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Sakowitz S, Bakhtiyar SS, Verma A, Ebrahimian S, Vadlakonda A, Mabeza RM, Lee H, Benharash P. Association of time to resection with survival in patients with colon cancer. Surg Endosc 2024; 38:614-623. [PMID: 38012438 DOI: 10.1007/s00464-023-10548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/15/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Colon cancer (CC) remains a leading cause of cancer-related mortality worldwide, for which colectomy represents the standard of care. Yet, the impact of delayed resection on survival outcomes remains controversial. We assessed the association between time to surgery and 10-year survival in a national cohort of CC patients. METHODS This retrospective cohort study identified all adults who underwent colectomy for Stage I-III CC in the 2004-2020 National Cancer Database. Those who required neoadjuvant therapy or emergent resection < 7 days from diagnosis were excluded. Patients were classified into Early (< 25 days) and Delayed (≥ 25 days) cohorts after an adjusted analysis of the relationship between time to surgery and 10-year survival. Survival at 1-, 5-, and 10-years was assessed via Kaplan-Meier analyses and Cox proportional hazard modeling, adjusting for age, sex, race, income quartile, insurance coverage, Charlson-Deyo comorbidity index, disease stage, location of tumor, receipt of adjuvant chemotherapy, as well as hospital type, location, and case volume. RESULTS Of 165,991 patients, 84,665 (51%) were classified as Early and 81,326 (49%) Delayed. Following risk adjustment, Delayed resection was associated with similar 1-year [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.97-1.04, P = 0.72], but inferior 5- (HR 1.24, CI 1.22-1.26; P < 0.001) and 10-year survival (HR 1.22, CI 1.20-1.23; P < 0.001). Black race [adjusted odds ratio (AOR) 1.36, CI 1.31-1.41; P < 0.001], Medicaid insurance coverage (AOR 1.34, CI 1.26-1.42; P < 0.001), and care at high-volume hospitals (AOR 1.12, 95%CI 1.08-1.17; P < 0.001) were linked with greater likelihood of Delayed resection. CONCLUSIONS Patients with CC who underwent resection ≥ 25 days following diagnosis demonstrated similar 1-year, but inferior 5- and 10-year survival, compared to those who underwent surgery within 25 days. Socioeconomic factors, including race and Medicaid insurance, were linked with greater odds of delayed resection. Efforts to balance appropriate preoperative evaluation with expedited resection are needed to optimize patient outcomes.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
| | - Shayan Ebrahimian
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
| | - Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
| | - Hanjoo Lee
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA
- Division of Colon & Rectal Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Surgery, University of California, Los Angeles, CA, USA.
- UCLA Division of Cardiac Surgery, 64-249 Center for Health Sciences, Los Angeles, CA, 90095, USA.
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2
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Chiu LS, Huang KZ, Xu X, Heeren T, Haque R, Schroy PS. Initial Stage of Disease Similar for White and Black Patients With Early-Onset Colorectal Cancer at a Safety-Net Hospital. J Clin Gastroenterol 2024; 58:162-168. [PMID: 36806090 DOI: 10.1097/mcg.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Non-Hispanic Black (NHB) patients with early-onset colorectal cancer (EOCRC) are more likely to present with advanced-stage disease than their Non-Hispanic White (NHW) counterparts. To further elucidate whether differences in tumor biology or disparities in access to care may be responsible, we examined the association between race/ethnicity and initial stage of disease, time to diagnosis, and tumor characteristics among NHW and NHB patients with EOCRC cared for in a safety-net health care setting. METHODS We performed a retrospective cohort study of NHW and NHB patients diagnosed with primary EOCRC who received care at Boston Medical Center between January 2000 and May 2020. We compared demographics, risk factors, presenting signs/symptoms, time to diagnosis, health care utilization, and tumor characteristics (stage, grade, location, and mutational status). RESULTS We identified 103 patients (mean age 41.5±7.2 y, 53.4% men), including 40 NHWs and 63 NHBs, with EOCRC. NHB and NHW patients were similar with respect to demographics, presenting signs/symptoms, and risk factor distribution. There were also no significant differences between NHWs and NHBs with respect to the advanced stage of disease at presentation (45.0% vs. 42.9%, P =0.83), the median time to diagnosis [152 d (IQR, 40 to 341) vs. 160 d (IQR, 61 to 312), P =0.79] or tumor characteristics, except for a predilection for proximal disease among NHBs (30.2% vs. 15.0%). CONCLUSIONS NHB patients were no more likely than NHW patients to present with advanced-stage disease, aggressive tumor histology, or experience delays in diagnosis within a safety-net health care system.
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Affiliation(s)
- Laura S Chiu
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Kevin Z Huang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Xixi Xu
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Rubiya Haque
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul S Schroy
- Department of Medicine, Section of Gastroenterology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Drosdowsky A, Lamb KE, Karahalios A, Bergin RJ, Milley K, Boyd L, IJzerman MJ, Emery JD. The effect of time before diagnosis and treatment on colorectal cancer outcomes: systematic review and dose-response meta-analysis. Br J Cancer 2023; 129:993-1006. [PMID: 37528204 PMCID: PMC10491798 DOI: 10.1038/s41416-023-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate existing evidence on the relationship between diagnostic and treatment intervals and outcomes for colorectal cancer. METHODS Four databases were searched for English language articles assessing the role of time before initial treatment in colorectal cancer on any outcome, including stage and survival. Two reviewers independently screened articles for inclusion and data were synthesised narratively. A dose-response meta-analysis was performed to examine the association between treatment interval and survival. RESULTS One hundred and thirty papers were included in the systematic review, eight were included in the meta-analysis. Forty-five different intervals were considered in the time from first symptom to treatment. The most common finding was of no association between the length of intervals on any outcome. The dose-response meta-analysis showed a U-shaped association between the treatment interval and overall survival with the nadir at 45 days. CONCLUSION The review found inconsistent, but mostly a lack of, association between interval length and colorectal cancer outcomes, but study design and quality were heterogeneous. Meta-analysis suggests survival becomes increasingly poorer for those commencing treatment more than 45 days after diagnosis. REGISTRATION This review was registered, and the protocol is available, in PROSPERO, the international database of systematic reviews, with the registration ID CRD42021255864.
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Affiliation(s)
- Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia.
| | - Karen E Lamb
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Amalia Karahalios
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rebecca J Bergin
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Kristi Milley
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
| | - Lucy Boyd
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Maarten J IJzerman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, VIC, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, VIC, Australia
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Drosdowsky A, Lamb KE, Bergin RJ, Boyd L, Milley K, IJzerman MJ, Emery JD. A systematic review of methodological considerations in time to diagnosis and treatment in colorectal cancer research. Cancer Epidemiol 2023; 83:102323. [PMID: 36701982 DOI: 10.1016/j.canep.2023.102323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
Research focusing on timely diagnosis and treatment of colorectal cancer is necessary to improve outcomes for people with cancer. Previous attempts to consolidate research on time to diagnosis and treatment have noted varied methodological approaches and quality, limiting the comparability of findings. This systematic review was conducted to comprehensively assess the scope of methodological issues in this field and provide recommendations for future research. Eligible articles had to assess the role of any interval up to treatment, on any outcome in colorectal cancer, in English, with no limits on publication time. Four databases were searched (Ovid Medline, EMBASE, EMCARE and PsycInfo). Papers were screened by two independent reviewers using a two-stage process of title and abstract followed by full text review. In total, 130 papers were included and had data extracted on specific methodological and statistical features. Several methodological problems were identified across the evidence base. Common issues included arbitrary categorisation of intervals (n = 107, 83%), no adjustment for potential confounders (n = 65, 50%), and lack of justification for included covariates where there was adjustment (n = 40 of 65 papers that performed an adjusted analysis, 62%). Many articles introduced epidemiological biases such as immortal time bias (n = 37 of 80 papers that used survival as an outcome, 46%) and confounding by indication (n = 73, 56%), as well as other biases arising from inclusion of factors outside of their temporal sequence. However, determination of the full extent of these problems was hampered by insufficient reporting. Recommendations include avoiding artificial categorisation of intervals, ensuring bias has not been introduced due to out-of-sequence use of key events and increased use of theoretical frameworks to detect and reduce bias. The development of reporting guidelines and domain-specific risk of bias tools may aid in ensuring future research can reliably contribute to recommendations regarding optimal timing and strengthen the evidence base.
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Affiliation(s)
- Allison Drosdowsky
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia.
| | - Karen E Lamb
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Rebecca J Bergin
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Lucy Boyd
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia
| | - Kristi Milley
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia; Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, Australia
| | - Maarten J IJzerman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Jon D Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Australia; Primary Care Collaborative Cancer Clinical Trials Group (PC4), Carlton, Australia
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5
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Outcome of Operated Colorectal Cancers in Relation to the Type of Initial Referral. Cureus 2023; 15:e36840. [PMID: 37009351 PMCID: PMC10051034 DOI: 10.7759/cureus.36840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Aim Since the introduction of the target referral system, there has been controversy about its value and whether it affected the short- and long-term outcomes of colorectal cancer surgeries. With contradicting results, this study highlights differences in personal and tumour characteristics, management differences, and outcomes in each referral pathway, including target pathway referrals for suspected cancers, emergency presentations, routine referrals, and incidentally discovered cancers during screening. Methods A retrospective study of colorectal cancer (CRC) patients operated on between January 1, 2010, and December 31, 2014, with records dating to the end of the five-year follow-up, was extracted anonymously from the database of CRC outcomes at the North Middlesex University Hospital NHS Trust, London. The total number of patients operated on through the four pathways was 176, with full records and competent follow-ups. Patients were classified according to the mode of referral: two-week wait (2WW or target), routine, emergency, and incidental discovery referrals. Comparisons were made between these groups with regard to personal and tumour characteristics, management, and outcome. Results It has been demonstrated by this study that target referrals present mainly with stage I cancers as compared to emergency referrals that present with more stage II (IIa+ IIb+ IIc). The highest percentage of cancer locations within the large bowel was rectal, followed by sigmoid in both target and emergency groups; 8.8% of target patients needed neoadjuvant chemoradiotherapy in the form of FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) chemotherapy protocol with the addition of radiotherapy in patients with advanced rectal cancers, compared to 13.3% of emergency patients. Conclusion The colorectal 2WW system was the main pathway supplying colorectal cancer operations; it mostly showed earlier cancers than the other referral groups; its cancers were mostly rectosigmoid with less need for adjuvant chemotherapy; fewer recurrences; and it also showed a lower five-year mortality rate than the emergency group.
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Gbolahan O, Hashemi‐Sadraei N, Yash S, Williams G, Ramachandran R, Kim Y, Paluri R, Outlaw D, El‐Rayes B, Nabell L. Time to treatment initiation and its impact on real-world survival in metastatic colorectal cancer and pancreatic cancer. Cancer Med 2023; 12:3488-3498. [PMID: 35979540 PMCID: PMC9939095 DOI: 10.1002/cam4.5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Given the dearth of data regarding the time to treatment initiation (TTI) in the palliative setting, and its impact on survival outcomes, we sought to determine TTI in a real-world cohort of metastatic colorectal cancer (mCRC) and metastatic pancreatic cancer (mPC) patients and evaluate the impact of TTI on real-world survival outcomes. METHODS We collected survival and treatment data for mCRC and mPC from the Flatiron Health electronic health records (EHR) derived database. We divided TTI into 3 categories: < 2 weeks, 2-< 4 weeks, and 4-8 weeks, from diagnosis to first-line therapy. Outcome measures were median TTI, real-world overall survival (RW-OS) based on TTI categories by Kaplan-Meier method, and impact of TTI on survival using cox proportional hazard models. RESULTS Among 7108 and 3231 patients with mCRC and mPC treated within 8 weeks of diagnosis, the median TTI were 28 days and 20 days. Median RW-OS for mCRC was 24 months; 26.9 months versus 22.6 and 18.05 months in the 4-8-week, 2-< 4 week (control) and < 2-week groups, respectively (p < 0.0001). For mPC, median RW-OS was 8 months, without significant difference in RW-OS among the groups (p = 0.05). The 4-8-week group was associated with lower hazard of death (HR 0.782, 95% CI 0.73-0.84, p < 0.0001) and the < 2-week group was associated with a higher hazard of death (HR 1.26, 95% CI 1.15-1.38, p < 0.0001) in mCRC. The 4-8-week group was associated with lower hazard of death for mPC (HR 0.88, 95% CI 0.8-0.97, p = 0.0094). CONCLUSION In a real-world cohort of patients treated within 8 weeks of diagnosis, and with the limitations of a retrospective study, later TTI did not have a negative impact on survival outcomes in mCRC and mPC.
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Affiliation(s)
- Olumide Gbolahan
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | | | - Suri Yash
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Grant Williams
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Rekha Ramachandran
- Division of Preventive MedicineUniversity of Alabama School of MedicineBirminghamAlabamaUSA
| | - Young‐il Kim
- Division of Preventive MedicineUniversity of Alabama School of MedicineBirminghamAlabamaUSA
| | - Ravikumar Paluri
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
- Wake Forest School of MedicineNorth CarolinaUnited States
| | - Darryl Outlaw
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Bassel El‐Rayes
- Emory University School of Medicine, and Winship Cancer InstituteGeorgia
| | - Lisle Nabell
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
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7
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Castelo M, Sue-Chue-Lam C, Paszat L, Scheer AS, Hansen BE, Kishibe T, Baxter NN. Clinical Delays and Comparative Outcomes in Younger and Older Adults with Colorectal Cancer: A Systematic Review. Curr Oncol 2022; 29:8609-8625. [PMID: 36421332 PMCID: PMC9689013 DOI: 10.3390/curroncol29110679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Outcome disparities between adults <50 with colorectal cancer (CRC) and older adults may be explained by clinical delays. This study synthesized the literature comparing delays and outcomes between younger and older adults with CRC. Databases were searched until December 2021. We included studies published after 1990 reporting delay in adults <50 that made comparisons to older adults. Comparisons were described narratively and stage between age groups was meta-analyzed. 39 studies were included representing 185,710 younger CRC patients and 1,422,062 older patients. Sixteen delay intervals were compared. Fourteen studies (36%) found significantly longer delays among younger adults, and nine (23%) found shorter delays among younger patients. Twelve studies compared time from symptom onset to diagnosis (N younger = 1538). Five showed significantly longer delays for younger adults. Adults <50 years also had higher odds of advanced stage (16 studies, pooled OR for Stage III/IV 1.76, 95% CI 1.52-2.03). Ten studies compared time from diagnosis to treatment (N younger = 171,726) with 4 showing significantly shorter delays for younger adults. All studies showing longer delays for younger adults examined pre-diagnostic intervals. Three studies compared the impact of delay on younger versus older adult. One showed longer delays were associated with advanced stage and worse survival in younger but not older adults. Longer delays among younger adults with CRC occur in pre-diagnostic intervals.
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Affiliation(s)
- Matthew Castelo
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Colin Sue-Chue-Lam
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Lawrence Paszat
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Adena S. Scheer
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Bettina E. Hansen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
| | - Nancy N. Baxter
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P5, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- School of Population and Global Health, University of Melbourne, 207 Bouverie St. Level 5, Melbourne, VIC 3010, Australia
- Correspondence: ; Tel.: +61-43-531-3313
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Mouni O, Idrissi A, Bouziane M, Ahid S, Sair K. Impact of the COVID-19 pandemic on digestive cancer staging, a case series. Ann Med Surg (Lond) 2022; 82:104471. [PMID: 36059595 PMCID: PMC9419999 DOI: 10.1016/j.amsu.2022.104471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Method Results Conclusion This is study assesses the impact of The COVID-19 pandemic on the diagnosis delay in digestive cancers and its impact on their staging. A three-year study that includes 165 patients, 1 year before the COVID-19 pandemic and two years during. The pandemic had a statistically significant impact on the staging of the tumor but no impact on the short-term outcome of the patients. The first study of its kind in Morocco.
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Esteva M, Leiva A, Ramos-Monserrat M, Espí A, González-Luján L, Macià F, Murta-Nascimento C, Sánchez-Calavera MA, Magallón R, Balboa-Barreiro V, Seoane-Pillado T, Pertega-Díaz S. Relationship between time from symptom's onset to diagnosis and prognosis in patients with symptomatic colorectal cancer. BMC Cancer 2022; 22:910. [PMID: 35996104 PMCID: PMC9394014 DOI: 10.1186/s12885-022-09990-7] [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: 03/30/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Controversy exists regarding the relationship of the outcome of patients with colorectal cancer (CRC) with the time from symptom onset to diagnosis. The aim of this study is to investigate this association, with the assumption that this relationship was nonlinear and with adjustment for multiple confounders, such as tumor grade, symptoms, or admission to an emergency department. METHODS This multicenter study with prospective follow-up was performed in five regions of Spain from 2010 to 2012. Symptomatic cases of incident CRC from a previous study were examined. At the time of diagnosis, each patient was interviewed, and the associated hospital and clinical records were reviewed. During follow-up, the clinical records were reviewed again to assess survival. Cox survival analysis with a restricted cubic spline was used to model overall and CRC-specific survival, with adjustment for variables related to the patient, health service, and tumor. RESULTS A total of 795 patients had symptomatic CRC and 769 of them had complete data on diagnostic delay and survival. Univariate analysis indicated a lower HR for death in patients who had diagnostic intervals less than 4.2 months. However, after adjustment for variables related to the patient, tumor, and utilized health service, there was no relationship of the diagnostic delay with survival of patients with colon and rectal cancer, colon cancer alone, or rectal cancer alone. Cubic spline analysis indicated an inverse association of the diagnostic delay with 5-year survival. However, this association was not statistically significant. CONCLUSIONS Our results indicated that the duration of diagnostic delay had no significant effect on the outcome of patients with CRC. We suggest that the most important determinant of the duration of diagnostic delay is the biological profile of the tumor. However, it remains the responsibility of community health centers and authorities to minimize diagnostic delays in patients with CRC and to implement initiatives that improve early diagnosis and provide better outcomes.
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Affiliation(s)
- Magdalena Esteva
- Department of Primary Care, Primary Care Research Unit, Majorca, Baleares Health Service [IbSalut]. Escola Graduada 3, 07001, Palma, Spain. .,Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Edificio S, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain. .,Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.
| | - Alfonso Leiva
- Department of Primary Care, Primary Care Research Unit, Majorca, Baleares Health Service [IbSalut]. Escola Graduada 3, 07001, Palma, Spain.,Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Edificio S, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain.,Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.,Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS) , Madrid, Spain.,University of the Balearic Islands (UIB), Carretera de Valldemossa, km 7.5, 07122, Palma, Spain
| | - María Ramos-Monserrat
- Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Edificio S, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain.,Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.,Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS) , Madrid, Spain.,Balearic Islands Public Health Department, C/ Jesus 38A, 07010, Palma, Spain
| | - Alejandro Espí
- Department of Surgery, University of Valencia, Avenida Blasco Ibáñez 15, 46010, Valencia, Spain
| | - Luis González-Luján
- Serrería II Primary Care Centre, Valencia Institute of Health, Pedro de Valencia 26, 46022, Valencia, Spain
| | - Francesc Macià
- Epidemiology and Evaluation Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | | | - María A Sánchez-Calavera
- Department of Medicine, University of Zaragoza, Building A, 50009, Saragossa, Spain.,Las Fuentes Norte Health Center, Calle Dr. Iranzo 69, 50002, Saragossa, Spain
| | - Rosa Magallón
- University of the Balearic Islands (UIB), Carretera de Valldemossa, km 7.5, 07122, Palma, Spain.,Department of Medicine, University of Zaragoza, Building A, 50009, Saragossa, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Saragossa, Spain.,Centro de Salud Arrabal, Andador Aragüés del Puerto, 3, 50015, Saragossa, Spain
| | - Vanesa Balboa-Barreiro
- Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), As Xubias, 15006. A, Coruña, Spain
| | - Teresa Seoane-Pillado
- Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), As Xubias, 15006. A, Coruña, Spain
| | - Sonia Pertega-Díaz
- Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), As Xubias, 15006. A, Coruña, Spain
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Influence of Diagnostic Delay on Survival Rates for Patients with Colorectal Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063626. [PMID: 35329320 PMCID: PMC8953516 DOI: 10.3390/ijerph19063626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
Colorectal cancer affects men and women alike. Sometimes, due to clinical-pathological factors, the absence of symptoms or the failure to conduct screening tests, its diagnosis may be delayed. However, it has not been conclusively shown that such a delay, especially when attributable to the health system, affects survival. The aim of the present study is to evaluate the overall survival rate of patients with a delayed diagnosis of colorectal cancer. This observational, prospective, multicenter study was conducted at 22 public hospitals located in nine Spanish provinces. For this analysis, 1688 patients with complete information in essential variables were included. The association between diagnostic delay and overall survival at five years, stratified according to tumor location, was estimated by the Kaplan-Meier method. Hazard ratios for this association were estimated using multivariable Cox regression models. The diagnostic delay ≥ 30 days was presented in 944 patients. The presence of a diagnostic delay of more than 30 days was not associated with a worse prognosis, contrary to a delay of less than 30 days (HR: 0.76, 0.64-0.90). In the multivariate analysis, a short delay maintained its predictive value (HR: 0.80, 0.66-0.98) regardless of age, BMI, Charlson index or TNM stage. A diagnostic delay of less than 30 days is an independent factor for short survival in patients with CRC. This association may arise because the clinical management of tumors with severe clinical characteristics and with a poorer prognosis are generally conducted more quickly.
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11
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Montiel Ishino FA, Odame EA, Villalobos K, Whiteside M, Mamudu H, Williams F. Applying Latent Class Analysis on Cancer Registry Data to Identify and Compare Health Disparity Profiles in Colorectal Cancer Surgical Treatment Delay. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E487-E496. [PMID: 33729186 PMCID: PMC8435045 DOI: 10.1097/phh.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Colorectal cancer (CRC) surgical treatment delay (TD) has been associated with mortality and morbidity; however, disparities by TD profiles are unknown. OBJECTIVES This study aimed to identify CRC patient profiles of surgical TD while accounting for differences in sociodemographic, health insurance, and geographic characteristics. DESIGN We used latent class analysis (LCA) on 2005-2015 Tennessee Cancer Registry data of CRC patients and observed indicators that included sex/gender, age at diagnosis, marital status (single/married/divorced/widowed), race (White/Black/other), health insurance type, and geographic residence (non-Appalachian/Appalachian). SETTING The state of Tennessee in the United States that included both Appalachian and non-Appalachian counties. PARTICIPANTS Adult (18 years or older) CRC patients (N = 35 412) who were diagnosed and surgically treated for in situ (n = 1286) and malignant CRC (n = 34 126). MAIN OUTCOME MEASURE The distal outcome of TD was categorized as 30 days or less and more than 30 days from diagnosis to surgical treatment. RESULTS Our LCA identified a 4-class solution and a 3-class solution for in situ and malignant profiles, respectively. The highest in situ CRC patient risk profile was female, White, aged 75 to 84 years, widowed, and used public health insurance when compared with respective profiles. The highest malignant CRC patient risk profile was male, Black, both single/never married and divorced/separated, resided in non-Appalachian county, and used public health insurance when compared with respective profiles. The highest risk profiles of in situ and malignant patients had a TD likelihood of 19.3% and 29.4%, respectively. CONCLUSIONS While our findings are not meant for diagnostic purposes, we found that Blacks had lower TD with in situ CRC. The opposite was found in the malignant profiles where Blacks had the highest TD. Although TD is not a definitive marker of survival, we observed that non-Appalachian underserved/underrepresented groups were overrepresented in the highest TD profiles. The observed disparities could be indicative of intervenable risk.
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Affiliation(s)
- Francisco A. Montiel Ishino
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Emmanuel A. Odame
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Kevin Villalobos
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Martin Whiteside
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Hadii Mamudu
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland (Drs Montiel Ishino and William and Mr Villalobos); Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Dr Odame); Tennessee Cancer Registry, Tennessee Department of Health, Nashville, Tennessee (Dr Whiteside); and Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee (Dr Mamudu)
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12
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Lesi OK, Igho-Osagie E, Walton SJ. The impact of COVID-19 pandemic on colorectal cancer patients at an NHS Foundation Trust hospital-A retrospective cohort study. Ann Med Surg (Lond) 2022; 73:103182. [PMID: 34931144 PMCID: PMC8673748 DOI: 10.1016/j.amsu.2021.103182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Current NHS guidelines recommend that treatment of colorectal patients referred through the two-week wait referral system should occur within sixty two days from the date of referral. The COVID-19 pandemic which started in March 2020 has however led to significant delays in the delivery of health services, including colorectal cancer treatments. This study investigates the effects of delayed colorectal cancer treatments during the COVID pandemic on disease progression. METHODS A retrospective chart review of 107 patients with histologically confirmed diagnosis of colorectal cancer was conducted. The occurrence of cancer upstaging after initial diagnosis was assessed and compared between patients with treatment delays and patients who received treatments within the period recommended by NHS guidelines. A logistic regression was performed to evaluate the association between treatment delays beyond 62 days and cancer upstaging. RESULTS The median age of the cohort was 71.2 years and 64.5% of the patients were over 65 years. Treatment delays were observed in 53.3% of reviewed patients. Patients with treatment delays received cancer treatments 95.8 (31.0) days on average after referral, compared to 46.3 (11.5) days in patients who experienced no treatment delays (p-value<0.0001). 38.6% of patients with treatment delays experienced cancer upstaging by the time of treatment, compared to 20% in the non-delay group (p-value = 0.036). Patients who received treatment after sixty two days from date of referral were 3.27 times more likely to experience colorectal cancer upstaging compared to those who received timely treatments. CONCLUSION Although an effective response to the Covid-19 pandemic requires the reallocation of healthcare resources, there is a need to ensure that treatments and health outcomes of patients with chronic diseases such as colorectal cancer continue to be prioritized and delivered in timely fashion.
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Affiliation(s)
- Omotara Kafayat Lesi
- Mid and South Essex NHS Foundation Trust, Basildon and Thurrock University Hospitals, Essex, United Kingdom
| | | | - Sarah-Jane Walton
- Mid and South Essex NHS Foundation Trust, Basildon and Thurrock University Hospitals, Essex, United Kingdom
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13
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Brajcich BC, Benson AB, Gantt G, Eng OS, Marsh RW, Mulcahy MF, Polite BN, Shogan BD, Yang AD, Merkow RP. Management of colorectal cancer during the COVID-19 pandemic: Recommendations from a statewide multidisciplinary cancer collaborative. J Surg Oncol 2021; 125:560-563. [PMID: 34820843 PMCID: PMC9015333 DOI: 10.1002/jso.26758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/13/2021] [Indexed: 11/09/2022]
Abstract
COVID‐19 has resulted in significant disruptions in cancer care. The Illinois Cancer Collaborative (ILCC), a statewide multidisciplinary cancer collaborative, has developed expert recommendations for triage and management of colorectal cancer when disruptions occur in usual care. Such recommendations would be applicable to future outbreaks of COVID‐19 or other large‐scale disruptions in cancer care.
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Affiliation(s)
- Brian C Brajcich
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Al B Benson
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gerald Gantt
- Department of Surgery, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Robert W Marsh
- Department of Medical Oncology, NorthShore University HealthSystem, University of Chicago, Chicago, Illinois, USA
| | - Mary F Mulcahy
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Blase N Polite
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
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14
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2021; 24:1-332. [PMID: 33252328 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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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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Whittaker TM, Abdelrazek MEG, Fitzpatrick AJ, Froud JLJ, Kelly JR, Williamson JS, Williams GL. Reply to: Franssen, Ruud; Strous, Maud; Vogelaar, F Jeroen; Janssen-Heijnen, Maryska. Can we really conclude that treatment delays are associated with poorer outcome in patients with colorectal cancer awaiting elective surgery? Colorectal Dis 2021; 23:2198-2199. [PMID: 33991390 DOI: 10.1111/codi.15730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | | | | | - J L J Froud
- Cardiff University School of Medicine, Cardiff, UK
| | - J R Kelly
- Cardiff University School of Medicine, Cardiff, UK
| | - J S Williamson
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK
| | - G L Williams
- Department of Colorectal Surgery, Royal Gwent Hospital, Newport, UK
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17
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Rao A, Rich NE, Marrero JA, Yopp AC, Singal AG. Diagnostic and Therapeutic Delays in Patients With Hepatocellular Carcinoma. J Natl Compr Canc Netw 2021; 19:1063-1071. [PMID: 34077908 DOI: 10.6004/jnccn.2020.7689] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delays in diagnosis and treatment have been reported for many cancers, with resultant stage migration and worse survival; however, few data exist in patients with hepatocellular carcinoma (HCC). These data are of particular importance in light of the COVID-19 pandemic, which has caused disruptions in healthcare processes and may continue to impact cancer care for the foreseeable future. The aim of our study was to characterize the prevalence and clinical significance of diagnostic and treatment delays in patients with HCC. METHODS We performed a retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and July 2017 at 2 US health systems. Diagnostic and treatment delays were defined as >90 days between presentation and HCC diagnosis and between diagnosis and treatment, respectively. We used multivariable logistic regression to identify factors associated with diagnostic and treatment delays and Cox proportional hazard models to identify correlates of overall survival. RESULTS Of 925 patients with HCC, 39.0% were diagnosed via screening, 33.1% incidentally, and 27.9% symptomatically. Median time from presentation to diagnosis was 37 days (interquartile range, 18-94 days), with 120 patients (13.0%) experiencing diagnostic delays. Median time from HCC diagnosis to treatment was 46 days (interquartile range, 29-74 days), with 17.2% of patients experiencing treatment delays. Most (72.5%) diagnostic delays were related to provider-level factors (eg, monitoring indeterminate nodules), whereas nearly half (46.2%) of treatment delays were related to patient-related factors (eg, missed appointments). In multivariable analyses, treatment delays were not associated with increased mortality (hazard ratio, 0.90; 95% CI, 0.60-1.35); these results were consistent across subgroup analyses by Barcelona Clinic Liver Cancer stage and treatment modality. CONCLUSIONS Diagnostic and therapeutic delays exceeding 3 months are common in patients with HCC; however, observed treatment delays do not seem to significantly impact overall survival.
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Affiliation(s)
| | - Nicole E Rich
- 1Department of Internal Medicine.,2Harold C. Simmons Comprehensive Cancer Center
| | - Jorge A Marrero
- 1Department of Internal Medicine.,3Department of Population and Data Sciences, and
| | - Adam C Yopp
- 2Harold C. Simmons Comprehensive Cancer Center.,4Department of Surgery, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Texas
| | - Amit G Singal
- 1Department of Internal Medicine.,2Harold C. Simmons Comprehensive Cancer Center.,3Department of Population and Data Sciences, and
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18
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Abelson JS, Barron J, Bauer PS, Chapman WC, Schad C, Ohman K, Glasgow S, Hunt S, Mutch M, Smith RK, Wise PE, Silviera M. Travel Time to a High Volume Center Negatively Impacts Timing of Care in Rectal Cancer. J Surg Res 2021; 266:96-103. [PMID: 33989893 DOI: 10.1016/j.jss.2021.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/16/2021] [Accepted: 02/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Regionalization of rectal cancer surgery may lead to worse disease free survival owing to longer travel time to reach a high volume center yet no study has evaluated this relationship at a single high volume center volume center. MATERIALS AND METHODS This was a retrospective review of rectal cancer patients undergoing surgery from 2009 to 2019 at a single high volume center. Patients were divided into two groups based on travel time. The primary outcome was disease-free survival (DFS). Additional outcomes included treatment within 60 d of diagnosis, completeness of preoperative staging, and evaluation by a colorectal surgeon prior to initiation of treatment. RESULTS A lower proportion of patients with long travel time began definitive treatment within 60 d of diagnosis (74.0% versus 84.0%, P= 0.01) or were seen by the treating colorectal surgeon before beginning definitive treatment (74.8% versus 85.4%, P < 0.01). On multivariable logistic regression analysis, patients with long travel time were significantly less likely to begin definitive treatment within 60 d of diagnosis (OR = 0.54; 95% CI = 0.31-0.93) or to be evaluated by a colorectal surgeon prior to initiating treatment (OR = 0.45; 95% CI = 0.25-0.80). There were no significant differences in DFS based on travel time. CONCLUSIONS Although patients with long travel times may be vulnerable to delayed, lower quality rectal cancer care, there is no difference in DFS when definitive surgery is performed at a high volume canter. Ongoing research is needed to identify explanations for delays in treatment to ensure all patients receive the highest quality care.
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Affiliation(s)
- Jonathan S Abelson
- Division of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - John Barron
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Philip S Bauer
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - William C Chapman
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Christine Schad
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Kerri Ohman
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Sean Glasgow
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Steven Hunt
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Matthew Mutch
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Radhika K Smith
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Paul E Wise
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Matthew Silviera
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, Missouri
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19
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DE Rosa M, Pasculli A, Rondelli F, Mariani L, Avenia S, Ceccarelli G, Testini M, Avenia N, Bugiantella W. Could diagnostic and therapeutic delay affect the prognosis of gastrointestinal primary malignancies in the COVID-19 pandemic era? A literature review. Minerva Surg 2021; 76:467-476. [PMID: 33890444 DOI: 10.23736/s2724-5691.21.08736-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emergency situations, as the Covid-19 pandemic that is striking the world nowadays, stress the national health systems which are forced to rapidly reorganizing their sources. Therefore, many elective diagnostic and surgical procedures are being suspended or significantly delayed. Moreover, patients might find it difficult to refer to physicians and delay the diagnostic and even the therapeutic procedures because of emotional or logistic problems. The effect of diagnostic and therapeutic delay on survival in patients affected by gastrointestinal malignancies is still unclear. METHODS We carried out a review of the available literature, in order to determine whether the delay in performing diagnosis and curative-intent surgical procedures affects the oncological outcomes in patients with oesophageal, gastric, colorectal cancers, and colorectal liver metastasis. RESULTS The findings indicate that for oesophageal, gastric and colon cancers delaying surgery up to 2 months after the end of the staging process does not worsen the oncological outcomes. Oesophageal cancer should undergo surgery within 7-8 weeks after the end of neoadjuvant chemoradiation. Rectal cancers should undergo surgery within 31 days after the diagnostic process and within 12 weeks after neoadjuvant therapy. Adjuvant therapy should start within 4 weeks after surgery, especially in gastric cancer; a delay up to 42 days may be allowed for oesophageal cancer undergoing adjuvant radiotherapy. CONCLUSIONS Gastrointestinal malignancies can be safely managed taking into account that reasonable delays of planned treatments appear a generally safe approach, not having a significant impact on long-term oncological outcome.
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Affiliation(s)
- Michele DE Rosa
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, University A. Moro of Bari, Polyclinic of Bari, Bari, Italy
| | - Fabio Rondelli
- General and Specialized Surgery, Santa Maria Hospital, Terni, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Lorenzo Mariani
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Stefano Avenia
- Postgraduate School of General Surgery, University of Perugia, Perugia, Italy
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, University A. Moro of Bari, Polyclinic of Bari, Bari, Italy
| | - Nicola Avenia
- General and Specialized Surgery, Santa Maria Hospital, Terni, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Walter Bugiantella
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy -
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20
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Saito MK, Quaresma M, Fowler H, Majano SB, Rachet B. Exploring socioeconomic differences in surgery and in time to elective surgery for colon cancer in England: Population-based study. Cancer Epidemiol 2021; 71:101896. [PMID: 33516139 DOI: 10.1016/j.canep.2021.101896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/12/2020] [Accepted: 01/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND A persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential surgical care by SES. METHODS We analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010-2013). We examined patterns of presentation and surgery by SES, and whether socioeconomic differences exist in the length of time from diagnosis to elective major resection using linear regression. RESULTS Among a total of 68 169 patients with colon cancer, 21.0 % (3138/14 917) in the most affluent group had emergency presentation (EP) whereas 27.9 % (2901/10 386) in the most deprived. Among 45 332 (66.5 %) patients who underwent resection, the proportion of patients receiving urgent surgery (surgery before or ≤ 7 days of diagnosis) was higher in the most deprived group (39.9 %, 2685/6733) than the most affluent (35.4 %, 3595/10 146). Days from diagnosis to elective surgery (surgery > 7 days after diagnosis) ranged from 33.9 (95 % CI 33.1-34.8) in stage II to 38.2 (95 % CI 36.8-39.7) in stage I, but no socioeconomic differences in time were seen in all stages. CONCLUSIONS Time to elective surgery for colon cancer did not differ by SES, whereas a higher proportion among deprived patients tended to be diagnosed through EP and to receive urgent surgery. These results suggest that the waiting time target may not be an appropriate measure to assess access to cancer care. Reducing both EP and urgent surgery should be a key policy target.
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Affiliation(s)
- Mari Kajiwara Saito
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Manuela Quaresma
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Helen Fowler
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sara Benitez Majano
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Damhus CS, Siersma V, Dalton SO, Brodersen J. Non-specific symptoms and signs of cancer: different organisations of a cancer patient pathway in Denmark. Scand J Prim Health Care 2021; 39:23-30. [PMID: 33629891 PMCID: PMC7971193 DOI: 10.1080/02813432.2021.1880094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE We aimed to investigate the Non-specific Symptoms and Signs of Cancer-Cancer Patient Pathway (NSSC-CPP) in order to describe organisational and clinical practice similarities and differences in the diagnostic work-up of suspected cancer in Denmark. MATERIAL AND METHODS A questionnaire on the organisation and practice pertaining to the NSSC-CPP was completed by all 21 diagnostic units in the five healthcare regions in Denmark. RESULTS The questionnaire responses revealed regional and intraregional differences in the organisation and clinical practice of the NSSC-CPP. CT scan was the most often used imaging in the NSSC-CPP but there was no consensus whether the CT scan should be ordered and evaluated by general practitioners (GPs) or by the diagnostic units. Two regions were consistent but had different modalities regarding referrals from GPs. Three regions had intra-regional differences. The units reported on different types and frequency of forum for patient plan discussion and how to end a NSSC-CPP. CONCLUSION The NSSC-CPP is implemented with great regional and intra-regional differences in Denmark. GPs face different requirements when referring to the NSSC-CPP, which indicates that the division of role and responsibility between GPs and the diagnostic units is not well defined.KEY POINTSIn Denmark, the cancer patient pathway for non-specific symptoms and signs of cancer (NSSC-CPP) has been implemented with variations, but little is known about these different modalities. This study showed that both at a regional and an intra-regional level:•General practitioners meet different implementation of national guidelines in the diagnostic units when referring to the NSSCP-CPP•The suitable patient group for the NSSC-CPP is not well defined•Quality criteria are needed to monitor, evaluate and improve the diagnostic work-up for patients with non-specific symptoms and signs of cancer.
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Affiliation(s)
- Christina Sadolin Damhus
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Primary Health Care Research Unit, Region Zealand, Denmark
- Survivorship and Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- CONTACT Christina Sadolin Damhus The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Primary Health Care Research Unit, Region Zealand, Denmark
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22
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Molenaar CJL, Winter DC, Slooter GD. Contradictory guidelines for colorectal cancer treatment intervals. Lancet Oncol 2021; 22:167-168. [PMID: 33539739 DOI: 10.1016/s1470-2045(20)30738-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Desmond C Winter
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Gerrit D Slooter
- Department of Surgery, Máxima MC, 5504 DB Veldhoven, Netherlands.
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23
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Warps AK, de Neree tot Babberich MPM, Dekker E, Wouters MWJM, Dekker JWT, Tollenaar RAEM, Tanis PJ. Interhospital referral of colorectal cancer patients: a Dutch population-based study. Int J Colorectal Dis 2021; 36:1443-1453. [PMID: 33743051 PMCID: PMC8195929 DOI: 10.1007/s00384-021-03881-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. METHODS Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. RESULTS In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. CONCLUSION A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.
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Affiliation(s)
- A. K. Warps
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands
| | - M. P. M. de Neree tot Babberich
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - E. Dekker
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - M. W. J. M. Wouters
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands ,grid.430814.aDepartment of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, Netherlands
| | - J. W. T. Dekker
- grid.415868.60000 0004 0624 5690Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625AD Delft, Netherlands
| | - R. A. E. M. Tollenaar
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands
| | - P. J. Tanis
- grid.7177.60000000084992262Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
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24
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Johnson BA, Waddimba AC, Ogola GO, Fleshman JW, Preskitt JT. A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic. Am J Surg 2020; 222:311-318. [PMID: 33317814 PMCID: PMC7834494 DOI: 10.1016/j.amjsurg.2020.12.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
Background Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers. Methods PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included. Results Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28–1.65), lung (HR 1.04, 95%CI 1.02–1.06) and colon (HR 1.24, 95%CI 1.12–1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16–1.40) and II (HR 1.13, 95%CI 1.02–1.24) but not in stage III (HR 1.20, 95%CI 0.94–1.53). Conclusion Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival. Delaying cancer surgeries during the COVID-19 pandemic may impact survival. Surgical delays of 12 weeks decreases survival in breast, lung and colon cancers. Surgical delays worsen survival in stage I and II breast cancers but not stage III. Triage recommendations for future waves of COVID-19 should consider this evidence.
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Affiliation(s)
- Brett A Johnson
- College of Medicine, Texas A&M Health Science Center, Dallas Campus, Texas, United States; Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - Anthony C Waddimba
- Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States; Baylor Scott and White Research Institute, Dallas, TX, United States.
| | - Gerald O Ogola
- Baylor Scott and White Research Institute, Dallas, TX, United States; Biostatistics, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - James W Fleshman
- Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - John T Preskitt
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
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25
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Delaying definitive resection in early stage (I/II) colon cancer appears safe up to 6 weeks. Am J Surg 2020; 222:402-407. [PMID: 33602480 PMCID: PMC7723420 DOI: 10.1016/j.amjsurg.2020.11.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 11/21/2022]
Abstract
Background The objective of this study was to determine if there is an impact of surgical delay on 5-year overall survival (OS) from early stage colon cancer, and if so, to define how long surgery can safely be postponed. Methods Using the NCDB, we compared early (14–30 days) and delayed surgery (31–90 days) in patients with Stage I/II colon cancer. Outcomes included OS at five years and odds of death. Results Delayed resection conferred a decreased 5-year OS of 73.0% (95% CI, 72.6–73.4), compared to early resection 78.3% (95% CI, 77.9–78.8). When time to surgery was divided into one-week intervals, there was no difference in the odds of death with delay up to 35–41 days (6 weeks), but odds of death increased by 9% per week thereafter. Conclusions These data support that definitive resection for early stage colon cancer may be safely delayed up to 6 weeks.
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26
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Roshanaei G, Safari M, Faradmal J, Abbasi M, Khazaei S. Factors affecting the survival of patients with colorectal cancer using random survival forest. J Gastrointest Cancer 2020; 53:64-71. [PMID: 33174117 DOI: 10.1007/s12029-020-00544-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Colorectal cancer is one of the most common cancers and the leading cause of cancer death in Iran. This study aimed to develop and validate a random survival forest (RSF) to identify important risk factors on mortality in colorectal patients based on their demographic and clinical-related variables. METHODS In this retrospective cohort study, the information of 317 patients with colorectal cancer who were referred to Imam Khomeini Clinic of Hamadan during the years of 2002 to 2017 were examined. Patient survival was calculated from the time of diagnosis to death. In the present study, the RSF model was used to identify factors affecting patient survival. Also, the results of the RSF model were compared with the Cox model. The data were analyzed using R software (version 3.6.1) and survival packages. RESULTS One-, 2-, 3-, 4-, 5-, and 10-year survival rates of included patients were 81.4%, 63%, 57%, 52%, 45%, and 34%, respectively, and the median survival was obtained to be 53 months. The number of 150 patients was died at this time period. The four most important predictors of survival included metastasis to other organs, WBC count, disease stage, and number of lymphomas involved. RSF method predicted survival better than the conventional Cox proportional hazard model. CONCLUSION We found that metastasis to other organs, WBC count, disease stage, and number of lymphomas involved were the most four most important predictors of low survival for colorectal cancer patients.
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Affiliation(s)
- Ghodratollah Roshanaei
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Canter, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Malihe Safari
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Canter, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Canter, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Abbasi
- Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
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Carrasco-Peña F, Bayo-Lozano E, Rodríguez-Barranco M, Petrova D, Marcos-Gragera R, Carmona-Garcia MC, Borras JM, Sánchez MJ. Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186697. [PMID: 32938004 PMCID: PMC7558406 DOI: 10.3390/ijerph17186697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 01/19/2023]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28–0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46–0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16–0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55–72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival.
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Affiliation(s)
- Francisco Carrasco-Peña
- Radiation Oncology Department, University Hospital Virgen Macarena, 41009 Sevilla, Spain; (F.C.-P.); (E.B.-L.)
| | - Eloisa Bayo-Lozano
- Radiation Oncology Department, University Hospital Virgen Macarena, 41009 Sevilla, Spain; (F.C.-P.); (E.B.-L.)
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain; (M.R.-B.); (M.-J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain; (M.R.-B.); (M.-J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Correspondence:
| | - Rafael Marcos-Gragera
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Medical Sciences Department, Faculty of Medicine, University of Girona (UdG), 17071 Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Department of Health, Government of Catalonia, 17007 Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Girona Biomedical Research Institute—IDIBGI, Salt, 17190 Girona, Spain;
| | - Maria Carmen Carmona-Garcia
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Girona Biomedical Research Institute—IDIBGI, Salt, 17190 Girona, Spain;
- Medical Oncology Department, Catalan Institute of Oncology, University Hospital Dr Josep Trueta, 17007 Girona, Spain
| | - Josep Maria Borras
- Department of Clinical Sciences, IDIBELL, University of Barcelona, Hospitalet, 08908 Barcelona, Spain;
- Department of Health, Catalonian Cancer Strategy, Hospitalet, 08908 Barcelona, Spain
| | - Maria-José Sánchez
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain; (M.R.-B.); (M.-J.S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Department of Preventive Medicine and Public Health, University of Granada, 18010 Granada, Spain
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28
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Matthews C, Walker M, McLaughlin S, Milloy M, Harmston C. Effect of ethnicity and rurality on treatment delays in patients with colorectal cancer in Northland, New Zealand. ANZ J Surg 2020; 91:375-378. [PMID: 32869410 DOI: 10.1111/ans.16257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Ethnic and rural disparities in medical treatment and outcomes have been demonstrated across a range of conditions, including colorectal cancer. Timely treatment and investigation of symptoms in patients with suspicion of cancer is likely to improve outcomes and patient experience. Achieving equity in timeliness of care is important in achieving the goal of equitable cancer outcomes outlined in the New Zealand cancer action plan. The aim of this study was to compare treatment times in patients with colorectal cancer, between Māori and non-Māori patients as well as urban and rural patients in Northland, New Zealand. METHODS All adult patients diagnosed with colorectal adenocarcinoma from 2011 to 2016 were identified using hospital coding. Further information on the primary cohort was then obtained using the hospitals electronic results system, CONCERTO. The primary outcomes of interest were differences in delays to treatment between Māori and non-Māori as well as Urban versus rural residence. Secondary outcomes of interest included rate of emergency admission and treatment by curative intent in different groups. RESULTS A total of 511 patients formed the primary cohort; 12% were Māori and were on average 6 years younger than non-Māori. Māori had a 6% higher emergency admission rate and a 5% higher rate of palliative treatment intent. No significant difference in treatment delay times was seen between different ethnicities or different domiciles. CONCLUSION Ethnicity and rurality were not shown to affect treatment delays. Further research in this area is needed to help attain equitable outcomes for patients with colorectal cancer in New Zealand.
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Affiliation(s)
- Christina Matthews
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand
| | - Michael Walker
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand
| | - Scott McLaughlin
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Michal Milloy
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand
| | - Chris Harmston
- Department of General Surgery, Northland District Health Board, Whangarei, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
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29
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Onyirioha K, Mittal S, G Singal A. Is hepatocellular carcinoma surveillance in high-risk populations effective? Hepat Oncol 2020; 7:HEP25. [PMID: 32774835 PMCID: PMC7399579 DOI: 10.2217/hep-2020-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Several professional societies recommend hepatocellular carcinoma (HCC) surveillance in high-risk patients including patients with cirrhosis from any etiology and subsets of noncirrhotic chronic hepatitis B virus infection. The efficacy of HCC surveillance to increase early detection and improve survival has been demonstrated in a large randomized controlled trial among hepatitis B virus patients and several cohort studies among those with cirrhosis. However, the effectiveness on HCC surveillance, when applied in clinical practice, is lower due to low utilization of HCC surveillance among at-risk patients, poorer test performance given operator dependency and differences in patient characteristics, and downstream process failures such as treatment delays. Interventions to increase surveillance utilization and improve surveillance test performance should improve surveillance effectiveness in the future.
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Affiliation(s)
- Kristeen Onyirioha
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sukul Mittal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
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30
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He C, Li Y, Huang X, Hu S, Yan Y, Liu Y, Zhao P, Lin H, Xu X, Wang Y, Teng D, Du X. How should colorectal surgeons practice during the COVID-19 epidemic? A retrospective single-centre analysis based on real-world data from China. ANZ J Surg 2020; 90:1310-1315. [PMID: 32462756 PMCID: PMC7283805 DOI: 10.1111/ans.16057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Abstract
Background The coronavirus disease 2019 is currently of global concern. Cancer patients are advised to stay at home in case of potential infection, which may cause delays of routine diagnosis and necessary treatment. How colorectal surgeons should manage this during the epidemic remains a big challenge. The objective of the study is to evaluate the feasibility of routine colorectal surgery during coronavirus disease 2019 and to offer some Chinese recommendations to colorectal surgeons throughout the world. Methods A total of 166 patients receiving colorectal surgery from 20 December 2019 to 20 March 2020 at Department of General Surgery in Chinese General Hospital of People's Liberation Army were enrolled, and further divided into two groups based on before or after admission date of 20 January 2020. Clinicopathologic data such as hospital stay and economic data such as total costs were collected and analysed retrospectively. Results Longer hospital stay, higher proportion of non‐local patients and more hospitalization cost were found in the post‐20 January group (special‐time group) (P < 0.001; P < 0.05; P < 0.05, respectively). Apart from this, no difference existed with regard to baseline demographical data such as age, sex and height, as well as clinicopathological data such as previous history, surgery time, operation extent and TNM staging. Conclusions This real‐world study indicated that performing colorectal surgery during coronavirus disease 2019 epidemic might be safe and feasible based on comprehensive screening and investigation. We have summarized several recommendations here, hoping to help surgeons from related departments across the world.
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Affiliation(s)
- Changzheng He
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Yuxuan Li
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Xiaohui Huang
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Shidong Hu
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Yang Yan
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Yichen Liu
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Pengyue Zhao
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Haiguan Lin
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Xiaolei Xu
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Yufeng Wang
- Department of Patient Admission Management, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Da Teng
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Xiaohui Du
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
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Abdulaal A, Arhi C, Ziprin P. Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study. Interact J Med Res 2020; 9:e15911. [PMID: 32706666 PMCID: PMC7395251 DOI: 10.2196/15911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. OBJECTIVE The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. METHODS This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. RESULTS A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. CONCLUSIONS Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.
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Affiliation(s)
| | | | - Paul Ziprin
- Imperial College London, London, United Kingdom
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Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study. Br J Gen Pract 2020; 70:e463-e471. [PMID: 32540874 DOI: 10.3399/bjgp20x710441] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/16/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Delays in referral for patients with colorectal cancer may occur if the presenting symptom is falsely attributed to a benign condition. AIM To investigate whether delays in referral from primary care are associated with a later stage of cancer at diagnosis and worse prognosis. DESIGN AND SETTING A national retrospective cohort study in England including adult patients with colorectal cancer identified from the cancer registry with linkage to Clinical Practice Research Datalink, who had been referred following presentation to their GP with a 'red flag' or 'non-specific' symptom. METHOD The hazard ratios (HR) of death were calculated for delays in referral of between 2 weeks and 3 months, and >3 months, compared with referrals within 2 weeks. RESULTS A total of 4527 (63.5%) patients with colon cancer and 2603 (36.5%) patients with rectal cancer were included in the study. The percentage of patients presenting with red-flag symptoms who experienced a delay of >3 months before referral was 16.9% of those with colon cancer and 13.5% of those with rectal cancer, compared with 35.7% of patients with colon cancer and 42.9% of patients with rectal cancer who presented with non-specific symptoms. Patients referred after 3 months with red-flag symptoms demonstrated a significantly worse prognosis than patients who were referred within 2 weeks (colon cancer: HR 1.53; 95% confidence interval [CI] = 1.29 to 1.81; rectal cancer: HR 1.30; 95% CI = 1.06 to 1.60). This association was not seen for patients presenting with non-specific symptoms. Delays in referral were associated with a significantly higher proportion of late-stage cancers. CONCLUSION The first presentation to the GP provides a referral opportunity to identify the underlying cancer, which, if missed, is associated with a later stage in diagnosis and worse survival.
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Byskov Petersen G, Sadolin Damhus C, Ryborg Jønsson AB, Brodersen J. The perception gap: how the benefits and harms of cervical cancer screening are understood in information material focusing on informed choice. HEALTH RISK & SOCIETY 2020. [DOI: 10.1080/13698575.2020.1778645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Gabriela Byskov Petersen
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Christina Sadolin Damhus
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- The Research Unit for General Practice in Copenhagen, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice in Copenhagen, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Primary Health Care Research Unit, Zealand Region, Denmark
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Minicozzi P, Vicentini M, Innos K, Castro C, Guevara M, Stracci F, Carmona-Garcia M, Rodriguez-Barranco M, Vanschoenbeek K, Rapiti E, Katalinic A, Marcos-Gragera R, Van Eycken L, Sánchez MJ, Bielska-Lasota M, Rossi PG, Sant M. Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study. Eur J Surg Oncol 2020; 46:1151-1159. [PMID: 32147427 DOI: 10.1016/j.ejso.2020.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established. MATERIALS AND METHODS We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use. RESULTS Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time. CONCLUSIONS Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Clara Castro
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal; EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcela Guevara
- Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy; Umbria Cancer Registry, Perugia, Italy
| | - MaCarmen Carmona-Garcia
- Medical Oncology Department, Catalan Institute of Oncology, Universitary Hospital Dr Josep Trueta, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Miguel Rodriguez-Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | | | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | | | - Rafael Marcos-Gragera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; School of Medicine, University of Girona (UdG), Girona, Spain; Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Universidad de Granada (UGR), Granada, Spain
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Takvorian SU, Oganisian A, Mamtani R, Mitra N, Shulman LN, Bekelman JE, Werner RM. Association of Medicaid Expansion Under the Affordable Care Act With Insurance Status, Cancer Stage, and Timely Treatment Among Patients With Breast, Colon, and Lung Cancer. JAMA Netw Open 2020; 3:e1921653. [PMID: 32074294 DOI: 10.1001/jamanetworkopen.2019.21653] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. OBJECTIVE To examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, difference-in-differences (DID) cross-sectional study included nonelderly adults (aged 40-64 years) with a new diagnosis of invasive breast, colon, or non-small cell lung cancer from January 1, 2011, to December 31, 2016, in the National Cancer Database, a hospital-based registry capturing more than 70% of incident cancer diagnoses in the United States. Data were analyzed from March 8 to August 15, 2019. EXPOSURES Residence in a state that expanded Medicaid on January 1, 2014. MAIN OUTCOMES AND MEASURES The primary outcomes were insurance status, cancer stage, and timely treatment within 30 and 90 days of diagnosis. RESULTS A total of 925 543 patients (78.6% women; mean [SD] age, 55.0 [6.5] years; 14.2% black; and 5.7% Hispanic) had a new diagnosis of invasive breast (58.9%), colon (14.6%), or non-small cell lung (26.5%) cancer; 48.3% resided in Medicaid expansion states and 51.7% resided in nonexpansion states. Compared with nonexpansion states, the percentage of uninsured patients decreased more in expansion states (adjusted DID, -0.7 [95% CI, -1.2 to -0.3] percentage points), and the percentage of early-stage cancer diagnoses rose more in expansion states (adjusted DID, 0.8 [95% CI, 0.3 to 1.2] percentage points). Among the 848 329 patients who underwent cancer-directed therapy within 365 days of diagnosis, the percentage treated within 30 days declined from 52.7% before to 48.0% after expansion in expansion states (difference, -4.7 [95% CI, -5.1 to -4.5] percentage points). In nonexpansion states, this percentage declined from 56.9% to 51.5% (difference, -5.4 [95% CI, -5.6 to -5.1] percentage points), yielding no statistically significant DID in timely treatment associated with Medicaid expansion (adjusted DID, 0.6 [95% CI, -0.2 to 1.4] percentage points). CONCLUSIONS AND RELEVANCE This study found that, among patients with incident breast, colon, and lung cancer, Medicaid expansion was associated with a decreased rate of uninsured patients and increased rate of early-stage cancer diagnosis; no evidence of improvement or decrement in the rate of timely treatment was found. Further research is warranted to understand Medicaid expansion's effect on the treatment patterns and health outcomes of patients with cancer.
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Affiliation(s)
- Samuel U Takvorian
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Arman Oganisian
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ronac Mamtani
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lawrence N Shulman
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Justin E Bekelman
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel M Werner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Gorin SS. Multilevel Approaches to Reducing Diagnostic and Treatment Delay in Colorectal Cancer. Ann Fam Med 2019; 17:386-389. [PMID: 31501198 PMCID: PMC7032906 DOI: 10.1370/afm.2454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sherri Sheinfeld Gorin
- Annals of Family Medicine .,Department of Family Medicine, The University of Michigan School of Medicine, Ann Arbor, Michigan
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Öztürk E, Kuzu MA, Öztuna D, Işık Ö, Canda AE, Balık E, Erkasap S, Yoldaş T, Akyol C, Demirbaş S, Özoğul B, Topçu Ö, Gedik E, Baca B, Ergüner İ, Asoğlu O, Erkek B, Yılmazlar T, Reis E, Gençosmanoğlu R, Konan A. Fall of another myth for colon cancer: Duration of symptoms does not differ between right- or left-sided colon cancers. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:686-694. [PMID: 31418412 DOI: 10.5152/tjg.2019.17770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Patients with colorectal cancer continue to present with relatively advanced tumors that are associated with poor oncological outcomes. The aim of the present study was to assess the association between localization, symptom duration, and tumor stage. MATERIALS AND METHODS A prospective, multicenter cohort study was conducted on patients newly diagnosed with a histologically proven colorectal adenocarcinoma. Standardized questionnaire-interviews were performed. Data were collected on principal presenting symptoms, duration of symptoms (time to first presentation to a doctor and time to diagnosis) and treatment, diagnostic procedures, tumor site, and stage of the tumor (tumor, node, and metastasis (TNM)). RESULTS A total of 1795 patients with colorectal cancer were interviewed (mean age: 60.76±13.50 years, male patients: 1057, patients aged >50 years: 1444, colon/rectal cancer: 899/850, right side/left side: 383/1250, stage 0-1-2/stage 3-4: 746/923). No statistically significant correlations were found between duration of symptoms and either tumor site or stage. Principal presenting symptoms were significantly associated with left colon cancer. Patients who had "anemia," "change in bowel habits," "anal pruritus or discharge," "weight loss," and "tumor in right colon" had a significantly longer symptom time. CONCLUSION Symptom duration is not associated with localization, nor is the tumor stage. Diagnosis of colorectal cancer at an earlier stage may be best achieved by screening of the population.
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Affiliation(s)
- Ersin Öztürk
- Department of General Surgery, Uludağ University School of Medicine, Bursa, Turkey
| | - Mehmet Ayhan Kuzu
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Derya Öztuna
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Özgen Işık
- Department of General Surgery, Uludağ University School of Medicine, Bursa, Turkey
| | - Aras Emre Canda
- Department of General Surgery, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Emre Balık
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Serdar Erkasap
- Department of General Surgery, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Tayfun Yoldaş
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Cihangir Akyol
- Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
| | - Sezai Demirbaş
- Department of General Surgery, GATA School of Medicine, Ankara, Turkey
| | - Bünyamin Özoğul
- Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ömer Topçu
- Department of General Surgery, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ercan Gedik
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Bilgi Baca
- Department of General Surgery, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - İlknur Ergüner
- Department of General Surgery, İstanbul University-Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Oktar Asoğlu
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Bülent Erkek
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Tuncay Yılmazlar
- Department of General Surgery, Uludağ University School of Medicine, Bursa, Turkey
| | - Erhan Reis
- Department of General Surgery, Demetevler Oncology Hospital, Ankara, Turkey
| | - Rasim Gençosmanoğlu
- Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey
| | - Ali Konan
- Department of General Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Fernández-de Castro JD, Baiocchi Ureta F, Fernández González R, Pin Vieito N, Cubiella Fernández J. The effect of diagnostic delay attributable to the healthcare system on the prognosis of colorectal cancer. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:527-533. [PMID: 31421857 DOI: 10.1016/j.gastrohep.2019.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/25/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To analyse the effect of a delay attributable to the healthcare system on a consecutive cohort of outpatients diagnosed with colorectal cancer in the healthcare area of Ourense (Spain). PATIENTS AND METHODS We performed a retrospective cohort study that included patients diagnosed between 2009 and 2017. Delay attributable to the healthcare system was defined as the time between the first consultation with symptoms and the diagnostic confirmation. A logistic regression model was performed to evaluate the relationship between stage IV CRC and diagnostic delay. To analyse which variables were associated independently with overall mortality and mortality due to CRC we used a Cox regression model. RESULTS 575 patients were included (men 64.5%, age 71.9 ± 11.5 years), with a delay attributable to the healthcare system of 115 ± 153 days. None of the variables analysed were associated with tumour stage at diagnosis. With a mean follow-up of 30.6 ± 21 months, 121 patients died (79.3% due to CRC). The variables independently associated with CRC-related mortality were metastatic CRC (HR 50.65, 95% CI 12.28-209), age (HR 1.04, 95% CI 1.02-1.05) and colonoscopy requested from the Primary Healthcare level (HR 0.55, 95% CI 0.36-0.88). CONCLUSIONS Diagnostic delay attributable to the healthcare system is not related to the prognosis or stage of CRC. However, a direct referral to colonoscopy from the Primary Healthcare level reduces the risk of mortality in our patients.
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Affiliation(s)
| | - Franco Baiocchi Ureta
- Servicio de Aparato Dixestivo, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | | | - Noel Pin Vieito
- Servicio de Aparato Dixestivo, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - Joaquín Cubiella Fernández
- Servicio de Aparato Dixestivo, Complexo Hospitalario Universitario de Ourense, Ourense, España; Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Ourense, España
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Zurko JC, Wade RC, Mehta A. The impact of structural factors on diagnostic delay in diffuse large B-cell lymphoma. Cancer Med 2019; 8:1416-1422. [PMID: 30884208 PMCID: PMC6488145 DOI: 10.1002/cam4.2009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/29/2018] [Accepted: 01/15/2019] [Indexed: 11/08/2022] Open
Abstract
Background Reducing diagnostic delays in cancer has been a major interest worldwide; however, the literature on diagnostic delays in lymphoma remains scarce. Diffuse large B‐cell lymphoma (DLBCL) is the most common non‐Hodgkin's lymphoma. We aimed to determine whether certain structural factors predicted diagnostic delays in DLBCL and whether diagnostic delays impacted overall survival (OS). Methods Data were extracted via a retrospective cohort design from a single academic tertiary care referral center. A total of 104 patients were included. Time from first symptoms to diagnosis of <3 months was defined as “early diagnosis” and ≥3 months as “delayed diagnosis”. Analysis was performed with student's t‐test, chi‐square testing, binomial logistic regression, and Kaplan‐Meier log‐rank testing. Results “Delayed diagnosis” was more likely with lower stage, lower international prognostic index (IPI), and further distance from referral center (OR 0.66, CI 0.46‐0.95; OR 0.69, CI 0.51‐0.94; OR 1.008, CI 1.001‐1.015). Patients of “other” ethnicity and without medical insurance were more likely to have significant diagnostic delays and worse overall survival (P = 0.002 and P = 0.007, respectively). Diagnostic delays of ≥3 months did not predict worse OS. However, delays of >6 months did predict worse OS. Conclusion Our data suggest that excessive diagnostic delays of more than 6 months, ethnic minority status, and uninsured status in DLBCL may lead to worse outcomes. Efforts should be undertaken to reduce excessive diagnostic delays. More investigation needs to be done on the impacts of diagnostic delays in both DLBCL and other aggressive lymphomas.
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Affiliation(s)
- Joanna C Zurko
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raymond C Wade
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Lee YH, Kung PT, Wang YH, Kuo WY, Kao SL, Tsai WC. Effect of length of time from diagnosis to treatment on colorectal cancer survival: A population-based study. PLoS One 2019; 14:e0210465. [PMID: 30640932 PMCID: PMC6331126 DOI: 10.1371/journal.pone.0210465] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
Evidence is limited regarding the effect of diagnosis-to-treatment interval (DTI) on the survival of colorectal cancer (CRC) patients. In addition, previous studies on treatment delay and CRC survival have largely grouped patients from all stages (I-IV) into one cohort. Our study provides analysis on each stage individually. We conducted a retrospective cohort study with 39,000 newly diagnosed CRC patients obtained from the Taiwan Cancer Registry Database from 2004–2010 to examine the effect of DTIs on overall survival. DTIs were divided into 3 groups: ≤ 30 days (36,115 patients, 90.5% of study patients), 31–150 days (2,533, 6.4%), and ≥ 151 days (1,252, 3.15%). Risk of death was increased for DTI 31–150 days (hazard ratio 1.51; 95% confidence interval 1.43–1.59) and DTI ≥ 151 days (1.64; 1.54–1.76) compared to DTI ≤ 30. This risk was consistent across all cancer stages. Additional factors that increased risk of death include male gender, age >75, Charlson Comorbidity Index ≥7, other catastrophic illnesses, lack of multidisciplinary team involvement, and treatment in a low volume center. From these results, we advise that the DTI for all CRC patients, regardless of cancer staging, should be 30 days or less.
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Affiliation(s)
- Yung-Heng Lee
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- Department of Public Health, China Medical University, Taiwan, ROC
- Department of Orthopedics, Miaoli General Hospital, Miaoli, Taiwan, ROC
- Department of Nursing Administration, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Su-Ling Kao
- Department of Nursing Administration, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
- Department of Human Resource, Cishan General Hospital, Kaohsiung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- * E-mail:
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Xue L, Williamson A, Gaines S, Andolfi C, Paul-Olson T, Neerukonda A, Steinhagen E, Smith R, Cannon LM, Polite B, Umanskiy K, Hyman N. An Update on Colorectal Cancer. Curr Probl Surg 2018; 55:76-116. [PMID: 29631699 DOI: 10.1067/j.cpsurg.2018.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lai Xue
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | - Sara Gaines
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Ciro Andolfi
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Terrah Paul-Olson
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Anu Neerukonda
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Emily Steinhagen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Radhika Smith
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Lisa M Cannon
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Blasé Polite
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | | | - Neil Hyman
- Department of Surgery, University of Chicago Medicine, Chicago, IL.
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Bagaria SP, Heckman MG, Diehl NN, Parker A, Wasif N. Delay to Colectomy and Survival for Patients Diagnosed with Colon Cancer. J INVEST SURG 2018; 32:350-357. [PMID: 29351008 DOI: 10.1080/08941939.2017.1421732] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: A long wait-time for colectomy for colon cancer should theoretically affect survival but, to date, the association between delay to colectomy and survival remains unresolved. Methods: We studied 4,685 patients who underwent a colectomy for colon cancer between 1990 and 2012. Wait-time was defined as the number of days between diagnosis and colectomy. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Results: The number of patients in the wait-time group of 1-21 days was 3,529 (75.3%), 22-42 days was 842 (18.0%), 43-84 days was 253 (5.4%), and >84 days was 61 (1.3%). When compared to patients undergoing surgery in the first week after diagnosis, there was no increased risk of death until wait time >84 days (HR = 1.47; 95% CI, 1.02-2.11; p =.038). Patients in the wait time >84 day group tended to be older, traveled further for colectomy, and had tumors with a lower histologic grade. Conclusions: Colectomy for colon cancer performed up to 3 months following diagnosis is not associated with adverse long-term survival. These data provide a framework to address concerns over prolonged wait-times and direct efforts for timely surgery in patients with colon cancer.
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Affiliation(s)
- Sanjay P Bagaria
- a Department of Surgery , Mayo Clinic , Jacksonville , Florida , USA
| | - Michael G Heckman
- b Department of Health Sciences Research , Mayo Clinic , Jacksonville , Florida , USA
| | - Nancy N Diehl
- b Department of Health Sciences Research , Mayo Clinic , Jacksonville , Florida , USA
| | - Alexander Parker
- b Department of Health Sciences Research , Mayo Clinic , Jacksonville , Florida , USA
| | - Nabil Wasif
- c Department of Surgery , Mayo Clinic , Scottsdale , Arizona , USA
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Patel R, Anderson JE, McKenzie C, Simpson M, Singh N, Ruzvidzo F, Sharma P, Scott R, MacDonald A. Compliance with the 62-day target does not improve long-term survival. Int J Colorectal Dis 2018; 33:65-69. [PMID: 29101452 DOI: 10.1007/s00384-017-2930-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
AIMS Scottish Intercollegiate Guidelines Network (SIGN) guidelines require patients with colorectal cancer to wait no longer than 62 days from first referral to initiation of definitive treatment. We previously demonstrated that failure to meet with these guidelines did not appear to lead to poor outcomes in the short term. This study investigates whether this holds true over a longer period. METHODS The survival status of 1,012 patients treated for colorectal cancer between January 1999 and June 2005 was reviewed. As in the previous audit, patients were placed into four groups, standard met (elective), standard met (emergency), standard failed (elective) and standard failed (emergency). Parameters analysed were pathological staging, 30-day mortality, long-term survival and cause of death. Data was analysed using log rank and chi-squared tests. RESULTS Operative mortality was higher in patients meeting the standard (7% elective, 20% emergency) compared to those who did not meet the standard (4% elective, 7% emergency). The proportion of early stage disease (Dukes' A and B) was highest in elective patients who failed the standard (50%) and lowest in emergencies meeting the standard (30%). Long-term survival was greatest in elective patients who failed the standard with 52% alive in October 2011 compared to 34% of elective cases meeting the standard. The most common cause of recorded death was colorectal cancer in all groups. CONCLUSIONS Patients who were not treated within the time frame set by the SIGN guidelines survived for longer following surgery. Reasons for this are likely to be multifactorial and include pathological cancer stage.
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Affiliation(s)
- Ronak Patel
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland.
| | - John E Anderson
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland
| | - Claire McKenzie
- Department of Clinical Effectiveness, NHS Lanarkshire, Monklands Hospital, Airdrie, Scotland
| | - Mhairi Simpson
- Department of Clinical Effectiveness, NHS Lanarkshire, Monklands Hospital, Airdrie, Scotland
| | - Nina Singh
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland
| | - Fredrick Ruzvidzo
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland
| | - Praveen Sharma
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland
| | - Roy Scott
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland
| | - Angus MacDonald
- Department of Colorectal Surgery, NHS Lanarkshire, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, Scotland
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Abstract
BACKGROUND Studies examining treatment delay and survival after surgical treatment of colon cancer have varied in quality and outcome, with little evidence available regarding the safety of longer surgical treatment wait times. OBJECTIVE Our study examined the effect of surgical treatment wait times on survival for patients with stage I to III colon cancer. DESIGN A subset cohort analysis was performed using data from a prospectively maintained database. SETTINGS The study was conducted at a tertiary referral center. PATIENTS Data on all of the patients undergoing elective surgery for stage I to III colon cancer from 2006 to 2015 were collected from a prospectively maintained clinical and administrative database. MAIN OUTCOME MEASURES We examined the impact of prolonged wait time to surgery on disease-free and overall survival. Patients were divided into 2 groups based on a treatment wait time of ≤30 or >30 days and were compared using a Cox proportional hazards model. A subgroup analysis was performed using alternative treatment delay cutoffs of 60 and 90 days. RESULTS There were 908 patients with stage I to III colon cancer treated over the study period, with a median treatment wait time of 38 days (interquartile range, 21-61 days); 368 patients were treated within 30 days, and 540 were treated beyond 30 days from diagnosis. In adjusted multivariate analysis, a treatment delay of >30 days was not associated with decreased disease-free survival (HR = 0.89 (95% CI, 0.61-1.3); p = 0.52) or overall survival (HR = 0.82 (95% CI, 0.63-1.1); p = 0.16). Likewise, subgroup analysis using alternative treatment delay cutoffs of 60 and 90 days did not demonstrate an adverse effect on survival. LIMITATIONS This study was limited by retrospective analysis. CONCLUSIONS Despite longer median treatment wait times from diagnosis to surgery, with the majority of patients exceeding 30 days and many experiencing delays of 2 to 3 months, no adverse impact on survival was observed. Patients who require additional consultations or investigations preoperatively may safely have their surgery moderately delayed to minimize their perioperative risk without any evidence that this will compromise treatment outcomes. See Video Abstract at http://links.lww.com/DCR/A397.
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Kozak VN, Khorana AA, Amarnath S, Glass KE, Kalady MF. Multidisciplinary Clinics for Colorectal Cancer Care Reduces Treatment Time. Clin Colorectal Cancer 2017; 16:366-371. [DOI: 10.1016/j.clcc.2017.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/16/2017] [Indexed: 01/13/2023]
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46
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Soresi M, Licata A, Giannitrapani L, Montalto G. Waiting-time and quality of care deserved to patients with early stage hepatocellular carcinoma undergoing RFA treatment. Ann Hepatol 2017; 16:699-701. [PMID: 28809739 DOI: 10.5604/01.3001.0010.2706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Maurizio Soresi
- University of Palermo, Palermo, Italy Biomedical Department of Internal Medicine and Specialties
| | - Anna Licata
- University of Palermo, Palermo, Italy Biomedical Department of Internal Medicine and Specialties
| | - Lydia Giannitrapani
- University of Palermo, Palermo, Italy Biomedical Department of Internal Medicine and Specialties
| | - Giuseppe Montalto
- University of Palermo, Palermo, Italy Biomedical Department of Internal Medicine and Specialties
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Jones LA, Ferrans CE, Polite BN, Brewer KC, Maker AV, Pauls HA, Rauscher GH. Examining racial disparities in colon cancer clinical delay in the Colon Cancer Patterns of Care in Chicago study. Ann Epidemiol 2017; 27:731-738.e1. [PMID: 29173578 PMCID: PMC5728690 DOI: 10.1016/j.annepidem.2017.10.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 08/18/2017] [Accepted: 10/04/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE We explored a potential racial disparity in clinical delay among non-Hispanic (nH) Black and White colon cancer patients and examined factors that might account for the observed disparity. METHODS Patients aged 30-79 years with a newly diagnosed colon cancer from 2010 to 2014 (n = 386) were recruited from a diverse sample of nine public, private, and academic hospitals in and around Chicago. Prolonged clinical delay was defined as 60 days or more or 90 days or more between medical presentation (symptoms or a screen-detected lesion) and treatment initiation (surgery or chemotherapy). Multivariable logistic regression with model-based standardization was used to estimate the disparity as a difference in prevalence of prolonged delay by race. RESULTS Prevalence of delay in excess of 60 days was 12 percentage points (95% confidence interval: 2%, 22%) higher among nH Blacks versus Whites after adjusting for age, facility, and county of residence. Travel burden (time and distance traveled from residence to facility) explained roughly one-third of the disparity (33%, P = .05), individual and area-level socioeconomic status measures explained roughly one-half (51%, P = .21), and socioeconomic measures together with travel burden explained roughly four-fifths (79%, P = .08). CONCLUSIONS Low socioeconomic status and increased travel burden are barriers to care disproportionately experienced by nH Black colon cancer patients.
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Affiliation(s)
- Lindsey A Jones
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago
| | - Carol Estwing Ferrans
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago; Institute for Health Research and Policy, University of Illinois, Chicago
| | - Blase N Polite
- Department of Medical Oncology, University of Chicago Medicine, Chicago, IL
| | - Katherine C Brewer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of Illinois, Chicago; Creticos Cancer Center, Advocate Illinois Masonic Medical Center, Chicago
| | - Heather A Pauls
- Institute for Health Research and Policy, University of Illinois, Chicago
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago; Institute for Health Research and Policy, University of Illinois, Chicago.
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Merki-Künzli C, Kerstan-Huber M, Switalla D, Gisi D, Raptis DA, Greco N, Mungo G, Wirz M, Gloor S, Misirlic M, Breitenstein S, Tschuor C. Assessing the Value of Prehabilitation in Patients Undergoing Colorectal Surgery According to the Enhanced Recovery After Surgery (ERAS) Pathway for the Improvement of Postoperative Outcomes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e199. [PMID: 29079551 PMCID: PMC5681719 DOI: 10.2196/resprot.7972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023] Open
Abstract
Background A key element in the postoperative phase of the standardized Enhanced Recovery After Surgery (ERAS) treatment pathways is mobilization. Currently, there are no recommendations in the ERAS guidelines for preoperative physical activity. Patients undergoing major surgery are prone to functional decline due to the impairment of muscle, cardiorespiratory, and neurological function as a response to surgical stress. It has been shown that preoperative physical training reduces postoperative complications. To date, there are limited studies that investigate preoperative physical training combined with ERAS. Objective The aim of this study is to assess the impact of tailored physical training prior to colorectal surgery conducted according to an ERAS protocol on overall morbidity. This study proposes the initial hypothesis that 3-6 weeks of prehabilitation before elective colorectal surgery may improve postoperative outcome and reduce complication rates, assessed using the Comprehensive Complication Index. The primary objective is to evaluate overall morbidity due to postoperative complications. Additionally, complications are assessed according to the Clavien-Dindo classification, length of stay, readmission rate, mortality rate, and treatment-related costs. Methods The prehabilitation Enhanced Recovery After colorectal Surgery (pERACS) study is a single-center, single-blinded prospective randomized controlled trial. Patients scheduled for colorectal resections are randomly assigned either to the prehabilitation group or the control group. All patients are treated with the ERAS pathway for colorectal resections according to a standardized study schedule. Sample size calculation performed by estimating a clinically relevant 25% reduction of postoperative complications (alpha=.05, power 80%, dropout rate of 10%) resulted in 56 randomized patients per group. Results Following ethical approval of the study protocol, the first patient was included in June 2016. At this time, a total of 40 patients have been included; 27 patients terminated the study by the end of March 2017. Results are expected to be published in 2018. Conclusions The pERACS trial is a single-center, single-blinded prospective randomized controlled trial to assess the impact of tailored physical training prior to colorectal surgery, conducted according to an ERAS protocol, in order to evaluate overall morbidity. Trial Registration Clinicaltrials.gov NCT02746731; https://clinicaltrials.gov/ct2/show/NCT02746731 (Archived by WebCite at http://www.webcitation.org/6tzblGwge)
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Affiliation(s)
| | - Marta Kerstan-Huber
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Denise Switalla
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - David Gisi
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Dimitri Aristotle Raptis
- Division of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Nicola Greco
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Giuseppe Mungo
- Institute of Physiotherapy, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Severin Gloor
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Merima Misirlic
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Christoph Tschuor
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Division of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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Jensen H, Vedsted P, Møller H. Prognosis of cancer in persons with infrequent consultations in general practice: A population-based cohort study. Int J Cancer 2017; 141:2400-2409. [DOI: 10.1002/ijc.30916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Henry Jensen
- Department of Public Health; Research Centre for Cancer Diagnosis in Primary Care, Aarhus University; Denmark
- Department of Public Health; Research Unit for General Practice, Aarhus University; Denmark
| | - Peter Vedsted
- Department of Public Health; Research Centre for Cancer Diagnosis in Primary Care, Aarhus University; Denmark
- Department of Public Health; Research Unit for General Practice, Aarhus University; Denmark
| | - Henrik Møller
- Department of Public Health; Research Centre for Cancer Diagnosis in Primary Care, Aarhus University; Denmark
- Cancer Epidemiology and Population Health; King's College London; United Kingdom
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50
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Tørring ML, Murchie P, Hamilton W, Vedsted P, Esteva M, Lautrup M, Winget M, Rubin G. Evidence of advanced stage colorectal cancer with longer diagnostic intervals: a pooled analysis of seven primary care cohorts comprising 11 720 patients in five countries. Br J Cancer 2017; 117:888-897. [PMID: 28787432 PMCID: PMC5589987 DOI: 10.1038/bjc.2017.236] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/24/2017] [Accepted: 06/29/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The benefits from expedited diagnosis of symptomatic cancer are uncertain. We aimed to analyse the relationship between stage of colorectal cancer (CRC) and the primary and specialist care components of the diagnostic interval. METHODS We identified seven independent data sets from population-based studies in Scotland, England, Canada, Denmark and Spain during 1997-2010 with a total of 11 720 newly diagnosed CRC patients, who had initially presented with symptoms to a primary care physician. Data were extracted from patient records, registries, audits and questionnaires, respectively. Data sets were required to hold information on dates in the diagnostic interval (defined as the time from the first presentation of symptoms in primary care until the date of diagnosis), symptoms at first presentation in primary care, route of referral, gender, age and histologically confirmed stage. We carried out reanalysis of all individual data sets and, using the same method, analysed a pooled individual patient data set. RESULTS The association between intervals and stage was similar in the individual and combined data set. There was a statistically significant convex (∩-shaped) association between primary care interval and diagnosis of advanced (i.e., distant or regional) rather than localised CRC (P=0.004), with odds beginning to increase from the first day on and peaking at 90 days. For specialist care, we saw an opposite and statistically significant concave (∪-shaped) association, with a trough at 60 days, between the interval and diagnosis of advanced CRC (P<0.001). CONCLUSIONS This study provides evidence that longer diagnostic intervals are associated with more advanced CRC. Furthermore, the study cannot define a specific 'safe' waiting time as the length of the primary care interval appears to have negative impact from day one.
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Affiliation(s)
- M L Tørring
- Department of Anthropology, School of Culture and Society, Aarhus University, Moesgaard Allé 20, Højbjerg DK-8270, Denmark
| | - P Murchie
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - W Hamilton
- University of Exeter, College House, St Luke’s Campus, Magdalen Road, Exeter EX1 2 LU, UK
| | - P Vedsted
- Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Bartholins Allé 20, Aarhus C DK-8000, Denmark
| | - M Esteva
- Primary Care Research Unit, Primary Care Majorca Department, Balearic Islands Health Research Institute (IdISBa), Reina Esclaramunda 9, Palma Mallorca 07003, Spain
| | - M Lautrup
- Department of Organ and Plastic Surgery, Breast Centre, Vejle Hospital, Kabbeltoft 25, Vejle DK-7100, Denmark
| | - M Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB #X214, Stanford, California CA 94305, USA
| | - G Rubin
- School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Queen’s Campus, University Boulevard, Stockton on Tees, England TS17 6BH, UK
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