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Beaton DR, Sharp L, Lu L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter MD. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database. Gut 2024:gutjnl-2024-332071. [PMID: 38697772 DOI: 10.1136/gutjnl-2024-332071] [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] [Received: 01/29/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. DESIGN A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett's oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. CONCLUSIONS Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.
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Affiliation(s)
- David Robert Beaton
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian D Nicholson
- University of Oxford Department of Primary Care Health Sciences, Oxford, UK
| | | | | | | | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf Department of Interdisciplinary Endoscopy, Hamburg, Germany
| | - Matthew D Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Sugumar K, Hue JJ, Gupta S, Elshami M, Rothermel LD, Ocuin LM, Ammori JB, Hardacre JM, Winter JM. Trends in and Prognostic Significance of Time to Treatment in Pancreatic Cancer: A Population-Based Study. Ann Surg Oncol 2023; 30:8610-8620. [PMID: 37624518 DOI: 10.1245/s10434-023-14221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The association of time to treatment (TTT) with survival remains unclear in pancreatic adenocarcinoma (PDAC). In this study, we evaluate the recent trends in TTT, causes for delay, and its effect on survival. METHODS We included patients with PDAC of all stages from the National Cancer Database (2004-2020) who underwent either surgery or chemotherapy/radiotherapy (CT/RT). TTT was defined as the duration between tissue diagnosis and first treatment. Linear regression (β) was used to study the temporal trends in time delay. RESULTS A total of 239,638 patients were included. The median TTT was 25 days. Using multivariable analysis, we found that increasing age (OR 1.48), female gender (OR 1.04), Black race (OR 1.3), lower educational status (OR 1.2), Medicaid, Medicare insurance, and uninsured (OR 1.2, 1.5, and 1.2, respectively), treatment at academic centers (OR 1.3), higher Charlson-Deyo comorbidity index (OR 1.2), and CT/RT (OR 1.5) were associated with increased TTT. There was a steady rise in median TTT from 21 to 28 days between 2004 and 2020 (β = 0.3), suggestive of a worsening trend. Concurrently, there was an increasing trend in utilization of neoadjuvant CT/RT between 2004 and 2020 in early-stage PDAC. On Cox regression, TTT delay was associated with poor overall survival in stage I-IV patients (HR 1.1, 1.1, 1.09, and 1.53, respectively). CONCLUSIONS Delayed treatment approaching 2 months was observed in 10% of the population. The rising temporal trend in TTT may be attributed to the increasing shift toward neoadjuvant CT/RT in early-stage PDAC and/or the increasing use of tissue biopsy prior to surgery.
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Affiliation(s)
- Kavin Sugumar
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA.
| | - Jonathan J Hue
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Shreya Gupta
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Mohamedraed Elshami
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Lee M Ocuin
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Jordan M Winter
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
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Zhang Y, Gan C, Xu J, Pang L, Li W, Cheng H. Psychological distress as a risk factor for the efficacy of chemotherapy in advanced gastric cancer patients. Support Care Cancer 2023; 31:669. [PMID: 37922088 DOI: 10.1007/s00520-023-08143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/24/2023] [Indexed: 11/05/2023]
Abstract
AIM To assess the relationship between psychological distress and quality of life (QoL), cancer-related fatigue (CRF), and chemotherapy efficacy in advanced gastric cancer patients. METHODS Advanced gastric cancer patients (39 with psychological distress and 35 without psychological distress) completed the Distress Thermometer (DT), QoL, and CRF test before receiving chemotherapy and assessed the efficacy after completing 2 courses of chemotherapy. RESULTS Psychological distress was a significant factor in the efficacy of chemotherapy in advanced gastric cancer patients (χ2 = 6.324; p = 0.042). Compared to advanced gastric cancer patients with no psychological distress, advanced gastric cancer patients with psychological distress had a poorer QoL (50.41 ± 6.17 vs. 60.01 ± 7.94, t = - 5.882, p < 0.01) and more pronounced CRF (5.75 ± 1.16 vs. 3.22 ± 0.75, t = 11.231, p < 0.01) while receiving chemotherapy. FACT-G (p = 0.0035, r = - 0.4568), as well as PFS (p < 0.0001, r = 0.6599), correlated significantly with efficacy for patients in the psychological distress group. The FACT-G (p = 0.0134, r = - 0.4139) of patients in the no psychological distress group correlated significantly with efficacy. CONCLUSION Psychological distress has a negative impact on QoL, CRF, and efficacy and may be a potential risk for the efficacy of palliative chemotherapy in advanced gastric cancer patients.
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Affiliation(s)
- Yongkang Zhang
- Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230088, China
| | - Chen Gan
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Jian Xu
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Lulian Pang
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Wen Li
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Huaidong Cheng
- Department of Oncology, Anhui Medical University, Hefei, 230601, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China.
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Chen YW, Kim T, Specht MC, Gadd MA, Smith BL, Chang DC, Oseni TO. Time to surgery: A health equity metric in breast cancer patients. Am J Surg 2023; 226:432-437. [PMID: 37291014 DOI: 10.1016/j.amjsurg.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND We evaluated whether time to surgery by race can be a health equity metric of surgical access. METHODS An observational analysis was performed using the National Cancer Database from 2010 to 2019. Inclusion criteria were women with stage I-III breast cancer. We excluded women with multiple cancers and whose diagnosis was made at a different hospital. The primary outcome variable was surgery within 90 days of diagnosis. RESULTS A total of 886,840 patients were analyzed, with 76.8% White and 11.7% Black patients. 11.9% of patients experienced delayed surgery, which was significantly more common in Black patients than White patients. On adjusted analysis, Black patients were still significantly less likely to receive surgery within 90 days when compared to White patients (OR 0.61, 95% CI 0.58-0.63). CONCLUSION The delay in surgery experienced by Black patients highlights the contribution of system factors in cancer inequity and should be a focus for targeted interventions.
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Affiliation(s)
- Ya-Wen Chen
- 55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 165 Cambridge St, Suite 403, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Tommy Kim
- 165 Cambridge St, Suite 403, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 55 N Lake Ave, UMass Chan Medical School, Worcester, MA, USA.
| | - Michelle C Specht
- 55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 55 Fruit St, Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michele A Gadd
- 55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 55 Fruit St, Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Barbara L Smith
- 55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 55 Fruit St, Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - David C Chang
- 55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 165 Cambridge St, Suite 403, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Tawakalitu O Oseni
- 55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 55 Fruit St, Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Lee YJ, Jeong JH, Jung J, Yoo TK, Lee SB, Kim J, Ko BS, Kim HJ, Lee JW, Son BH, Chung IY. Waiting Time for Breast Cancer Treatment in Korea: A Nationwide Cohort Study. J Breast Cancer 2023; 26:334-343. [PMID: 37565927 PMCID: PMC10475710 DOI: 10.4048/jbc.2023.26.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/14/2023] [Accepted: 05/14/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE This study aimed to analyze the waiting time for initial treatment after breast cancer diagnosis and determine the factors influencing treatment delay in South Korea. METHODS This nationwide retrospective cohort study was conducted using the Health Insurance Review and Assessment data. The participants were classified according to the regions where their biopsy and treatment were performed (Seoul-Seoul, Metro-Metro, Other-Other, Metro-Seoul, Other-Seoul). Waiting time was analyzed according to regional subgroup, year of diagnosis, and type of treatment. Multivariable logistic regression models were constructed to identify the factors associated with treatment delay (after 30 days of diagnosis). RESULTS A total of 133,514 participants newly diagnosed between January 2010 and December 2017 were included in the study. The median waiting time for initial treatment in the total population increased from 8 days, in 2010, to 14 days, in 2017. In the Seoul-Seoul group, the waiting time increased from 10 days, in 2010, to 16 days, in 2017. Although the median waiting time was approximately 10 days in the Metro-Metro and Other-Other groups, it was 27 and 24 days, in the Metro-Seoul and Other-Seoul group, respectively, in 2017. The proportion of delayed upfront surgery by more than 30 days was higher in the Metro-Seoul (odds ratio [OR], 8.088; 95% confidence interval [CI], 7.357-8.893; p < 0.001) and Other-Seoul (OR, 6.210; 95% CI, 5.717-6.750; p < 0.001) groups than in the Metro-Metro (OR, 1.468; 95% CI, 1.352-1.594; p < 0.001) and Other-Other (reference) groups. Previous medical history and treatment at tertiary hospital were observed as factors related to delayed surgery. CONCLUSION Waiting times for breast cancer surgery have increased across all regions of Korea, with those traveling to Seoul experiencing particularly long wait times.
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Affiliation(s)
- Young-Jin Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Yang JH, Huynh V, Leonard LD, Kovar A, Bronsert M, Ludwigson A, Wolverton D, Hampanda K, Christian N, Kim SP, Ahrendt G, Mathes DW, Tevis SE. Are Diagnostic Delays Associated with Distress in Breast Cancer Patients? Breast Care (Basel) 2023; 18:240-248. [PMID: 37900555 PMCID: PMC10601706 DOI: 10.1159/000529586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Receiving a new breast cancer diagnosis can cause anxiety and distress, which can lead to psychologic morbidity, decreased treatment adherence, and worse clinical outcomes. Understanding sources of distress is crucial in providing comprehensive care. This study aims to evaluate the relationship between delays in breast cancer diagnosis and patient-reported distress. Secondary outcomes include assessing patient characteristics associated with delay. Methods Newly diagnosed breast cancer patients who completed a distress screening tool at their initial evaluation at an academic institution between 2014 and 2019 were retrospectively evaluated. The tool captured distress levels in the emotional, social, health, and practical domains with scores of "high distress" defined by current clinical practice guidelines. Delay from mammogram to biopsy, whether diagnostic or screening mammogram, was defined as >30 days. Result 745 newly diagnosed breast cancer patients met inclusion criteria. Median time from abnormal mammogram to core biopsy was 12 days, and 11% of patients experienced a delay in diagnosis. The non-delayed group had higher emotional (p = 0.04) and health (p = 0.03) distress than the delayed group. No statistically significant differences in social distress were found between groups. Additionally, patients with higher practical distress had longer time interval between mammogram and surgical intervention compared to those with lower practical distress. Older age, diagnoses of invasive lobular carcinoma or ductal carcinoma in situ, and clinical anatomic stages 0-I were associated with diagnostic delay. Conclusion Patients with higher emotional or health-related distress were more likely to have timely diagnoses of breast cancer, suggesting that patients with higher distress may seek healthcare interventions more promptly. Improved understanding of sources of distress will permit early intervention regarding the devastating impact of breast cancer diagnosis.
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Affiliation(s)
- Jerry H. Yang
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura D. Leonard
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra Kovar
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | | | - Dulcy Wolverton
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Christian
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Simon P. Kim
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David W. Mathes
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah E. Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Sheni R, Qin J, Viswanathan S, Castellucci E, Kalnicki S, Mehta V. Predictive Factors for Cancer Treatment Delay in a Racially Diverse and Socioeconomically Disadvantaged Urban Population. JCO Oncol Pract 2023:OP2200779. [DOI: 10.1200/op.22.00779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
PURPOSE Incremental delays in time to treatment initiation (TTI) have been shown to cause a proportional, increased independent risk of disease-specific mortality for breast cancer, colorectal cancer (CRC), head and neck cancer (HNC), non–small-cell lung cancer (NSCLC), and pancreatic cancer. Studies suggest that delays are associated with racial and socioeconomic disparities. We evaluated associations between patient factors and TTI to identify those associated with delay. MATERIALS AND METHODS This is a retrospective cohort study at an urban community-based academic center of patients diagnosed with or referred for curative-intent treatment of breast cancer, CRC, HNC, NSCLC, and pancreatic cancer from January 2019 to December 2021. Variables of interest included Charlson Comorbidity Index (CCI) score, insurance type, language preference, and inpatient admission 30 days before diagnosis. Factors associated with TTI delay, defined as TTI ≥ 30 days, were assessed using multivariable logistic regression. RESULTS Among 2,543 patients (69% female), the mean age was 63.4 years and the median TTI was 25 days (IQR, 6-44). Within multivariable models, patients treated as outpatient and not admitted 30 days before diagnosis experienced statistically significant greater delay for CRC (odds ratio [OR], 2.82; 95% CI, 1.71 to 4.66) and NSCLC (OR, 2.11; 95% CI, 1.31 to 3.39). Higher CCI score was associated with delay for HNC (OR, 2.63; 95% CI, 1.04 to 6.66) and NSCLC (OR, 1.75; 95% CI, 1.14 to 2.71). For breast cancer, uninsured and Spanish-speaking patients (OR, 1.79; 95% CI, 1.21 to 2.67) experienced increased TTI. CONCLUSION Care coordination/compliance (eg, inpatient 30 days before diagnosis), clinical (eg, medical comorbidities), and socioeconomic (eg, uninsured status) predictors for delayed TTI were identified and may inform delay minimizing interventions. Our data support evidence that TTI delays are associated with demographic and socioeconomic disparities. Existing disparities are likely exacerbated by delays that disproportionately affect patients with care coordination/compliance issues, multiple comorbidities, and lower socioeconomic status.
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Change Trajectory of Symptom Distress, Coping Strategies, and Spiritual Wellbeing in Colorectal Cancer Patients Undergoing Chemotherapy. Healthcare (Basel) 2023; 11:healthcare11060857. [PMID: 36981514 PMCID: PMC10047921 DOI: 10.3390/healthcare11060857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Impacts caused by cancer and associated treatment may change with time. The objective of this study is to examine the change trajectory of symptom distress, coping strategies, and spiritual wellbeing in colorectal cancer patients during chemotherapy and to further examine the predictors of spiritual wellbeing. A prospective longitudinal repeated measures study design was employed. A total of 97 patients undergoing chemotherapy for the first time were enrolled. A structured questionnaire was used to collect data at three timepoints, which were before chemotherapy (T0), during chemotherapy (T1: 3 months after T0), and after chemotherapy (T2: 6 months after T0). The results of this study show that patients have significantly lower spiritual wellbeing and significantly higher symptom distress during chemotherapy treatment (T1). Family support (B = 0.39, p = 0.007) and problem-focused coping strategies (B = 0.47, p = 0.001) are significant predictors of spiritual wellbeing before chemotherapy (T0). Symptom distress (B = −0.18, p = 0.048) and problem-focused coping strategies (B = 0.26, p = 0.028) are significant predictors of spiritual wellbeing during chemotherapy (T1). The results provide care recommendations for different stages of chemotherapy to help to achieve more precise patient care and improve care quality.
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Time interval between diagnosis to treatment of breast cancer and the impact of health insurance coverage: a sub analysis of the AMAZONA III Study (GBECAM 0115). Breast Cancer Res Treat 2023; 198:123-130. [PMID: 36586038 DOI: 10.1007/s10549-022-06809-8] [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: 02/12/2022] [Accepted: 11/09/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Breast cancer (BC) is the most common type of cancer among women in Brazil. Evidence shows that delayed treatment onset is associated with increased mortality. This study aimed to evaluate median days between diagnosis and treatment and factors associated with delayed start of treatment (> 60 days after diagnosis): stage, treatment received, subtype, epidemiological characteristics, and type of healthcare coverage. METHODS This analysis included 1709 stage I-III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil. RESULTS The median number of days from diagnosis to beginning of first oncologic treatment was 46 days (IQR 28-75) overall, 43 days (IQR 25-75) for stage I disease, 49 days (IQR 28-81) for stage II, and 44 days (IQR 30-68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43 days (IQR 29-65) for neoadjuvant chemotherapy and 48 days (IQR 26-81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34 days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09-7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country. CONCLUSION By characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil. CLINICALTRIALS gov Identifier: NCT02663973, registered on January, 26th, 2016.
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Krasnoselskyi MV, Kyrylova OO, Rublova TV, Svynarenko AV, Artiukh SV. ASSESSMENT OF DISTRESS DYNAMICS AND QUALITY OF LIFE OF CANCER PATIENTS AT THE STAGE OF RADIATION THERAPY AND POSSIBILITIES OF THEIR CORRECTION. PROBLEMY RADIATSIINOI MEDYTSYNY TA RADIOBIOLOHII 2022; 27:353-362. [PMID: 36582100 DOI: 10.33145/2304-8336-2022-27-353-362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Indexed: 06/17/2023]
Abstract
Radiation therapy (RT) is the main type of antitumor treatment in inoperable patients. Low awareness and fear of the development of radiation reactions contributes to the destabilization of psycho-emotional state of patients, which can result in withdrawal from treatment and deterioration of their quality of life (QOL). Despite a steady increase in cancer rates in Ukraine, there are currently no studies to develop measures to improve psychological condition of patients undergoing treatment in radiation therapy departments. OBJECTIVE to assess the dynamics of psycho-emotional status and QOL of cancer patients at the stage of radiation therapy. MATERIALS AND METHODS The study involved psychodiagnostic examination of 66 cancer patients who underwent radiation treatment in the clinic of the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the NAMS of Ukraine», of whom Group 1 included 44 patients with head and neck cancer, Group 2 comprised 22 patients with colorectal cancer. Comparison group comprised 30 conditionally «healthy» respondents without cancer. All patients had stage III-IV cancer. The study implied the employment of «Distress Thermometer», Hospital Anxiety and Depression Scale (HADS), and the SF-36 Questionnaire (Short Form). The examination was performed before and following the course of radiation therapy. Group 1 patients underwent only psychodiagnostic examination, Group 2 patients apart from psychodiagnostic were accompanied by a psychologist before undergoing radiation procedures. In the comparison group, the survey was conducted once. RESULTS AND DISCUSSION Assessment of the data showed that before the start of RT most subjects (72.73 % in Group 1 and 77.3 % in Group 2) had a high level of distress, they were worried and nervous before the first radiation procedure, had fears about the consequences and side effects. The level of anxiety in Group 1 at the pathological and subclinical level was recorded in 54.55 % of patients, the rate of depression at the subclinical level was diagnosed in 18.20 %, and in 9.10 % of patients at the clinical one. In Group 2, the level of anxiety that exceeded the norm was recorded significantly less often (27.25 % vs. 54.55 %, pt < 0.05), and the rate of depression at the subclinical level was diagnosed significantly more often than in Group 1 (54.50 % vs. 18.20 %, pt < 0.05), and in 18.2 % of patients at the clinical level. After radiation, 81.81 % of Group 1 patients showed an increase in distress and anxiety, and depressive symptoms tended to worsen. The level of distress in Group 2 after consulting a psychologist in preparation for RT and undergoing radiation procedures decreased almost twice, the level of anxiety decreased to normal, the indicators of depressive symptoms remained unchanged. According to QOL assessments on the scales of physical and role functioning (PF and RP), general health (GH) and mental health (MH), patients in both groups had significantly lower scores before the RT than in the comparison groups. After the procedures, there was a significant deterioration in the RP scale in Group 1 (18.75 vs. 40.00, pt < 0.05), and an improvement of almost 2 times in Group 2 (35.73 vs. 68.33, pt < 0.06). The indicator of general health (GH) at the end of RT in Group 1 did not change, and in Group 2 it tended to improve (20.93 vs. 47.26, pt < 0.06). Life expectancy (LE) in Group 1 tended to decrease further after treatment, having increased 1.7 times in Group 2. CONCLUSIONS The study showed that cancer patients before the onset of RT experienced a rather strong distress and level of anxiety. Psychological correction of the emotional state at the beginning of treatment allowed for a significant improvement in the QOL of patients on the scales of role physical functioning (RF) and vitality (VT). An important area of work of a clinical psychologist at this stage of treatment involved correction of cognitive sphere, support of role functioning and formation of behavior aimed at further treatment.
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Affiliation(s)
- M V Krasnoselskyi
- SE «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska St., Kharkiv 61024, Ukraine
| | - O O Kyrylova
- SE «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska St., Kharkiv 61024, Ukraine
| | - T V Rublova
- SE «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska St., Kharkiv 61024, Ukraine
| | - A V Svynarenko
- SE «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska St., Kharkiv 61024, Ukraine
| | - S V Artiukh
- SE «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska St., Kharkiv 61024, Ukraine
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11
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Hopstaken JS, Vissers PAJ, Quispel R, de Vos-Geelen J, Brosens LAA, de Hingh IHJT, van der Geest LG, Besselink MG, van Laarhoven KJHM, Stommel MWJ. Impact of multicentre diagnostic workup in patients with pancreatic cancer on repeated diagnostic investigations, time-to-diagnosis and time-to-treatment: A nationwide analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2195-2201. [PMID: 35701256 DOI: 10.1016/j.ejso.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/04/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Due to the centralization of pancreatic surgery, patients with suspected pancreatic cancer may undergo diagnostic workup in both a non-pancreatic centre and a pancreatic centre, i.e. multicentre workup. This retrospective study assessed whether multicentre diagnostic workup is associated with repeated diagnostics, delayed time-to-diagnosis, delayed time-to-treatment, survival and whether variation existed among pancreatic cancer networks. METHODS This nationwide study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) in 2015, registered by the Netherlands Cancer Registry. A delayed time-to-diagnosis was defined as ≥3 weeks from initial hospital visit to final diagnosis. A delayed time-to-treatment was defined as ≥6 weeks from the first hospital visit to start of first tumour treatment. Multilevel logistic regression analyses and survival analyses were performed. RESULTS In total, 931 patients with non-metastatic PDAC were included. Overall, 175 patients (19%) underwent a multicentre diagnostic workup, which was significantly associated with repeated diagnostic investigations (OR = 6.31, 95% CI 4.13-9.64, P < 0.0001), a delayed time-to-diagnosis (OR = 2.66 95% CI 1.74-4.06, P < 0.001), and a delayed time-to-treatment (OR = 1.93 95% CI 1.12-3.31, P = 0.02), but not with decreased survival (HR = 1.09 95% CI 0.83-1.44; P = 0.532). Variation in outcomes per network was observed, especially for time-to-treatment, though the ICC was not statistically significant (P = 0.065). CONCLUSION Multicentre diagnostic workup for patients with PDAC is associated with repeated diagnostic investigations, a delayed time-to-diagnosis and delayed time-to-treatment compared to patients with monocentre workup. To reduce costs and improve treatment times, efforts should be made to improve network coordination, for example via network care pathways.
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Affiliation(s)
- Jana S Hopstaken
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Pauline A J Vissers
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Rutger Quispel
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands, Department of Pathology, UMC Utrecht, Utrecht, the Netherlands
| | | | - Lydia G van der Geest
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
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12
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Mendonça AB, Pereira ER, Magnago C, da Silva PG, Morett Leão DC, Costa Rosa Andrade Silva RM, Meira KC. Distress and Spiritual Well-Being in Brazilian Patients Initiating Chemotherapy during the COVID-19 Pandemic-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413200. [PMID: 34948809 PMCID: PMC8702099 DOI: 10.3390/ijerph182413200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/27/2022]
Abstract
Social distancing and the priority given to COVID-19 patients in health services, which caused postponement of appointments and cancer treatment, may have triggered unprecedented levels of distress in cancer patients. The aim of this study was to analyze the prevalence of distress and the levels of spiritual well-being of people initiating chemotherapy during the COVID-19 pandemic, identifying the factors associated with distress, and determining if there is a relationship between distress and spiritual well-being. A cross-sectional study was conducted with 91 Brazilians. Data were collected by applying the Spiritual Well-Being Scale (SWBS) and the Distress Thermometer and Problem List for Patients. The prevalence of distress was 59.5%, and the average score of spiritual well-being was 106.54 (±9.06). Emotional issues were the most reported by patients with distress. The Poisson regression showed that male sex (PR = 0.588; 95% CI 0.392–0.881), age (PR = 0.985; 95% CI 0.973–0.996), and spiritual well-being score were predictors of distress (PR = 0.971; 95% CI 0.946–0.996). These findings indicate that distress relief involves implementation of public health programs capable of integrating spiritual interventions into cancer care.
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Affiliation(s)
| | | | - Carinne Magnago
- School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Pedro Gilson da Silva
- School of Health, Federal University of Rio Grande do Norte, Natal 59075-000, Brazil
| | | | | | - Karina Cardoso Meira
- School of Health, Federal University of Rio Grande do Norte, Natal 59075-000, Brazil
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13
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Nica A, Sutradhar R, Kupets R, Covens A, Vicus D, Li Q, Ferguson SE, Gien LT. Pre-operative wait times in high-grade non-endometrioid endometrial cancer: Do surgical delays impact patient survival? Gynecol Oncol 2021; 164:333-340. [PMID: 34895897 DOI: 10.1016/j.ygyno.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Practice guidelines advocating for regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were published in Ontario in June 2013. Our objectives were to determine whether this policy affected surgical wait times, and whether longer wait time to surgery is a predictor of survival in high grade endometrial cancer patients. METHODS This was a population-based retrospective cohort study, which included patients diagnosed with high-grade non-endometrioid endometrial cancer who had a hysterectomy between 2003 and 2017. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between surgical wait time and overall survival (OS). RESULTS We identified 3518 patients who underwent hysterectomy for high-grade non-endometrioid endometrial cancer. Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 53 days compared to 57 days pre-regionalization (p = 0.0007), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p = 0.0006). Survival was inferior for patients who had surgery within 14 days of diagnosis (HR death 2.7 for 1-7 days, 95% CI 1.61-4.51, and HR death 1.96 for 8-14 days, 95% CI 1.50-2.57), reflective of disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic oncology appointment (HR death 1.19 for 46-60 days, 95% CI 1.04-1.36, and HR death 1.42 for 61-75 days, 95% CI 1.11-1.83). CONCLUSIONS Regionalization of surgery for high-grade endometrial cancer has not had an impact on surgical wait times. Patients who have surgery more than 45 days after surgical consultation have reduced survival.
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Affiliation(s)
- Andra Nica
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | | | - Rachel Kupets
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada
| | - Allan Covens
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada
| | | | - Sarah E Ferguson
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Lilian T Gien
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Division of Gynecologic Oncology, Odette Cancer Center, Toronto, ON, Canada.
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14
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Brincat A, Vella Bonanno P, Stewart D, Weidmann AE. Patients’ experiences of medicines on initiation of antineoplastic agents for the treatment of colorectal cancer: a qualitative study. BMJ Open 2021. [PMCID: PMC8719168 DOI: 10.1136/bmjopen-2020-047749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To explore the patients’ experiences on initiation of treatment with antineoplastic medicines for colorectal cancer. Design A qualitative study using semistructured, face-to-face interviews based on the adapted patients’ lived experience with medicines conceptual model was conducted. Ethics approval was granted. Interviews took place while eligible patients were receiving their first cycle of antineoplastic medicines, audiorecorded and transcribed verbatim. Interpretative phenomenological analysis was used. Setting National oncology hospital in Malta. Participants Adult patients over 18 years, newly diagnosed with colorectal cancer and initiating treatment with 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX) or capecitabine plus oxaliplatin (XELOX) between October 2018 and September 2019 were recruited. Patients were included if fully aware of their diagnosis and the treatment being received. A purposive sample of 16 patients participated in the study. Results Five themes emerged from our analysis: (1) beliefs and knowledge on cancer and treatment; (2) healthcare system in relation to treatment; (3) medicine-taking practice; (4) medicine-related impact and (5) personal support structure. In addition, 16 subthemes were identified to describe the interplay of all aspects of the patients’ experiences on initiation of treatment with antineoplastic medicines. Conclusion This qualitative study illustrated that the patients find themselves in a complex situation on initiation of treatment with antineoplastic medicines. The patients’ knowledge on their specific treatment and active participation in making an informed decision need to be addressed. The healthcare system should develop tailored patient-centred services that specifically address the lack of patient empowerment and patient’s concern about treatment specific information.
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Affiliation(s)
- Alison Brincat
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Patricia Vella Bonanno
- Department of Health Systems Management and Leadership, University of Malta, Msida, Malta
| | - Derek Stewart
- Department of Clinical Pharmacy and Practice, Qatar University, Doha, Qatar
| | - Anita E Weidmann
- Department of Clinical Pharmacy, University of Innsbruck, Innsbruck, Austria
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15
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What's the magic number? Impact of time to initiation of treatment for rectal cancer. Surgery 2021; 171:1185-1192. [PMID: 34565608 PMCID: PMC8940728 DOI: 10.1016/j.surg.2021.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND National guidelines, including the National Accreditation Program for Rectal Cancer, recommend initiation of rectal cancer treatment within 60 days of diagnosis; however, the effect of timely treatment initiation on oncologic outcomes is unclear. The purpose of this study was to evaluate the impact on oncologic outcomes of initiation of rectal cancer treatment within 60 days of diagnosis. METHODS This was a retrospective review of stage II/III rectal cancer patients performed using the United States Rectal Cancer Consortium, a collaboration of 6 academic medical centers. Patients with clinical stage II/III rectal cancer who underwent radical resection between January 1, 2010 and December 31, 2018 were included. The primary exposure was treatment initiation, defined as either resection or initiation of chemotherapy or chemoradiotherapy, within 60 days of diagnosis. The primary outcome was disease recurrence, and the secondary outcome was all-cause mortality. RESULTS A total of 1,031 patients meeting inclusion criteria were included in the analysis. Treatment was initiated within 60 days of diagnosis in 830 patients (80.5%) and after 60 days in 201 patients (20.3%). In multivariable logistic regression, older age, non-White race, and residence greater than 100 miles from the treatment center were significantly associated with delay in treatment beyond 60 days. In survival analysis, 167 patients (16.2%) experienced recurrent disease, and 127 patients (12.3%) died of any cause. In an adjusted model accounting for pathologic staging, treatment sequence, distance to care, age, comorbidities, treatment center, and receipt of adjuvant chemotherapy, neither progression-free survival nor all-cause mortality was significantly associated with timely initiation of therapy with hazard ratios of 1.09 (0.70, 1.69) and 1.03 (0.63, 1.66), respectively. CONCLUSION This study found no difference in oncologic outcomes with initiation of treatment beyond 60 days.
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16
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Dijkstra S, Kraal KCJM, Tytgat GAM, van Noesel MM, Wijnen MHWA, Hoogerbrugge PM. Use of quality indicators in neuroblastoma treatment: A feasibility assessment. Pediatr Blood Cancer 2021; 68:e28301. [PMID: 32735384 DOI: 10.1002/pbc.28301] [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] [Received: 12/15/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quality indicators (QIs) may be used to monitor the quality of neuroblastoma (NBL) care during treatment, in addition to survival and treatment toxicity, which can only be evaluated in the years after treatment. The present study aimed to assess the feasibility of a new set of indicators for the quality of NBL therapy. PROCEDURE Seven QIs have been proposed based on literature and consensus of experts: (a) duration of complete diagnostic work-up, (b) prescription of thyroid prophylaxis before metaiodobenzylguanidine imaging, (c) treatment intensity, (d) use of tumor board meetings, (e) number of outpatient visits and sedation procedures during follow-up, (f) protocolled follow-up, and (g) required apheresis sessions. A retrospective data analysis from October 2014 to November 2017 including all patients with NBL in the centralized Princess Máxima Center in the Netherlands was performed to assess these parameters and determine practicality of measurement. RESULTS A total number of 72 patients (aged between 2 weeks and 15 years) were analyzed. Adherence to all QIs could be determined for all eligible patients using their electronic medical records. Three indicators were compared over time, and an increase in adherence was observed. CONCLUSIONS Assessment of QIs in neuroblastoma treatment is feasible. Seven new QIs were found to be feasible to measure and showed improvement over time for three indicators. Monitoring of these QIs during treatment may provide tools for quality improvement activities and comparisons of treatment quality over time or between centers. Further study is required to investigate their association with long-term outcomes.
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Affiliation(s)
- Suzan Dijkstra
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Kathelijne C J M Kraal
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Godelieve A M Tytgat
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max M van Noesel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Peter M Hoogerbrugge
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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17
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Joly F, Rigal O, Guittet L, Lefèvre-Arbogast S, Grellard JM, Binarelli G, Lange M, Rieux C, Fernette M, Tron L, Gernier F, Travers R, Morel A, Richard D, Griffon B, Leconte A, Bastien E, Quilan F, Pépin LF, Jardin F, Leheurteur M, Clarisse B, Lequesne J, Faveyrial A. Post-traumatic stress symptomatology and adjustment of medical oncology practice during the COVID-19 pandemic among adult patients with cancer in a day care hospital. Cancer 2021; 127:4636-4645. [PMID: 34398970 PMCID: PMC8426939 DOI: 10.1002/cncr.33856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 12/20/2022]
Abstract
Background The COVID‐19 pandemic may induce post‐traumatic stress disorder (PTSD) symptoms among patients with cancer, who also face adaptations to their treatment. The authors assessed the occurrence of PTSD symptoms, investigated pandemic‐induced adjustments in medical oncology practice in patients with cancer, and explored risk factors for PTSD and the association between PTSD symptoms, insomnia, and quality of life (QoL). Methods This prospective French study was conducted in patients with solid/hematologic tumors who were receiving medical treatment in the day care departments of 2 cancer centers during the lockdown. Adjustments to medical oncology practice were collected from medical records. PTSD (measured using the Impact of Event Scale‐Revised), insomnia (measured using the Insomnia Severity Index), QoL (measured using the Functional Assessment of Cancer Therapy‐General instrument), and cognitive complaints (measured using the Functional Assessment of Cancer Therapy–Cognitive Function instrument) were collected through validated questionnaires. Results Clinical data and questionnaires were available for 734 and 576 patients, respectively. The median patient age was 64 years, and 69% of patients were women. Twenty‐one percent of patients had PTSD. Twenty‐seven percent (95% CI, 23%‐30%) had an adjustment in their medical oncology program, including adjournments (29%), treatment interruptions (16%), modified treatment plans (27%), or adapted monitoring (27%). Women and patients experiencing an adjustment in oncology practice had a higher odds of PTSD (odds ratio= 2.10 [95% CI, 1.07‐4.14] and 1.65 [95% CI, 1.03‐2.63]; P < .05). PTSD symptoms were correlated with worse scores for QoL, cognition, and insomnia. Conclusions Twenty‐one percent of patients with cancer experienced PTSD symptoms associated with poor QoL during the first COVID‐19–induced lockdown. Medical oncology practice was adjusted in approximately one‐quarter of patients and was associated with the occurrence of PTSD symptoms. Psychosocial support should be offered in cancer centers to promote emotional resilience and avoid PTSD symptoms in patients. Post‐traumatic stress disorder symptomatology occurred in 21% of patients with cancer during the first lockdown due to COVID‐19, was more frequent among women, and was associated with adjustment in medical oncology treatments. Caregivers should pay special attention to the psychological needs of patients with cancer to prevent or manage post‐traumatic stress disorder symptoms.
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Affiliation(s)
- Florence Joly
- Medical Oncology Department, Francois Baclesse Center, Caen, France.,Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | - Olivier Rigal
- Medical Oncology, Henri Becquerel Center, Rouen, France.,Clinical Research, Henri Becquerel Center, Rouen, France
| | - Lydia Guittet
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France
| | - Sophie Lefèvre-Arbogast
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | | | - Giulia Binarelli
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | - Marie Lange
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | - Chantal Rieux
- Clinical Research, Francois Baclesse Center, Caen, France
| | - Marie Fernette
- Clinical Research, Francois Baclesse Center, Caen, France
| | - Laure Tron
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France
| | | | | | - Adeline Morel
- Medical Oncology Department, Francois Baclesse Center, Caen, France
| | | | | | | | - Etienne Bastien
- Medical Oncology Department, Francois Baclesse Center, Caen, France
| | - Florian Quilan
- Medical Oncology Department, Francois Baclesse Center, Caen, France
| | | | - Fabrice Jardin
- Clinical Research, Henri Becquerel Center, Rouen, France.,Hematology, Henri Becquerel Center, Rouen, France
| | | | | | | | - Audrey Faveyrial
- Medical Oncology Department, Francois Baclesse Center, Caen, France
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18
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Garcia-Botello S, Martín-Arevalo J, Cozar-Lozano C, Benitez-Riesco A, Moro-Valdezate D, Pla-Martí V, Espí-Macías A. Does delaying curative surgery for colorectal cancer influence long-term disease-free survival? A cohort study. Langenbecks Arch Surg 2021; 406:2383-2390. [PMID: 34247257 PMCID: PMC8272683 DOI: 10.1007/s00423-021-02251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical wait list time is a major problem in many health-care systems and its influence on survival is unclear. The aim of this study is to assess the impact of wait list time on long-term disease-free survival in patients scheduled for colorectal cancer resection. MATERIALS AND METHODS A prospective study was carried out in patients with colorectal cancer scheduled for surgery at a tertiary care center. Wait list time was defined as the time from completion of diagnostic workup to definitive surgery and divided into 2-week intervals from 0 to 6 weeks. The outcome variables were 2-year and 5-year disease-free survival. RESULTS A total of 602 patients, 364 (60.5%) male, median age 73 years (range = 71) were defined. The median wait list time was 28 days (range = 99). Two and 5-year disease-free survival rates were 521 (86.5%) and 500 (83.1%) respectively. There were no differences in 2-year or 5-year disease-free survival for the whole cohort or by tumor stage between wait list time intervals except for AJCC stage II tumors which showed a higher 5-year disease-free survival for the 2-4 and 4-6-week wait list time interval (p = 0.021). CONCLUSIONS Time from diagnosis to definitive surgery up to 6 weeks is not associated with a decrease in 2-year or 5-year disease-free survival (DFS) in AJCC stage I through III colorectal cancer patients. These are important findings in the light of the COVID-19 pandemic and offer a window of opportunity for preoperative optimization and prehabilitation.
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Affiliation(s)
- Stephanie Garcia-Botello
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain. .,Department of Surgery, Universidad de Valencia, Valencia, Spain.
| | - J Martín-Arevalo
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain
| | - C Cozar-Lozano
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain
| | - A Benitez-Riesco
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain
| | - D Moro-Valdezate
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain.,Department of Surgery, Universidad de Valencia, Valencia, Spain
| | - V Pla-Martí
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain.,Department of Surgery, Universidad de Valencia, Valencia, Spain
| | - A Espí-Macías
- Colorectal Surgery Unit, Biomedical Research Institute INCLIVA, Hospital Clinico Universitario, Valencia, Spain.,Department of Surgery, Universidad de Valencia, Valencia, Spain
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Weng YP, Hong RM, Chen VCH, Tsai CJ, Yeh DC, Fang YH. Sleep Quality and Related Factors in Patients with Breast Cancer: A Cross-Sectional Study in Taiwan. Cancer Manag Res 2021; 13:4725-4733. [PMID: 34163247 PMCID: PMC8213945 DOI: 10.2147/cmar.s302966] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background Sleep disturbances are common and symptomatic burden in patients with breast cancer, but they are poorly documented and managed in routine clinical practice. This descriptive and cross-sectional study evaluated factors associated with post-treatment sleep disturbances in patients with breast cancer. Patients and Methods Patients with breast cancer who underwent standard treatment were enrolled and surveyed for their basic demographic data and precancerous and cancer treatment-related factors; they were also administered self-report questionnaires including the Family Adaptation, Partnership, Growth, Affection, Resolve questionnaire; Impact of Event Scale; Center for Epidemiologic Studies Depression Scale; and Maudsley Personality Inventory. Their sleep disturbances were evaluated using the Pittsburgh sleep quality index (PSQI). Independent sample t test and chi-square tests were used to compare the variables between patients with or without sleep disturbance, and multivariate logistic regression analyses were conducted to detect the independent factors. Results In total, 448 patients, including 145 with PSQI ≤ 5 and 303 with PSQI > 5, completed the investigation. Multiple logistic regression analysis revealed that significantly more patients with sleep disturbances demonstrated psychological distress, severe pain, depression, and impact of stress events than patients without sleep disturbances (adjusted odds ratios [95% confidence intervals]: 2.83 [1.135–7.067], P = 0.026; 1.14 [1.023–1.280], P = 0.018; 1.08 [1.036–1.133], P < 0.001; and 1.03 [1.002–1.051], P = 0.037, respectively). Conclusion Patients with breast cancer showed 67.6% prevalence of sleep disturbances after treatment. The patients with sleep disturbances were more likely to have previously experienced psychological disturbances, severe pain, depression within 5 years after diagnosis. After diagnosis for more than 5 years, higher distress caused by traumatic events still associated with sleep disturbances.
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Affiliation(s)
- Yi-Ping Weng
- Department of Nursing, Chia-Yi Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C.,Department of Nursing, Chia-Yi Chang Gung University of Science and Technology, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C
| | - Rei-Mei Hong
- Department of Nursing, Chia-Yi Chang Gung University of Science and Technology, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Dah-Cherng Yeh
- Breast Medical Center, Cheng Ching Hospital, Chung Kang Branch, Taichung City, Taiwan, R.O.C
| | - Yu-Hung Fang
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, 61363, Taiwan, R.O.C
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20
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Gagliardi AR, Yip CYY, Irish J, Wright FC, Rubin B, Ross H, Green R, Abbey S, McAndrews MP, Stewart DE. The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: A scoping review. Health Expect 2021; 24:978-990. [PMID: 33769657 PMCID: PMC8235883 DOI: 10.1111/hex.13241] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Waiting for procedures delayed by COVID-19 may cause anxiety and related adverse consequences. OBJECTIVE To synthesize research on the mental health impact of waiting and patient-centred mitigation strategies that could be applied in the COVID-19 context. METHODS Using a scoping review approach, we searched 9 databases for studies on waiting lists and mental health and reported study characteristics, impacts and intervention attributes and outcomes. RESULTS We included 51 studies that focussed on organ transplant (60.8%), surgery (21.6%) or cancer management (13.7%). Most patients and caregivers reported anxiety, depression and poor quality of life, which deteriorated with increasing wait time. The impact of waiting on mental health was greater among women and new immigrants, and those of younger age, lower socio-economic status, or with less-positive coping ability. Six studies evaluated educational strategies to develop coping skills: 2 reduced depression (2 did not), 1 reduced anxiety (2 did not) and 2 improved quality of life (2 did not). In contrast, patients desired acknowledgement of concerns, peer support, and periodic communication about wait-list position, prioritization criteria and anticipated procedure date. CONCLUSIONS Findings revealed patient-centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID-19 context. PATIENT OR PUBLIC CONTRIBUTION Six patients and four caregivers waiting for COVID-19-delayed procedures helped to establish eligibility criteria, plan data extraction and review a draft and final report.
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Affiliation(s)
- Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | | | - Jonathan Irish
- Surgical Oncology Program/Access to Care‐SurgeryOntario Health‐Cancer Care OntarioTorontoCanada
| | | | - Barry Rubin
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
| | - Heather Ross
- Ted Rogers Centre of Excellence in Heart FunctionUniversity Health NetworkTorontoCanada
| | - Robin Green
- Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
| | - Susan Abbey
- Medical Psychiatry & Psychosocial OncologyUniversity Health NetworkTorontoCanada
| | | | - Donna E. Stewart
- University Health Network Centre for Mental HealthUniversity of TorontoTorontoCanada
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21
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Andersson E, Nyhlin N, van Nieuwenhoven MA. The effectiveness of the colorectal cancer referral pathway - identification of colorectal cancer in a Swedish region. Scand J Gastroenterol 2021; 56:552-558. [PMID: 33749502 DOI: 10.1080/00365521.2021.1899276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION To shorten the time for diagnosis of suspected colorectal cancer (CRC), a standardized colorectal cancer referral pathway (CCRP) was introduced in Sweden in September 2016. However, the effects of the CCRP are still uncertain, and CRC is also found in patients undergoing a routine colonoscopy. OBJECTIVE To identify all CRC-cases in the Region Örebro County and to investigate via which diagnostic pathway they were diagnosed. Furthermore, to investigate the reasons for and possible effect of not being included in the CCRP for cases found via colonoscopy. METHODS Review of medical records of patients with CRC referred to the department of surgery in the Region Örebro County in 2016-2018 (n = 459). RESULTS In CRC-cases found through colonoscopy (n = 347), 37.5% were diagnosed via a routine waiting list and 62.5% within the CCRP. No difference in tumor stage or tumor grade was found between the two groups. The non-CCRP showed a longer time to diagnosis than the CCRP group (21.5 days, IQR 7-43 vs. 13 days, IQR 8-17 (p < .001), respectively). Non-rectal cancer was more common in the non-CCRP group (81.5% vs. 57.6%, p < .001). The non-CCRP group had lower median Hb-value (106, IQR 87-129 vs. 117, IQR 101-136, p = .001). 85% of the non-CCRP group was found to meet one or more CCRP referral criteria, with bleeding anemia being the dominant criterion to meet. CONCLUSION The CCRP did not appear to improve prognostic outcomes for CRC-patients. ClinicalTrials.gov Identifier: NCT04585516.
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Affiliation(s)
- Emilia Andersson
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils Nyhlin
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michiel A van Nieuwenhoven
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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22
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Ortega-Morán JF, Azpeitia Á, Sánchez-Peralta LF, Bote-Curiel L, Pagador B, Cabezón V, Saratxaga CL, Sánchez-Margallo FM. Medical needs related to the endoscopic technology and colonoscopy for colorectal cancer diagnosis. BMC Cancer 2021; 21:467. [PMID: 33902503 PMCID: PMC8077886 DOI: 10.1186/s12885-021-08190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies. Methods Semi-structured interviews and an online survey were used. Results Six endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation. Conclusions This study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient’s bowel preparation. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08190-z.
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Affiliation(s)
| | - Águeda Azpeitia
- Biobanco Vasco, Fundación Vasca de Investigaciones e Innovación Sanitaria (BIOEF), Ronda de Azkue, 1, 48902, Barakaldo, Spain
| | | | - Luis Bote-Curiel
- Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, Km 41.8, 10071, Cáceres, Spain
| | - Blas Pagador
- Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, Km 41.8, 10071, Cáceres, Spain
| | - Virginia Cabezón
- Biobanco Vasco, Fundación Vasca de Investigaciones e Innovación Sanitaria (BIOEF), Ronda de Azkue, 1, 48902, Barakaldo, Spain
| | - Cristina L Saratxaga
- TECNALIA, Basque Research and Technology Alliance (BRTA), Parque Tecnológico de Bizkaia, C/Geldo. Edificio 700, E-48160, Derio, Bizkaia, Spain
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23
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Meng X, Wang X, Dong Z. Impact of non-pharmacological interventions on quality of life, anxiety, and depression scores in patients with colorectal cancer: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 2021; 29:5635-5652. [PMID: 33786669 DOI: 10.1007/s00520-021-06185-x] [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: 11/17/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Different non-pharmacological interventions have been considered and applied to patients with colorectal cancer to improve their quality of life and distress symptoms; however, there is little evidence comparing the effectiveness of these strategies. This review aimed at assessing the effect of non-pharmacological interventions on quality of life, anxiety, and depression scores among patients with colorectal cancer. METHODS A systematic search for articles published until August 1, 2020, in the English language was performed in Medline, EMBASE, Web of Science, and the Cochrane Library; the reference lists of eligible articles were scanned for other potentially eligible publications. A meta-analysis was performed using random-effects models to estimate pooled effect sizes. RESULTS Twenty studies were included, representing a total of 3438 patients with colorectal cancer. Non-pharmacological interventions were associated with a significant reduction in anxiety (standardized mean difference [SMD] = - 0.157; 95% confidence interval [CI], - 0.312-[- 0.002]) and depression (SMD = - 0.207; 95% CI, - 0.390-[- 0.024]) scores during 5-8 months of follow-up. Subgroup analyses revealed that interventions delivered face-to-face improved patients' quality of life during 1-4 months of follow-up. Moreover, interventions delivered face-to-face but without a behavioral component were associated with improved anxiety scores, whereas interventions with a behavioral component improved the depression scores during 5-8 months of follow-up. CONCLUSIONS Non-pharmacological interventions were associated with reduced anxiety and depression scores, whereas interventions delivered face-to-face were associated with improved quality of life scores in patients with colorectal cancer. Given the few studies and patients included in this meta-analysis, these conclusions should be interpreted with caution.
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Affiliation(s)
- Xinyu Meng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaodong Wang
- Gastrointestinal Surgery Center of West China Hospital, Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China.
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24
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Does Delaying Time in Cancer Treatment Affect Mortality? A Retrospective Cohort Study of Korean Lung and Gastric Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073462. [PMID: 33810467 PMCID: PMC8036321 DOI: 10.3390/ijerph18073462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
The aim of this study is to investigate the association between delays in surgical treatment and five- and one- year mortality in patients with lung or gastric cancer. The National Health Insurance claims data from 2006 to 2015 were used. The association between time to surgical treatment, in which the cut-off value was set at average time (30 or 50 days), and five year mortality was analyzed using the Cox proportional hazard model. Subgroup analysis was performed based on treatment type and location of medical institution. A total of 810 lung and 2659 gastric cancer patients were included, in which 74.8% of lung and 71.2% of gastric cancer patients received surgery within average. Compared to lung cancer patients who received treatment within 50 days, the five-year (HR 1.826, 95% CI 1.437–2.321) mortality of those who received treatment afterwards was higher. The findings were not significant for gastric cancer based on the after 30 days standard (HR: 1.003, 95% CI: 0.822–1.225). In lung cancer patients, time-to-treatment and mortality risk were significantly different depending on region. Delays in surgical treatment were associated with mortality in lung cancer patients. The findings imply the importance of monitoring and assuring timely treatment in lung cancer patients.
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25
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Yin LX, Karp EE, Elias A, O'Byrne TJ, Routman DM, Price DL, Kasperbauer JL, Neben-Wittich M, Chintakuntlawar AV, Price KA, Ma DJ, Foote RL, Moore EJ, Van Abel KM. Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus-Associated Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2021; 165:830-837. [PMID: 33752487 DOI: 10.1177/01945998211000426] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Diagnostic delay in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset. STUDY DESIGN This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation). SETTING 2006-2016, tertiary care center. METHODS Tumor stage was compared between patients with and without delayed diagnosis using χ2 tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes. RESULTS In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation (P < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases-free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases-free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage (P > .05 for all). CONCLUSIONS Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna Elias
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Katharine A Price
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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26
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Golding H, Webber CE, Groome PA. Factors contributing to time to diagnosis in symptomatic colorectal cancer: A scoping review. Eur J Cancer Care (Engl) 2020; 30:e13397. [PMID: 33377574 DOI: 10.1111/ecc.13397] [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: 03/13/2020] [Revised: 07/11/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common cancer worldwide (Ferlay et al., 2015, International Journal of Cancer, 136, E359), and delayed diagnosis is associated with mortality (Tørring et al., 2011, British Journal of Cancer, 104, 934; Tørring et al., 2012, Journal of Clinical Epidemiology, 65, 669). The purpose of this review was to determine the factors associated with time to diagnosis in symptomatic CRC using scoping review methods. METHODS We performed database and citation searches to identify studies which examine the length of any interval from symptom presentation to diagnosis. Study selection was conducted by two independent reviewers. Factors contributing to time to diagnosis were extracted from selected articles and mapped onto a conceptual framework consisting of four levels: patient and disease factors, provider factors, organisation/setting factors and sectors of influence. RESULTS From the 31 studies included in this review, we identified 138 unique factors, 17 of which were investigated by at least three studies and 11 of which had consistent results. Patient and disease factors were most commonly studied. Patient perception that their symptoms were benign, a non-urgent referral, female sex and rectal tumour location were each associated with a longer time to diagnosis. CONCLUSION Thus far, the literature has focused on patient or disease-related factors, while other levels of influence have been relatively understudied.
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Affiliation(s)
- Haley Golding
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Colleen E Webber
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
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27
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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.
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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
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28
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Rittitit A, Promthet S, Suwanrungruang K, Jenwitheesuk K, Santong C, Vatanasapt P. Factors Associated with Time Intervals for Diagnosis of Colorectal Cancer: A Hospital Based Study in Khon Kaen, Thailand. Asian Pac J Cancer Prev 2020; 21:1835-1840. [PMID: 32592385 PMCID: PMC7568870 DOI: 10.31557/apjcp.2020.21.6.1835] [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: 02/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Colorectal cancer (CRC) is among the five-leading cancers in Thailand. Delayed diagnosis is crucial for undermining the prognosis of the patients. This study aims to evaluate the factors associated with the time interval for diagnosis (TID). Methods: A cross-sectional analytical study of 191 CRC patients with histological confirmation who were undergoing treatment in the tertiary hospital in Khon Kaen Province was conducted. The data were obtained by interview and retrieving from medical records. The time interval in each diagnostic process is reported in geometric mean. The geometric mean ratio (GMR) used to interpret the results from multiple linear regressions that analyze the relationship between factors and log-transformed TID. Results: Most patients were males (61.78%) with mean age of 61.28±10.2 years old. The geometric mean of TID was 263.48 days. Two factors were significantly associated with longer TID: first visit at a tertiary hospital (GMR=7.77 relative to secondary hospital; 95%CI=1.95 to 30.57) and distance to tertiary healthcare. Two factors were significantly associated with shorter TID: officer/ state enterprise (GMR=0.53 relative to agriculture; 95%CI=0.28 to 0.98) and cost of traveling to secondary healthcare. Conclusions: The results showed the occupation, first health care visit, distance and cost were factors associated with TID. Improving the facilities at the secondary healthcare units for diagnosing CRC would be likely to help to reduce the wasted time in the healthcare system.
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Affiliation(s)
- Attapong Rittitit
- Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Supannee Promthet
- ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Krittika Suwanrungruang
- ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chalongpon Santong
- Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patravoot Vatanasapt
- ASEAN Cancer Epidemiology and Prevention Research Group (ACEP), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.,Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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29
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Han CJ, Gigic B, Schneider M, Kulu Y, Peoples AR, Ose J, Kölsch T, Jacobsen PB, Colditz GA, Figueiredo JC, Grady WM, Li CI, Shibata D, Siegel EM, Toriola AT, Ulrich AB, Syrjala KL, Ulrich CM. Risk factors for cancer-related distress in colorectal cancer survivors: one year post surgery. J Cancer Surviv 2020; 14:305-315. [PMID: 32166576 PMCID: PMC7261242 DOI: 10.1007/s11764-019-00845-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/01/2019] [Indexed: 01/12/2023]
Abstract
PURPOSES Cancer-related distress is known to persist long after completion of treatment. Factors related to distress are largely unexplored in colorectal cancer (CRC) survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery. METHODS We included 212 CRC patients with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support, and health-related quality of life (HrQOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress. RESULTS Distress subscale scores varied significantly over time: health burden subscale score increased (P < .001), while finances (P = .004), medical demands (P < .001), and identity (P < .001) subscale scores decreased over time. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced tumor stage, poorer social support, and poorer baseline HrQOL predicted higher level distress at 6 and 12 months. CONCLUSION Cancer-related distress continues unresolved after surgery. Although some risk factors are difficult to alter, those at highest risk can be identified earlier for possible preventive strategies. IMPLICATIONS FOR CANCER SURVIVORS Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.
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Affiliation(s)
- Claire J Han
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anita R Peoples
- Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Torsten Kölsch
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, California, LA, USA
| | - William M Grady
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Erin M Siegel
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Adetunji T Toriola
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO, USA
| | - Alexis B Ulrich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karen L Syrjala
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
| | - Cornelia M Ulrich
- Division of Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
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The Association Between Wait Times for Colorectal Cancer Treatment and Health Care Costs: A Population-Based Analysis. Dis Colon Rectum 2020; 63:160-171. [PMID: 31842159 DOI: 10.1097/dcr.0000000000001517] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health care costs and wait times for colorectal cancer treatment are increasing in Canada, but the association between the 2 remains unclear. OBJECTIVE This study aimed to determine the association between wait times and health care costs and utilization. DESIGN This is a population-based retrospective cohort study. SETTING This study was conducted in Manitoba, Canada. PATIENTS Patients diagnosed with colorectal cancer between 2004 and 2014 were sorted and ranked into quintiles based on the time from index contact for a colorectal cancer-related symptom to first treatment. MAIN OUTCOME MEASURES The primary outcome is risk-adjusted health care costs, and the secondary outcomes include health care utilization and overall mortality. RESULTS We included a total of 6936 patients. Total wait times ranged between 0 and 762 days. In comparison with very short wait times, longer wait times were associated with significantly increased costs (short: mean cost ratio 1.21; 95% CI, 1.10-1.32; moderate: mean cost ratio 1.30; 95% CI, 1.19-1.43; long: mean cost ratio 1.48; 95% CI, 1.33-1.64; and very long: mean cost ratio 1.39; 95% CI, 1.26-1.54). Compared with very short wait times, longer wait times were associated with significantly lower risk of mortality (short: HR, 0.78; 95% CI, 0.71-0.86; moderate: HR, 0.72; 95% CI, 0.65-0.80; long: HR, 0.73; 95% CI, 0.66-0.82; very long: HR, 0.76; 95% CI, 0.68-0.85). The median number of pretreatment radiological and endoscopic investigations and surgeon clinic visits increased over the study period across all wait time categories. LIMITATIONS This is a nonrandomized, retrospective cohort study with potentially limited generalizability. CONCLUSION Patients with very short and short wait times are likely those diagnosed with life-threatening complications of colorectal cancer. Outside this window, patients with longer wait times experience increased health care costs and utilization with similar overall mortality. Improved care coordination and patient navigation may help contain the increasing wait times and associated increasing health care costs and utilization. See Video Abstract at http://links.lww.com/DCR/B81. ASOCIACIÓN ENTRE LOS TIEMPOS DE ESPERA PARA EL TRATAMIENTO DE UN CÁNCER COLORRECTAL Y LOS COSTOS DE ATENCIÓN MÉDICA: UN ANÁLISIS DE POBLACIÓN: los costos de atención médica y los tiempos de espera para el tratamiento del cáncer colorrectal están aumentando en Canadá, pero la asociación entre los dos sigue sin estar clara.determinar la asociación entre los tiempos de espera y los costos y la utilización de la atención médicaun estudio de cohorte retrospectivo basado en la población.Manitoba, Canadálos pacientes diagnosticados con cáncer colorrectal entre 2004-2014 se clasificaron y sub-clasificaron en quintiles según el tiempo desde el primer contacto índice de síntomas relacionados con cáncer colorrectal hasta el primer tratamiento.El resultado primario son los costos de atención médica ajustados al riesgo, y los resultados secundarios incluyen la utilización de la atención médica y la mortalidad general.Incluimos un total de 6,936 pacientes. Los tiempos de espera totales oscilaron entre 0-762 días. En comparación con los tiempos de espera muy cortos, los tiempos de espera más largos se asociaron con costos significativamente mayores (Corto: relación de costo promedio 1.21, intervalo de confianza del 95% 1.10-1.32; Moderado: relación de costo promedio 1.30, intervalo de confianza del 95% 1.19-1.43; Largo: media relación de costo 1.48, intervalo de confianza del 95% 1.33-1.64; Muy largo: relación de costo promedio 1.39, intervalo de confianza del 95% 1.26-1.54). En comparación con tiempos de espera muy cortos, los tiempos de espera más largos se asociaron con un riesgo de mortalidad significativamente menor (Corto: razón de riesgo 0.78, intervalo de confianza del 95% 0.71-0.86; Moderado: razón de riesgo 0.72, intervalo de confianza del 95% 0.65-0.80; Largo: peligro cociente 0.73, intervalo de confianza del 95% 0.66-0.82; Muy largo: cociente de riesgos 0.76, intervalo de confianza del 95% 0.68-0.85). La mediana del número de investigaciones radiológicas y endoscópicas previas al tratamiento y las visitas al cirujano aumentaron durante el período de estudio en todas las categorías de tiempo de espera.estudio de cohortes retrospectivo, no aleatorio con generalización potencialmente limitadalos pacientes con tiempos de espera « muy cortos » y « cortos » son probablemente aquellos diagnosticados con complicaciones potencialmente mortales del cáncer colorrectal. Fuera de esta ventana, los pacientes con tiempos de espera más largos experimentan mayores costos de atención médica y utilización con una mortalidad general similar. La coordinación mejorada de la atención y la navegación del paciente pueden ayudar a contener el aumento de los tiempos de espera y el aumento de los costos y la utilización de la atención médica. Consulte Video Resumen en http://links.lww.com/DCR/B81. (Traducción-Dr. Edgar Xavier Delgadillo).
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Kazlauskiene J, Bulotiene G. Prevalence of post-traumatic stress disorder among Lithuanian breast cancer patients and its risk factors. J Psychosom Res 2020; 131:109939. [PMID: 32018216 DOI: 10.1016/j.jpsychores.2020.109939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is more common among oncology patients than in the general population. The purpose of this study was to examine the prevalence of PTSD symptoms among Lithuanian patients with breast cancer and to analyse its clinical, psychosocial and demographic risk factors. METHODS Women with T1-T3/N0-N3/M0 stages of breast cancer took part in this study. There were two phases of the study: the first, before breast surgery (N = 421) and the second, a year after (N = 188). Women were given the following questionnaires: an Impact of Event Scale-Revised (IES-R); Beck's Depression Inventory, second edition (BDI-II); and the Vrana-Lauterbach Traumatic Event Scale, Civilian version (TEQC). RESULTS The prevalence of PTSD symptoms significantly decreased over the year. Before surgery, women who were employed, had experienced emotionally traumatic events during their lifespan and were dissatisfied with delivery of the information about the disease had more PTSD symptoms. One year later, those who had undergone breast-saving surgery, were living in a partnership, had a higher education, were unemployed and had experienced severe traumatic events during the previous year had more PTSD symptoms. The IES-R questionnaire's estimates correlated with BDI-II estimates. CONCLUSIONS Health care professionals, who work with cancer patients, are recommended to pay closer attention to the stress patients' experience, especially in those more vulnerable women who have several of the aforementioned risk factors. Targeted training for doctors, during which they could learn how to report the diagnosis to oncology patients would be of great benefit.
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Affiliation(s)
- Jurgita Kazlauskiene
- Vilniaus Kolegija/University of Applied Sciences, Saltoniskiu str. 58, LT-08105 Vilnius, Lithuania.
| | - Giedre Bulotiene
- National Cancer Institute, Santariskiu str. 1, LT-08660 Vilnius, Lithuania; Vilnius University, Universiteto str. 3, LT-01513 Vilnius, Lithuania
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Strous MT, Janssen-Heijnen ML, Vogelaar F. Impact of therapeutic delay in colorectal cancer on overall survival and cancer recurrence – is there a safe timeframe for prehabilitation? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:2295-2301. [DOI: 10.1016/j.ejso.2019.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022]
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Pham TM, Gomez-Cano M, Salika T, Jardel D, Abel GA, Lyratzopoulos G. Diagnostic route is associated with care satisfaction independently of tumour stage: Evidence from linked English Cancer Patient Experience Survey and cancer registration data. Cancer Epidemiol 2019; 61:70-78. [PMID: 31153049 DOI: 10.1016/j.canep.2019.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/08/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Whether diagnostic route (e.g. emergency presentation) is associated with cancer care experience independently of tumour stage is unknown. METHODS We analysed data on 18 590 patients with breast, prostate, colon, lung, and rectal cancers who responded to the 2014 English Cancer Patient Experience Survey, linked to cancer registration data on diagnostic route and tumour stage at diagnosis. We estimated odds ratios (OR) of reporting a negative experience of overall cancer care by tumour stage and diagnostic route (crude and adjusted for patient characteristic and cancer site variables) and examined their interactions with cancer site. RESULTS After adjustment, the likelihood of reporting a negative experience was highest for emergency presenters and lowest for screening-detected patients with breast, colon, and rectal cancers (OR versus two-week-wait 1.51, 95% confidence interval [CI] 1.24-1.83; 0.88, 95% CI 0.75-1.03, respectively). Patients with the most advanced stage were more likely to report a negative experience (OR stage IV versus I 1.37, 95% CI 1.15-1.62) with little confounding between stage and route, and no evidence for cancer-stage or cancer-route interactions. CONCLUSIONS Though the extent of disease is strongly associated with ratings of overall cancer care, diagnostic route (particularly emergency presentation or screening detection) exerts important independent effects.
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Affiliation(s)
- Tra My Pham
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK
| | - Mayam Gomez-Cano
- University of Exeter Medical School (Primary Care), Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Theodosia Salika
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK
| | - Demian Jardel
- Cancer Alliance Data, Evidence and Analysis Service (CADEAS), NHS England, Skipton House, 80 London Road, London, SE1 6LH, UK
| | - Gary A Abel
- University of Exeter Medical School (Primary Care), Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, WC1E 7HB, London, UK; Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
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Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, Raymond D, Abraham J, Klein EA, Walsh RM, Monteleone EE, Wei W, Hobbs B, Bolwell BJ. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS One 2019; 14:e0213209. [PMID: 30822350 PMCID: PMC6396925 DOI: 10.1371/journal.pone.0213209] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. Methods and findings We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. Conclusions TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients.
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Affiliation(s)
- Alok A. Khorana
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
- * E-mail:
| | - Katherine Tullio
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Paul Elson
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Nathan A. Pennell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Stephen R. Grobmyer
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Matthew F. Kalady
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Daniel Raymond
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Jame Abraham
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Eric A. Klein
- Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - R. Matthew Walsh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Emily E. Monteleone
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Brian Hobbs
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Brian J. Bolwell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
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Raphael D, Frey R, Gott M. The nature and timing of distress among post-treatment haematological cancer survivors. Eur J Cancer Care (Engl) 2018; 28:e12951. [PMID: 30284333 DOI: 10.1111/ecc.12951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/19/2018] [Accepted: 09/12/2018] [Indexed: 11/26/2022]
Abstract
Many people with haematological cancers will not meet the diagnostic criteria for a psychological disorder, but will still suffer distress during treatment and beyond. The current study aimed to explore the nature and timing of psychosocial distress experienced by haematological cancer survivors. Twenty-three post-treatment haematological cancer survivors participated in a semi-structured interview. Data were analysed using thematic analysis which involved identifying, analysing and reporting themes. Four themes were identified: Apprehension about leaving the safety of the health care system comprises the struggles encountered when transitioning from patient to survivor, Uncertainty and life transitions in the post-treatment period encompasses the changes survivors face when attempting to re-enter their "normal" lives, Distress associated with ongoing physical problems or impairment describes issues associated with the ongoing physical sequelae, and Fear of recurrence encapsulates how the continuing threat of cancer recurrence impacted survivors. This study has found that distress is ongoing for many haematological cancer survivors in the post-treatment period. It is imperative that distress is identified and support offered to those in need to prevent further psychosocial issues. It is especially important to consider the psychosocial needs of survivors in the post-treatment stage who are discharged from the health system may be unsure where to seek help.
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Affiliation(s)
- Deborah Raphael
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Calderón C, Jimenez-Fonseca P, Jara C, Hernández R, Martínez de Castro E, Varma S, Ghanem I, Carmona-Bayonas A. Comparison of Coping, Psychological Distress, and Level of Functioning in Patients With Gastric and Colorectal Cancer Before Adjuvant Chemotherapy. J Pain Symptom Manage 2018; 56:399-405. [PMID: 29775693 DOI: 10.1016/j.jpainsymman.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT Patients with gastrointestinal cancers are at high risk for functional problems that are generally accompanied by a decline in their overall status and intense psychological distress. OBJECTIVES This study compares the level of functioning in individuals with gastric cancer (GC) and colorectal cancer (CRC) and analyzes whether improved functioning can be explained by patients' psychological status and coping strategies. METHODS This is a prospective, transversal, multicenter study in patients with nonmetastatic GC and CRC before initiating adjuvant chemotherapy. Participants answered questionnaires evaluating quality of life, including functioning (European Organization for Research and Treatment of Cancer Quality of Life questionnaire), coping strategies (Mini-Mental Adjustment to Cancer), and psychological distress (Brief Symptom Inventory-18). RESULTS Between December 2015 and July 2017, 266 patients with CRC and 69 patients with GC were consecutively recruited. A pathological level of functioning was more prevalent in people with GC than in those with CRC (20% vs. 5%). Individuals with GC presented worse functioning and more psychological distress and displayed more hopelessness, anxious preoccupation, and cognitive avoidance as coping strategies than those with CRC. Psychological distress and fighting spirit accounted for 40% of the functional status in GC patients, whereas psychological distress and hopelessness represented 58% of CRC patients' functional status. CONCLUSION Our findings suggest that level of functioning affects many subjects with GC and reveals the importance of developing interventions targeted at enhancing adaptive coping strategies before initiating adjuvant cancer treatment.
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Affiliation(s)
- Caterina Calderón
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
| | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Jara
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, University Rey Juan Carlos, Madrid, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Eva Martínez de Castro
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sonal Varma
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Ismael Ghanem
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
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Parker PA, Peterson SK, Shen Y, Bedrosian I, Black DM, Thompson AM, Nelson JC, DeSnyder SM, Cook RL, Hunt KK, Volk RJ, Cantor SB, Dong W, Brewster AM. Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer. J Clin Oncol 2018; 36:2630-2638. [PMID: 30044695 DOI: 10.1200/jco.2018.78.6442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( Pinteraction < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( Pinteraction = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.
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Affiliation(s)
- Patricia A Parker
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Susan K Peterson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Yu Shen
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Isabelle Bedrosian
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Dalliah M Black
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Alastair M Thompson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Jonathan C Nelson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Sarah M DeSnyder
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert L Cook
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Kelly K Hunt
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert J Volk
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Scott B Cantor
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Wenli Dong
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Abenaa M Brewster
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
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Rastpour A, Begen MA, Louie AV, Zaric GS. Variability of waiting times for the 4 most prevalent cancer types in Ontario: a retrospective population-based analysis. CMAJ Open 2018; 6:E227-E234. [PMID: 29880658 PMCID: PMC6117805 DOI: 10.9778/cmajo.20170118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Longer waiting times in cancer care are associated with lower care quality and wait-related patient dissatisfaction. We analyzed the variability and median of waiting times from when a patient seeks care to first treatment for the 4 most prevalent cancer types in Ontario. METHODS Using retrospective health administrative data, we identified patients with a new diagnosis of prostate, breast, lung or colorectal cancer in Ontario between 2002 and 2012. Treatment interventions were categorized as chemotherapy, radiotherapy or surgery. We used regression analyses to calculate trends for the coefficient of variation, the Gini coefficient and the median waiting time for each cancer type-treatment type pair over the study period. RESULTS During the study period, 95 501 new cases of prostate cancer, 89 244 breast cancer cases, 82 604 lung cancer cases and 80 761 colorectal cancer cases were registered. The coefficient of variation and the Gini coefficient of waiting times decreased for all cancer type-treatment type pairs (except for the Gini coefficient for breast cancer-radiotherapy) over the study period. However, both decreasing and increasing trends in median waiting times were observed across cancer type-treatment type pairs. INTERPRETATION The variability of waiting time to first treatment for patients with prostate, breast, lung or colorectal cancer decreased between 2002 and 2012, which indicates improvements in equity in access to cancer care. This trend aligns with provincial efforts to improve access to and the efficiency of cancer care treatment in Ontario. The lack of consistent decreases in median waiting time highlights the need to identify improvement opportunities for cancer type-treatment type pairs with increasing median waiting times.
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Affiliation(s)
- Amir Rastpour
- Faculty of Business and Information Technology (Rastpour), University of Ontario Institute of Technology, Oshawa, Ont.; Ivey Business School (Begen, Zaric), University of Western Ontario; Department of Radiation Oncology (Louie), London Regional Cancer Program, University of Western Ontario, London, Ont.
| | - Mehmet A Begen
- Faculty of Business and Information Technology (Rastpour), University of Ontario Institute of Technology, Oshawa, Ont.; Ivey Business School (Begen, Zaric), University of Western Ontario; Department of Radiation Oncology (Louie), London Regional Cancer Program, University of Western Ontario, London, Ont
| | - Alexander V Louie
- Faculty of Business and Information Technology (Rastpour), University of Ontario Institute of Technology, Oshawa, Ont.; Ivey Business School (Begen, Zaric), University of Western Ontario; Department of Radiation Oncology (Louie), London Regional Cancer Program, University of Western Ontario, London, Ont
| | - Gregory S Zaric
- Faculty of Business and Information Technology (Rastpour), University of Ontario Institute of Technology, Oshawa, Ont.; Ivey Business School (Begen, Zaric), University of Western Ontario; Department of Radiation Oncology (Louie), London Regional Cancer Program, University of Western Ontario, London, Ont
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Adam R, Garau R, Raja EA, Jones B, Johnston M, Murchie P. Do patients' faces influence General Practitioners' cancer suspicions? A test of automatic processing of sociodemographic information. PLoS One 2017; 12:e0188222. [PMID: 29166652 PMCID: PMC5699847 DOI: 10.1371/journal.pone.0188222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Delayed cancer diagnosis leads to poorer patient outcomes. During short consultations, General Practitioners (GPs) make quick decisions about likelihood of cancer. Patients' facial cues are processed rapidly and may influence diagnosis. AIM To investigate whether patients' facial characteristics influence immediate perception of cancer risk by GPs. DESIGN AND SETTING Web-based binary forced choice experiment with GPs from Northeast Scotland. METHOD GPs were presented with a series of pairs of face prototypes and asked to quickly select the patient more likely to have cancer. Faces were modified with respect to age, gender, and ethnicity. Choices were analysed using Chi-squared goodness-of-fit statistics with Bonferroni corrections. RESULTS Eighty-two GPs participated. GPs were significantly more likely to suspect cancer in older patients. Gender influenced GP cancer suspicion, but this was modified by age: the male face was chosen as more likely to have cancer than the female face for young (72% of GPs;95% CI 61.0-87.0) and middle-aged faces (65.9%; 95% CI 54.7-75.5); but 63.4% (95% CI 52.2-73.3) decided the older female was more likely to have cancer than the older male (p = 0.015). GPs were significantly more likely to suspect cancer in the young Caucasian male (65.9% (95% CI 54.7, 75.5)) compared to the young Asian male (p = 0.004). CONCLUSION GPs' first impressions about cancer risk are influenced by patient age, gender, and ethnicity. Tackling GP cognitive biases could be a promising way of reducing cancer diagnostic delays, particularly for younger patients.
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Affiliation(s)
- Rosalind Adam
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- * E-mail:
| | - Roberta Garau
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Edwin Amalraj Raja
- Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Benedict Jones
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Peter Murchie
- Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Langford DJ, Cooper B, Paul S, Humphreys J, Keagy C, Conley YP, Hammer MJ, Levine JD, Wright F, Melisko M, Miaskowski C, Dunn LB. Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress. Health Psychol 2017; 36:1147-1160. [PMID: 28825498 DOI: 10.1037/hea0000524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to (a) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and (b) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. METHOD Patients (n = 957), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised. Coping strategies since beginning chemotherapy were assessed with the Brief COPE; 2 latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and Impact of Event Scale-Revised scores and the mediating role of engagement and disengagement coping on this relationship. RESULTS On average, patients reported 6.1 (SD = 4.0; range = 0-23 out of 30) SLEs. Patients who were not married/partnered, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship. CONCLUSIONS Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress. (PsycINFO Database Record
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Affiliation(s)
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco
| | - Steven Paul
- School of Nursing, University of California, San Francisco
| | | | | | | | | | - Jon D Levine
- School of Dentistry, University of California, San Francisco
| | | | | | | | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University
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