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Hiscock J, Law RJ, Brain K, Smits S, Nafees S, Williams NH, Rose J, Lewis R, Roberts JL, Hendry A, Neal RD, Wilkinson C. Hidden systems in primary care cancer detection: an embedded qualitative intervention development study. Br J Gen Pract 2024; 74:e544-e551. [PMID: 38806209 PMCID: PMC11257065 DOI: 10.3399/bjgp.2023.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 05/13/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND UK cancer mortality is worse than in many other high-income countries, partly because of diagnostic delays in primary care. AIM To understand beliefs and behaviours of GPs, and systems of general practice teams, to inform the Think Cancer! intervention development. DESIGN AND SETTING An embedded qualitative study guided by behaviour change models (COM-B [Capability, Opportunity, Motivation - Behaviour] and theoretical domains framework [TDF]) in primary care in Wales, UK. METHOD Twenty qualitative, semi-structured telephone interviews with GPs were undertaken and four face-to-face focus groups held with practice teams. Framework analysis was used and results were mapped to multiple, overlapping components of COM-B and TDF. RESULTS Three themes illustrate complex, multilevel referral considerations facing GPs and practice teams; external influences and constraints; and the role of practice systems and culture. Tensions emerged between individual considerations of GPs (Capability and Motivation) and context-dependent external pressures (Opportunity). Detecting cancer was guided not only by external requirements, but also by motivational factors GPs described as part of their cancer diagnostics process. External influences on the diagnosis process often resulted from the primary-secondary care interface and social pressures. GPs adapted their behaviour to deal with this disconnect. Positive practice culture and supportive practice-based systems ameliorated these tensions and complexity. CONCLUSION By exploring individual GP behaviours together with practice systems and culture we contribute new understanding about how cancer diagnosis operates in primary care and how delays can be improved. We highlight commonly overlooked dynamics and tensions that are experienced by GPs as a tension between individual decision making (Capability and Motivation) and external considerations, such as pressures in secondary care (Opportunity).
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Affiliation(s)
- Julia Hiscock
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | - Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | - Sadia Nafees
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Jan Rose
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Ruth Lewis
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Jessica L Roberts
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Annie Hendry
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
| | - Richard D Neal
- DISCO (Diagnosis of Symptomatic Cancer Optimally), University of Exeter, Exeter
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Wrexham
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Kızılırmak D, Yılmaz Kaya Z, Gökçimen G, Havlucu Y, Cengiz Özyurt B, Gündoğuş B, Esendağlı D, Serez Kaya B, Yılmam İ, Aydemir Y, Çolak M, Afşin E, Çetin N, İdikut A, Değirmenci C, Oral Tapan Ö, Gündüz Gürkan C, Kocatürk Cİ, Ömeroğlu Şimşek G, Kalafat CE, Özgün Niksarlıoğlu EY, Ergün Serdaroğlu M, Karcıoğlu O, Özyurt S, Karahacıoğlu Madran E, Yaprak Bayrak B, Alasgarova Z, Baydar Toprak O, Yılmazel Uçar E, Topal BN, Argun Barış S, Guliyev E, Güzel E, Küçük S, Ocaklı B, Baran Ketencioğlu B, Selçuk NT, Sarı Akyüz M, Sercan Özgür E, Yetkin NA, Çetinkaya PD, Deniz PP, Atlı S, Çetindoğan H, Karakaş FG, Yılmaz ES, Ergün D, Ergün R, Tulay CM, Ünsal M, Demirkaya İ, Marım F, Kaya İ, Demirdöğen E, Görek Dilektaşlı A, Ursavaş A, Çelik P. Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey. Cancer Epidemiol 2023; 87:102480. [PMID: 37897971 DOI: 10.1016/j.canep.2023.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.
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Affiliation(s)
- Deniz Kızılırmak
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey.
| | - Zeynep Yılmaz Kaya
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
| | - Gizem Gökçimen
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
| | - Yavuz Havlucu
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
| | - Beyhan Cengiz Özyurt
- Manisa Celal Bayar University, Faculty of Medicine, Department of Public Health, Manisa, Turkey
| | - Baran Gündoğuş
- Health Sciences University, Faculty of Medicine, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | - Dorina Esendağlı
- Başkent University Ankara Hospital, Faculty of Medicine, Chest Diseases Department, Ankara, Turkey
| | - Bilkay Serez Kaya
- Trakya University, Faculty of Medicine, Chest Diseases Department, Edirne, Turkey
| | - İlker Yılmam
- Trakya University, Faculty of Medicine, Chest Diseases Department, Edirne, Turkey
| | - Yusuf Aydemir
- Sakarya University, Faculty of Medicine, Chest Diseases Department, Sakarya, Turkey
| | - Mücahit Çolak
- Sakarya University, Faculty of Medicine, Chest Diseases Department, Sakarya, Turkey
| | - Emine Afşin
- Abant İzzet Baysal University, Faculty of Medicine, Chest Diseases Department, Bolu, Turkey
| | - Nazlı Çetin
- Pamukkale University, Faculty of Medicine, Chest Diseases Department, Denizli, Turkey
| | - Aytekin İdikut
- Hacettepe University, Faculty of Medicine, Chest Diseases Department, Ankara, Turkey
| | - Ceren Değirmenci
- Muğla Training and Research Hospital, Chest Diseases Department, Muğla, Turkey
| | - Özge Oral Tapan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Chest Diseases Department, Muğla, Turkey
| | - Canan Gündüz Gürkan
- Health Sciences University, Faculty of Medicine, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | | | | | - Cem Emrah Kalafat
- Medicana Ataşehir Hospital, Thoracic Surgery Department, İstanbul, Turkey
| | - Elif Yelda Özgün Niksarlıoğlu
- Health Sciences University, Faculty of Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | - Merdiye Ergün Serdaroğlu
- Health Sciences University, Faculty of Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | - Oğuz Karcıoğlu
- Hacettepe University, Faculty of Medicine, Chest Diseases Department, Ankara, Turkey
| | - Songül Özyurt
- Recep Tayyip Erdoğan University, Faculty of Medicine, Chest Diseases Department, Rize, Turkey
| | | | - Büşra Yaprak Bayrak
- Kocaeli University, Faculty of Medicine, Departmant of Medical Pathology, Kocaeli, Turkey
| | | | - Oya Baydar Toprak
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Elif Yılmazel Uçar
- Atatürk University, Faculty of Medicine, Chest Diseases Department, Erzurum, Turkey
| | - Burcu Nur Topal
- Atatürk University, Faculty of Medicine, Chest Diseases Department, Erzurum, Turkey
| | - Serap Argun Barış
- Kocaeli University, Faculty of Medicine, Chest Diseases Department, Kocaeli, Turkey
| | - Elif Guliyev
- Kocaeli University, Faculty of Medicine, Chest Diseases Department, Kocaeli, Turkey
| | - Efraim Güzel
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Salih Küçük
- Kocaeli City Hospital, Chest Diseases Department, Kocaeli, Turkey
| | - Birsen Ocaklı
- Health Sciences University, Faculty of Medicine, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | | | | | - Merve Sarı Akyüz
- Antalya Training and Research Hospital, Chest Diseases Department, Antalya, Turkey
| | - Eylem Sercan Özgür
- Mersin University, Faculty of Medicine, Chest Diseases Department, Mersin, Turkey
| | - Nur Aleyna Yetkin
- Erciyes University, Faculty of Medicine, Chest Diseases Department, Kayseri, Turkey
| | - Pelin Duru Çetinkaya
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Pelin Pınar Deniz
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Siahmet Atlı
- Van Training and Research Hospital, Chest Diseases Department, Van, Turkey
| | - Hatice Çetindoğan
- Dr. Ersin Arslan Training and Research Hospital, Chest Diseases Department, Gaziantep, Turkey
| | | | - Emine Serap Yılmaz
- Ordu University, Faculty of Medicine, Chest Diseases Department, Ordu, Turkey
| | - Dilek Ergün
- Selçuk University, Faculty of Medicine, Chest Diseases Department, Konya, Turkey
| | - Recai Ergün
- Selçuk University, Faculty of Medicine, Chest Diseases Department, Konya, Turkey
| | - Cumhur Murat Tulay
- Manisa Celal Bayar University, Faculty of Medicine, Department of Thoracic Surgery, Manisa, Turkey
| | - Meftun Ünsal
- Ondokuz Mayıs University, Faculty of Medicine, Chest Diseases Department, Samsun, Turkey
| | - İlker Demirkaya
- Ondokuz Mayıs University, Faculty of Medicine, Chest Diseases Department, Samsun, Turkey
| | - Feride Marım
- Kütahya Health Sciences University, Faculty of Medicine, Chest Diseases Department, Kütahya, Turkey
| | - İlknur Kaya
- Kütahya Health Sciences University, Faculty of Medicine, Chest Diseases Department, Kütahya, Turkey
| | - Ezgi Demirdöğen
- Uludağ University, Faculty of Medicine, Chest Diseases Department, Bursa, Turkey
| | | | - Ahmet Ursavaş
- Uludağ University, Faculty of Medicine, Chest Diseases Department, Bursa, Turkey
| | - Pınar Çelik
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
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Fahim AM, Dacrory S, Elsayed GH. Anti-proliferative activity, molecular genetics, docking analysis, and computational calculations of uracil cellulosic aldehyde derivatives. Sci Rep 2023; 13:14563. [PMID: 37666882 PMCID: PMC10477303 DOI: 10.1038/s41598-023-41528-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
In this study, the oxidation of microcrystalline cellulose using NaIO4 to yield the corresponding cellulose aldehyde utilized microwave irradiation as a green tool, the obtained cellulosic aldehyde was confirmed through spectral analysis and it has an active site to react with the synthesized uracil acetamide to afford the corresponding arylidene cellulosic MDAU(4), the latter compound which can easily due to presence of active CH=group behind a cyano group react with nitrogen nucleophile's and cyclized with hydrazine hydrate to give pyrazole cellulosic MDPA(5). The spectral analysis of the obtained cellulosic derivatives was confirmed with FT-IR, NMR, and SEM. Additionally, a neutral red uptake analysis has been used to investigate the cytotoxic activity of the cellulosic compounds MDAC(2), MDAU(4), and MDAP(5) against the cancer cells A549 and Caco2. After 48 h, Compound MDAU(4) had a stronger inhibitory effect on the growth of A549 and Caco2, compared to standard values. Then, using QRT-PCR, the appearance sites of the genes -Catenin, c-Myc, Cyclin D1, and MMP7 in A549 cells were examined. By reducing the expression levels of the Wnt signaling cascade genes -Catenin, c-Myc, Cyclin D1, and MMP7 when administered to A549 cells, compound MDAU(4) was shown in this investigation to be a viable candidate compared to lung cancer. Additionally, docking simulation was used to explore the uracil cellulosic heterocycles attached to different proteins, and computational investigations of these compounds looked at how well their physical characteristics matched the outcomes of their experiments.
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Affiliation(s)
- Asmaa M Fahim
- Green Chemistry Department, National Research Centre (NRC), P.O. Box 12622, DokkiCairo, Egypt.
| | - Sawsan Dacrory
- Cellulose and Paper Department, National Research Centre, P.O. Box 12622, Giza, Egypt
| | - Ghada H Elsayed
- Department of Hormones, National Research Centre (NRC), P.O. Box 12622, Dokki, Giza, Egypt
- Stem Cells Lab, Center of Excellence for Advanced Sciences, National Research Centre (NRC), P.O. Box 1262, Dokki, Giza, Egypt
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimizing the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect 2022; 25:3246-3258. [PMID: 36263948 PMCID: PMC9700133 DOI: 10.1111/hex.13632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.
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Affiliation(s)
- Debbie Cavers
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Mia Nelson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jasmin Rostron
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
- Present address:
The National Institute of Economic and Social Research2 Dean Trench Street, London NW1P 3HEUK
| | - Kathryn A. Robb
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Christine Campbell
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ahsan R. Akram
- Centre for Inflammation Research and Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Graeme Dickie
- Care of the Usher InstituteUniversity of Edinburgh, EdinburghEdinburghUK
| | | | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Robert J. Steele
- School of Medicine, Ninewells HospitalUniversity of DundeeDundeeUK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - David Weller
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
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Marzo-Castillejo M, Bartolomé-Moreno C, Bellas-Beceiro B, Melús-Palazón E, Vela-Vallespín C. [PAPPS Expert Groups. Cancer prevention recommendations: Update 2022]. Aten Primaria 2022; 54 Suppl 1:102440. [PMID: 36435580 PMCID: PMC9705215 DOI: 10.1016/j.aprim.2022.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Cancer is a major cause of morbidity and mortality. Tobacco use, unhealthy diet, and physical inactivity are some of the lifestyle risk factors that have led to an increase in cancer. This article updates the evidence and includes recommendations for prevention strategies for each of the cancers with the highest incidence. These are based on the reduction of risk factors (primary prevention) and early diagnosis of cancer through screening and early detection of signs and symptoms, in medium-risk and high-risk populations. This update of the 2022 PAPPS has taken into account the vision of the National Health System Cancer Strategy, an update approved by the Interterritorial Council of the National Health System on January 2021 and the European Strategy (Europe's Beating Cancer Plan) presented on 4 February 2021.
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Affiliation(s)
- Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca Metropolitana Sud, IDIAP Jordi Gol, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, España.
| | - Cruz Bartolomé-Moreno
- Centro de Salud Parque Goya de Zaragoza y Unidad Docente de Atención Familiar y Comunitaria Sector Zaragoza I, Servicio Aragonés de Salud, Zaragoza, España
| | - Begoña Bellas-Beceiro
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | - Elena Melús-Palazón
- Centro de Salud Actur Oeste de Zaragoza y Unidad Docente de Atención Familiar y Comunitaria Sector Zaragoza I, Servicio Aragonés de Salud, Zaragoza, España
| | - Carmen Vela-Vallespín
- ABS del Riu Nord i Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Barcelona, España
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Maxwell SS, Weller D. Lung cancer and Covid-19: lessons learnt from the pandemic and where do we go from here? NPJ Prim Care Respir Med 2022; 32:19. [PMID: 35637231 PMCID: PMC9151755 DOI: 10.1038/s41533-022-00283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
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Samhouri BF, Koo CW, Yi ES, Ryu JH. Is the combination of bilateral pulmonary nodules and mosaic attenuation on chest CT specific for DIPNECH? Orphanet J Rare Dis 2021; 16:490. [PMID: 34809674 PMCID: PMC8607646 DOI: 10.1186/s13023-021-02103-w] [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: 07/07/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterized by multifocal proliferation of pulmonary neuroendocrine cells. On chest CT, DIPNECH exhibits bilateral pulmonary nodules and mosaic attenuation in most patients. We sought to: (1) assess the specificity of this pattern (i.e., bilateral pulmonary nodules together with mosaic attenuation) for DIPNECH; (2) describe its differential diagnosis; and (3) identify the clinico-radiologic features that may help prioritize DIPNECH over other diagnostic considerations. Methods We searched the Mayo Clinic records from 2015 to 2019 for patients with bilateral pulmonary nodules and mosaic attenuation on CT who had a diagnostic lung biopsy. A thoracic radiologist reviewed all CT scans. Chi-square test was used for categorical variables, and odds ratios were utilized to measure the association between certain variables and DIPNECH. Results Fifty-one patients met our inclusion criteria; 40 (78%) were females and 34 (67%) were never-smokers. Median age was 65 (interquartile range 55–73) years. Lung biopsy was surgical in 21 patients (41%), transbronchial in 17 (33%), and transthoracic in 12 (24%); explanted lungs were examined in 1 (2%). Metastatic/multifocal cancer was the most common diagnosis, and was found in 17 (33%) cases. Bronchiolitis was diagnosed in 12 patients (24%), interstitial lung disease in 10 (20%), and DIPNECH in 5 (10%). Previous diagnosis of an obstructive lung disease (odds ratio 15.8; P = 0.002), and peribronchial nodular distribution on CT (odds ratio 14.4; P = 0.006) were significantly correlated with DIPNECH. Although statistical significance was not reached, DIPNECH nodules were more likely to display solid attenuations (80% vs. 67%, P = 0.45), and were more numerous; > 10 nodules were seen in 80% of DIPNECH cases vs. 52% in others (P = 0.23). Because DIPNECH primarily affects women, we analyzed the women-only cohort and found similar results. Conclusions Various disorders can manifest the CT pattern of bilateral pulmonary nodules together with mosaic attenuation, and this combination is nonspecific for DIPNECH, which was found in only 10% of our cohort. Previous diagnosis of an obstructive lung disease, and peribronchial distribution of the nodules on CT increased the likelihood of DIPNECH vs. other diagnoses. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02103-w.
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Affiliation(s)
- Bilal F Samhouri
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18 South, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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He R, Zhu Q, Wang Y, Chen G, Chen S, Wang Y. Influence of respiratory function training under the mode of mutual-assisted patients on postoperative pulmonary infection and immune function on lung cancer. Am J Transl Res 2021; 13:9260-9268. [PMID: 34540042 PMCID: PMC8430099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study explored the effect of respiratory function training under the mode of mutual-help of patients to the postoperative pulmonary infection and immune function on lung cancer. METHODS 116 lung cancer patients who received surgical treatment from June 2018 to June 2019 were enrolled as the object. Patients were categorized into a control or observation group, according to the admission time of patients. Each group contained 58 subjects. The control-group was given regular nursing intervention, and the observation-group received respiratory function training under the mode of mutual assist between patients. Subsequently, the postoperative pulmonary infection, pulmonary function, and the changes of immune function before and after surgery were compared between the two groups. RESULT The pulmonary infection rate of the group for observation was much lower than that of the control-group. The difference was statistically significant (5.17%, 17.24%, = 0.0394). The postoperative pulmonary function indexes in the observation-group were conspicuously better than those in control-group, the difference was statistically conspicuous (P<0.05). After nursing intervention, the cellular immune factors TNF-α, IL-8, and IL-6 of the two groups were conspicuously lower than those before the nursing intervention, and the decrease in the observation-group was remarkably greater than that in control-group, with the difference of statistical significance (P<0.05). In addition, the T cell subsets CD4+ and CD4+/CD8+ in the observation-group were conspicuously higher than those in the control-group. CD8+ in the observation-group was conspicuously lower than that in the group of control, with statistical significance (P<0.05). CONCLUSION The respiratory function training under the mode of mutual-assist of patients can effectively reduce the incidence of postoperative pulmonary infection, improve the postoperative pulmonary function index, and improve the immune function, which is worthy of clinical promotion.
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Weller D. Early diagnosis of lung cancer: diverse populations need diverse solutions. Eur J Cancer Care (Engl) 2021; 30:e13444. [PMID: 33742507 DOI: 10.1111/ecc.13444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Rodríguez M, Ajona D, Seijo LM, Sanz J, Valencia K, Corral J, Mesa-Guzmán M, Pío R, Calvo A, Lozano MD, Zulueta JJ, Montuenga LM. Molecular biomarkers in early stage lung cancer. Transl Lung Cancer Res 2021; 10:1165-1185. [PMID: 33718054 PMCID: PMC7947407 DOI: 10.21037/tlcr-20-750] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Low dose computed tomography (LDCT) screening, together with the recent advances in targeted and immunotherapies, have shown to improve non-small cell lung cancer (NSCLC) survival. Furthermore, screening has increased the number of early stage-detected tumors, allowing for surgical resection and multimodality treatments when needed. The need for improved sensitivity and specificity of NSCLC screening has led to increased interest in combining clinical and radiological data with molecular data. The development of biomarkers is poised to refine inclusion criteria for LDCT screening programs. Biomarkers may also be useful to better characterize the risk of indeterminate nodules found in the course of screening or to refine prognosis and help in the management of screening detected tumors. The clinical implications of these biomarkers are still being investigated and whether or not biomarkers will be included in further decision-making algorithms in the context of screening and early lung cancer management still needs to be determined. However, it seems clear that there is much room for improvement even in early stage lung cancer disease-free survival (DFS) rates; thus, biomarkers may be the key to refine risk-stratification and treatment of these patients. Clinicians’ capacity to register, integrate, and analyze all the available data in both high risk individuals and early stage NSCLC patients will lead to a better understanding of the disease’s mechanisms, and will have a direct impact in diagnosis, treatment, and follow up of these patients. In this review, we aim to summarize all the available data regarding the role of biomarkers in LDCT screening and early stage NSCLC from a multidisciplinary perspective. We have highlighted clinical implications, the need to combine risk stratification, clinical data, radiomics, molecular information and artificial intelligence in order to improve clinical decision-making, especially regarding early diagnostics and adjuvant therapy. We also discuss current and future perspectives for biomarker implementation in routine clinical practice.
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Affiliation(s)
- María Rodríguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Daniel Ajona
- Program in Solid Tumors, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Luis M Seijo
- Department of Pulmonology, Clínica Universidad de Navarra, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Julián Sanz
- Department of Pathology, Clínica Universidad de Navarra, Madrid, Spain
| | - Karmele Valencia
- Program in Solid Tumors, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Jesús Corral
- Department of Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | - Miguel Mesa-Guzmán
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Rubén Pío
- Program in Solid Tumors, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Alfonso Calvo
- Program in Solid Tumors, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Anatomy and Physiology, Schools of Medicine and Sciences, University of Navarra, Pamplona, Spain
| | - María D Lozano
- Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Anatomy and Physiology, Schools of Medicine and Sciences, University of Navarra, Pamplona, Spain.,Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J Zulueta
- Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis M Montuenga
- Program in Solid Tumors, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Anatomy and Physiology, Schools of Medicine and Sciences, University of Navarra, Pamplona, Spain
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11
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Hou M, Wu N, Yao L. LncRNA CBR3-AS1 potentiates Wnt/β-catenin signaling to regulate lung adenocarcinoma cells proliferation, migration and invasion. Cancer Cell Int 2021; 21:36. [PMID: 33422081 PMCID: PMC7796595 DOI: 10.1186/s12935-020-01685-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/27/2020] [Indexed: 12/11/2022] Open
Abstract
Background Long non-coding RNAs (lncRNAs) are pervasively transcribed in genome and emerging as a new player in tumorigenesis due to their functions in transcriptional, posttranscriptional and epigenetic mechanisms of gene regulation. As the most frequent malignancy and the foremost source of cancer mortality, lung cancer is a heterogeneous disorder. The most common type of lung cancer is Non-small cell lung cancer (NSCLC), occupying 85% of the total cases, and the main subtypes of NSCLC include lung adenocarcinoma (LAD), large cell carcinoma (LCC), and lung squamous cell carcinoma (LSCC). Recently, numerous lncRNAs have been reported to be strongly linked to NSCLC. In the present study, we found that a new lncRNA CBR3-AS1 is highly expressed in lung cancer. In addition, we also examined the expression of lncRNA CBR3-AS1 in 60 of LADs, 40 of LCCs and 40 of LSCCs patient samples, finding that CBR3-AS1 was specificity highly expressed in LAD cancer tissues. Mechanically, we discovered that CBR3-AS1 could regulate the proliferation, migration and invasion of LAD cells through targeting Wnt/β-catenin signaling. Methods Real-time PCR, RNA-pulldown, RIP, western blotting, lentivirus transfection, luciferase reporter assays, cell proliferation assays, colony formation assays, wound healing scratch assays and transwell assays were employed to examine the relationship between lncRNA CBR3-AS1 and its regulation of Wnt/β-catenin signaling in LAD cells. Results LncRNA CBR3-AS1 is highly-expressed in LAD and cell lines. LncRNA CBR3-AS1 shows physical association with β-catenin. CBR3-AS1 could facilitate Wnt/β-catenin signaling activation thought promoting nuclear localization of β-catenin. CBR3-AS1 promotes LAD cell proliferation, migration and invasion by targeting Wnt/β-catenin signaling. Conclusion It can be found that a new functional lncRNA CBR3-AS1 could promote nuclear localization of β-catenin so as to facilitate Wnt/β-catenin signaling activation and regulate the proliferation, migration and invasion of LAD cells.
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Affiliation(s)
- Min Hou
- Clinical Laboratory, Tianjin Chest Hospital, No. 261, South Taierzhuang Road, Tianjin, 300222, China.
| | - Nannan Wu
- Clinical Laboratory, Tianjin Chest Hospital, No. 261, South Taierzhuang Road, Tianjin, 300222, China
| | - Lili Yao
- Clinical Laboratory, Tianjin Chest Hospital, No. 261, South Taierzhuang Road, Tianjin, 300222, China
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12
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Primary Care Datasets for Early Lung Cancer Detection: An AI Led Approach. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-77211-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Lack of Efficacy of Combined Carbohydrate Antigen Markers for Lung Cancer Diagnosis. DISEASE MARKERS 2020; 2020:4716793. [PMID: 33488842 PMCID: PMC7787803 DOI: 10.1155/2020/4716793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 10/11/2020] [Accepted: 11/26/2020] [Indexed: 12/17/2022]
Abstract
Background Lung cancer (LC) is top-ranked in cancer incidence and is the leading cause of cancer death globally. Combining serum biomarkers can improve the accuracy of LC diagnosis. The identification of the best potential combination of traditional tumor markers is essential for LC diagnosis. Patients and Methods. Blood samples were collected from 132 LC cases and 118 benign lung disease (BLD) controls. The expression levels of ten serum tumor markers (CYFR21, CEA, NSE, SCC, CA15-3, CA 19-9, CA 125, CA50, CA242, and CA724) were assayed, and that the expression in the levels of tumor markers were evaluated, isolated, and combined in different patients. The performance of the biomarkers was analyzed by receiver operating characteristic (ROC) analyses, and the difference between combinations of biomarkers was compared by Chi-square (χ2) tests. Results As single markers, CYFR21 and CEA showed good diagnostic efficacy for nonsmall cell lung cancer (NSCLC) patients, while NSE and CEA were the most sensitive in the diagnosis of small cell lung cancer (SCLC). The area under the curve (AUC) value was 0.854 for the panel of four biomarkers (CYFR21, CEA, NSE, and SCC), 0.875 for the panel of six biomarkers (CYFR21, CEA, NSE, SCC, CA125, and CA15-3), and 0.884 for the panel of ten markers (CYFR21, CEA, NSE, SCC, CA125, CA15-3, CA19-9, CA50, CA242, and CA724). With a higher sensitivity and negative predictive value (NPV), the diagnostic accuracy of the three panels was better than that of any single biomarker, but there were no statistically significant differences among them (all P values > 0.05). However, the panel of six carbohydrate antigen (CA) biomarkers (CA125, CA15-3, CA19-9, CA50, CA242, and CA724) showed a lower diagnostic value (AUC: 0.776, sensitivity: 59.8%, specificity: 73.0%, and NPV: 60.4%) than the three panels (P value < 0.05). The performance was similar even when analyzed individually by LC subtypes. Conclusion The biomarkers isolated are elevated for different types of lung cancer, and the panel of CYFR21, CEA, NSE, and SCC seems to be a promising serum biomarker for the diagnosis of lung cancer, while the combination with carbohydrate antigen markers does not improve the diagnostic efficacy.
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14
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Gašperšič J, Videtič Paska A. Potential of modern circulating cell-free DNA diagnostic tools for detection of specific tumour cells in clinical practice. Biochem Med (Zagreb) 2020; 30:030504. [PMID: 32774122 PMCID: PMC7394254 DOI: 10.11613/bm.2020.030504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/20/2020] [Indexed: 12/11/2022] Open
Abstract
Personalized medicine is a developing field of medicine that has gained in importance in recent decades. New diagnostic tests based on the analysis of circulating cell-free DNA (cfDNA) were developed as a tool of diagnosing different cancer types. By detecting the subpopulation of mutated DNA from cancer cells, it is possible to detect the presence of a specific tumour in early stages of the disease. Mutation analysis is performed by quantitative polymerase chain reaction (qPCR) or the next generation sequencing (NGS), however, cfDNA protocols need to be modified carefully in preanalytical, analytical, and postanalytical stages. To further improve treatment of cancer the Food and Drug Administration approved more than 20 companion diagnostic tests that combine cancer drugs with highly efficient genetic diagnostic tools. Tools detect mutations in the DNA originating from cancer cells directly through the subpopulation of cfDNA, the circular tumour DNA (ctDNA) analysis or with visualization of cells through intracellular DNA probes. A large number of ctDNA tests in clinical studies demonstrate the importance of new findings in the field of cancer diagnosis. We describe the innovations in personalized medicine: techniques for detecting ctDNA and genomic DNA (gDNA) mutations approved Food and Drug Administration companion genetic diagnostics, candidate genes for assembling the cancer NGS panels, and a brief mention of the multitude of cfDNA currently in clinical trials. Additionally, an overview of the development steps of the diagnostic tools will refresh and expand the knowledge of clinics and geneticists for research opportunities beyond the development phases.
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Affiliation(s)
- Jernej Gašperšič
- Medical Centre for Molecular Biology, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alja Videtič Paska
- Medical Centre for Molecular Biology, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Pan S, Zhou G, Hu W, Pei H. SMAD-6, -7 and -9 are potential molecular biomarkers for the prognosis in human lung cancer. Oncol Lett 2020; 20:2633-2644. [PMID: 32782581 PMCID: PMC7401007 DOI: 10.3892/ol.2020.11851] [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: 12/11/2019] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
SMADs, a family of proteins that function as signal transducers and transcriptional regulators to regulate various signaling pathways, including the transforming growth factor-β signaling pathway, are similar to the mothers against decapentaplegic family of genes and the sma gene family in Caenorhabditis elegans. SMADs generate context-dependent modulation by interacting with various sequence-specific transcription factors, such as E2F4/5, c-Fos, GATA3, YY1 and SRF, which have been found to serve a key role in lung carcinoma oncogenesis and progression. However, the prognostic values of the eight SMADs in lung cancer have not been fully understood. In the present study, the expression levels and survival data of SMADs in patients with lung carcinoma from the Oncomine, Gene Expression Profiling Interactive Analysis, Kaplan-Meier plotter and cBioPortal databases were downloaded and analyzed. It was found that the mRNA expression levels of SMAD-6, -7 and -9 were decreased in lung adenocarcinoma and squamous cell carcinoma compared with that in adjacent normal tissues, while there was no significant difference in SMADs 1-5. Survival analysis revealed that not only were low transcriptional levels of SMAD-6, -7 and -9 associated with low overall survival but they also had prognostic role for progression-free survival and post-progression survival (P<0.05) in patients with lung carcinoma. In conclusion, the present study demonstrated that SMAD-6, -7 and -9 are potential biomarkers for the prognosis of patients with lung carcinoma.
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Affiliation(s)
- Shuxian Pan
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu 215123, P.R. China
- Department of Radiation Oncology, Yancheng Third People's Hospital, Yancheng, Jiangsu 224000, P.R. China
| | - Guangming Zhou
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Wentao Hu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Hailong Pei
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, Jiangsu 215123, P.R. China
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16
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White V, Bergin RJ, Thomas RJ, Whitfield K, Weller D. The pathway to diagnosis and treatment for surgically managed lung cancer patients. Fam Pract 2020; 37:234-241. [PMID: 31665265 DOI: 10.1093/fampra/cmz064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis. METHODS Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age. RESULTS One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than 'investigation' patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant. CONCLUSION Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.
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Affiliation(s)
- Victoria White
- School of Psychology, Deakin University, Burwood, Australia.,Centre for Behavioural Research in Cancer, Melbourne, Australia
| | - Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.,Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Robert J Thomas
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia
| | - Kathryn Whitfield
- Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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17
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Evaluation of a national lung cancer symptom awareness campaign in Wales. Br J Cancer 2019; 122:491-497. [PMID: 31839675 PMCID: PMC7029011 DOI: 10.1038/s41416-019-0676-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 01/21/2023] Open
Abstract
Background Lung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes. Methods Population-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods. Results Increased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis. Conclusions Symptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects.
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