précoces. De plus, il convient de gérer toutes les incertitudes, diagnostiques puis pronostiques, qui vont inévitablement bouleverser l’équilibre psychologique de la patiente. À la lumière des écrits, des recommandations et de l’expérience de plus de 20 ans d’un centre multidisciplinaire, les auteurs proposent une organisation de centre expert de prise en charge de la personne avec suspicion de cancer du sein, dans son intégralité somatique et psychique.
Collapse
|
50
|
Grassi L, Nanni MG, Rodin G, Li M, Caruso R. The use of antidepressants in oncology: a review and practical tips for oncologists. Ann Oncol 2019; 29:101-111. [PMID: 29272358 DOI: 10.1093/annonc/mdx526] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The use of psychotropic drugs, namely those with an antidepressant profile (ADs), is a mandatory part of an integrated treatment of psychiatric disorders among cancer patients. We aimed to synthetize the most relevant data emerging from published studies to provide tips about the use of ADs in oncology. Design A search was made of the major databases over the last 30 years (Embase/Medline, PsycLIT, PsycINFO, the Cochrane Library), including narrative reviews, systematic reviews and meta-analyses summarizing the results from observational studies and randomized clinical trials assessing effectiveness, safety profile, interactions, contraindications and use of ADs in oncology with regard to both psychiatric (depressive spectrum, stress-related, anxiety disorders) and cancer-related symptoms (e.g. pain, hot flashes and fatigue). Results The weight of evidence supports the efficacy of ADs for more severe major depression in individuals with cancer and as an adjuvant treatment in cancer-related symptoms, although the methodological limitations of reported randomized controlled trials do not permit definite conclusions. Data also indicate that there should be caution in the use of ADs in cancer patients in terms of their safety profile and potential clinically significant interactions with other prescribed medications. Practical recommendations that have been made for the use of ADs in cancer patients, in the context of a multimodal approach to depression treatment, have been summarized here. Conclusions ADs are a relatively safe and effective treatment for more severe major depression in cancer patients. However, more research is urgently needed regarding the efficacy of ADs in different cancer types and cancer settings, their interactions with anticancer agents and their additive benefit when integrated with psychosocial interventions.
Collapse
Affiliation(s)
- L Grassi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - M G Nanni
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - G Rodin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Supportive Care, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - M Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Supportive Care, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - R Caruso
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| |
Collapse
|