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Bergin RJ, O'Sullivan D, Dixon-Suen S, Emery JD, English DR, Milne RL, White VM. Time to Diagnosis and Treatment for Ovarian Cancer and Associations with Outcomes: A Systematic Review. J Womens Health (Larchmt) 2024. [PMID: 38976232 DOI: 10.1089/jwh.2023.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: Ovarian cancer is commonly diagnosed symptomatically at an advanced stage. Better survival for early disease suggests improving diagnostic pathways may increase survival. This study examines literature assessing diagnostic intervals and their association with clinical and psychological outcomes. Methods: Medline, EMBASE, and EmCare databases were searched for studies including quantitative measures of at least one interval, published between January 1, 2000 and August 9, 2022. Interval measures and associations (interval, outcomes, analytic strategy) were synthesized. Risk of bias of association studies was assessed using the Aarhus Checklist and ROBINS-E tool. Results: In total, 65 papers (20 association studies) were included and 26 unique intervals were identified. Interval estimates varied widely and were impacted by summary statistic used (mean or median) and group focused on. Of Aarhus-defined intervals, patient (symptom to presentation, n = 23; range [median]: 7-168 days) and diagnostic (presentation to diagnosis, n = 22; range [median]: 7-270 days) were most common. Nineteen association studies examined survival or stage outcomes with most, including five low risk-of-bias studies, finding no association. Conclusions: Studies reporting intervals for ovarian cancer diagnosis are limited by inconsistent definitions and reporting. Greater utilization of the Aarhus statement to define intervals and appropriate analytic methods is needed to strengthen findings from future studies.
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Affiliation(s)
- Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Deirdre O'Sullivan
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Suzanne Dixon-Suen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- School of Exercise & Nutrition Sciences, Deakin University, Burwood, Australia
| | - Jon D Emery
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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2
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Yuste V, Sanz E, Negredo I. Evaluation of the impact of a protocol for immediate vulvar reconstruction after vulvectomy. J Plast Reconstr Aesthet Surg 2024; 90:37-39. [PMID: 38354489 DOI: 10.1016/j.bjps.2024.01.022] [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: 07/08/2023] [Revised: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Vulvar cancers are usually diagnosed at an advanced stage and require wide surgical resections in the form of vulvectomy. Immediate vulvar reconstruction can potentially reduce the reoperation rate and postoperative complications. With this objective, we introduced a protocol for immediate vulvar reconstruction. This study, five years after its introduction, assesses the impact of this intervention on the postoperative evolution of vulvectomy patients. In January 2017 we introduced a protocol for immediate vulvar reconstruction that considered four criteria of high risk for postoperative dehiscence. Patients who meet the criteria were reconstructed at the time of the vulvectomy. To assess the impact of the protocol, we prospectively registered all included patients over a 5 years period (2017-2022). As a control group, we reviewed the vulvectomised patients at our centre from January 2012 to January 2017 (5 years) who would have met the protocol. No statistically significant differences were found in the epidemiological data (age, diabetes mellitus diagnosis, and obesity diagnosis) or in the tumour characteristics (tumour size). We obtained a statistically significant difference in the incidence of complications and need for reintervention, in favour of the reconstruction group. Our study shows the medical and economic benefits for vulvar cancer patients of immediate vulvar reconstruction.
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Affiliation(s)
- Valentin Yuste
- Plastic Surgery Unit, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Ester Sanz
- Plastic Surgery Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Isabel Negredo
- Gynecology Unit, Miguel Servet University Hospital, Zaragoza, Spain
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3
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Akhtar Z, Stearns V, Cartwright P, Blackford AL, Prasath V, Klein C, Jelovac D, Asrari F, Habibi M. The effect of 1-day multidisciplinary clinic on breast cancer treatment. Breast Cancer Res Treat 2020; 182:623-629. [PMID: 32507956 DOI: 10.1007/s10549-020-05721-3] [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: 12/17/2019] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A delay in breast cancer treatment is associated with inferior survival outcomes; however, no clear guidelines exist defining the appropriate time frame from diagnosis to definitive treatment of breast cancer. A multidisciplinary approach for breast cancer treatment can minimize the time from diagnosis to first treatment. We hypothesized single-day multidisciplinary clinic (MDC) may accelerate the time to first treatment on complex breast cancer cases at our institution. METHODS We identified patients who were treated at Johns Hopkins for stage II or III breast cancer, who were at least 18 years of age, and were seen in a new single-day MDC with coordination between two or three specialties or by specialists from varying disciplines on different days (IDC). Patients who initiated treatment between May 2015 (initiation of MDC clinic) and December 2017 were included in our study. RESULTS A total of 296 patient records were reviewed independently. The mean (SD) patient age was 55 (13) years. The median time to first neoadjuvant chemotherapy (NACT) was significantly reduced for patients seen in the MDC (12.7 days), compared to those seen at the IDC (24.4 days, logrank p < 0.001). The median time to definitive surgery was similar between groups (31 and 32 days for the MDC and IDC cohorts, respectively). CONCLUSIONS A single-day MDC visit is associated with a reduced time from diagnosis to NACT. Further studies are needed to determine if a shorter interval can improve the management and the outcome of complex breast cancer cases.
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Affiliation(s)
- Zohaib Akhtar
- School of Medicine, Johns Hopkins University, 4940 Eastern Ave, Room A-562, Baltimore, MD, 21224, USA.
| | - Vered Stearns
- Women's Malignancies Disease Group, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Cartwright
- Johns Hopkins Breast Center on the Johns Hopkins Bayview Campus, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics, Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Vishnu Prasath
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine Klein
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Danijela Jelovac
- Breast Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Fariba Asrari
- Johns Hopkins Breast Center - Green Spring Station, Johns Hopkins University, Baltimore, MD, USA
| | - Mehran Habibi
- Johns Hopkins Breast Center on the Johns Hopkins Bayview Campus, Baltimore, MD, USA
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4
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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] [MESH Headings] [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 MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Raymond C. Wade
- Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Amitkumar Mehta
- Division of Hematology and OncologyUniversity of Alabama at BirminghamBirminghamAlabama
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Rodriguez-Freixinos V, Lheureux S, Mandilaras V, Clarke B, Dhani NC, Mackay H, Butler MO, Wang L, Siu LL, Kamel-Reid S, Stockley T, Bedard PL, Oza AM. Impact of somatic molecular profiling on clinical trial outcomes in rare epithelial gynecologic cancer patients. Gynecol Oncol 2019; 153:304-311. [PMID: 30792002 DOI: 10.1016/j.ygyno.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Conducting clinical trials in rare malignancies is challenging due to the limited number of patients and differences in biologic behavior. We investigated the feasibility and clinical utility of using genomic profiling for rare gynecologic malignancies. METHODS Rare epithelial gynecologic cancer patients were analyzed for somatic variants through an institutional molecular profiling program using the Sequenom MassArray platform or the TruSeq Amplicon Cancer Panel on the MiSeq platform. Clinical trial outcomes by RECIST 1.1, and time on treatment were evaluated. RESULTS From March 2012 to November 2015, 767 gynecologic patients were enrolled and 194 (27%) were classified as rare epithelial malignancies. At least one somatic mutation was identified in 72% of patients, most commonly in TP53 (39%), KRAS (28%) and PIK3CA (27%). A total of 14% of patients were treated on genotype-matched trials. There were no significant differences in overall response rate between genotype-matched versus unmatched trials, nor in median time on treatment between genotype trials and the immediate prior systemic standard treatment. Among 13 evaluable Low Grade Serous ovarian cancer patients treated on genotype-matched trials with MEK inhibitor-based targeted combinations, there were four partial responses. CONCLUSIONS Somatic molecular profiling is feasible and enables the identification of patients with rare gynecologic cancers who are candidates for genotype-matched clinical trials. Genotype-matched trials, predominantly MEK-based combinations in KRAS and/or NRAS mutant Low Grade Serous ovarian cancer patients, and genotype-unmatched trials, have shown potential clinical activity. Prospective trials with integrated genotyping are warranted to assess the clinical utility of next generation sequencing tests as a standard clinical application in rare malignancies.
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Affiliation(s)
- V Rodriguez-Freixinos
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - S Lheureux
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - V Mandilaras
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - B Clarke
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - N C Dhani
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - H Mackay
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - M O Butler
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - L Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - L L Siu
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Cancer Genomics Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - S Kamel-Reid
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - T Stockley
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - P L Bedard
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Cancer Genomics Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - A M Oza
- Department of Medicine, Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Vulvar cancer: Two pathways with different localization and prognosis. Gynecol Oncol 2018; 149:310-317. [PMID: 29555332 DOI: 10.1016/j.ygyno.2018.03.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/21/2018] [Accepted: 03/03/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Two etiologic pathways for vulvar squamous cell carcinoma (SCC) are described: in a background of lichen sclerosus and/or differentiated vulvar intraepithelial neoplasia and related to high-risk human papillomavirus (HPV) infection with high grade squamous intraepithelial lesion (HSIL) as precursor. The aim was to compare the predilection site and survival of HPV-related to non HPV-related vulvar SCCs. METHODS Data of patients treated for primary vulvar SCC at the Radboudumc between March 1988 and January 2015 were analyzed. All histological specimens were tested for HPV with the SPF10/DEIA/LiPA25 system assay and p16INK4a staining was performed using CINtec® histology kit. Vulvar SCCs were considered HPV-related in case of either >25% p16INK4a expression and HPV positivity or >25% p16INK4a expression and HSIL next to the tumor without HPV positivity. Tumor localization, disease specific survival (DSS), disease free survival (DFS) and overall survival (OS) of patients with HPV-related and non HPV-related vulvar SCC were compared. RESULTS In total 318 patients were included: 55 (17%) had HPV-related (Group 1) and 263 (83%) had non HPV-related vulvar SCC (Group 2). Tumors in Group 1 were significantly more often located at the perineum compared to Group 2, 30% and 14%, respectively (p=0.001). The DSS, DFS and OS were significantly better in HPV-related than in non HPV-related vulvar SCC patients. CONCLUSION HPV-related vulvar SCCs are more frequently located at the perineum and have a favorable prognosis compared to non HPV-related vulvar SCCs. Both localization and HPV-relation could explain this favorable prognosis. HPV-related vulvar SCC seems to be a separate entity.
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Muigai J, Jacob L, Dinas K, Kostev K, Kalder M. Potential delay in the diagnosis of vulvar cancer and associated risk factors in women treated in German gynecological practices. Oncotarget 2018; 9:8725-8730. [PMID: 29492231 PMCID: PMC5823582 DOI: 10.18632/oncotarget.23848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/05/2017] [Indexed: 12/13/2022] Open
Abstract
The goal of this study was to estimate a potential delay in the diagnosis of vulvar cancer and identify associated risk factors in women treated in gynecological practices in Germany. The current study sample included 1,652 women from 218 gynecological practices who received an initial diagnosis of vulvar cancer (ICD 10: C51) between January 2000 and December 2015 (index date). After applying several exclusion criteria, 505 non-cancer controls were matched (1:1) to 505 vulvar cancer cases based on age, health insurance status, and index date. The primary outcome was the delay in vulvar cancer diagnosis in women who had received an initial diagnosis of diseases of Bartholin's gland, inflammation of vagina and vulva, or other specified noninflammatory disorders of vulva, including atrophy, hypertrophy, and cyst. A logistic regression model was used to estimate the association between vulvar cancer and pre-defined diagnoses. The mean age was 60.8 years (SD = 15.6 years), and 4.8% of women had private health insurance coverage. Inflammation of vagina and vulva was diagnosed 328 days (SD = 95 days) prior to the detection of vulvar cancer. This delay was 186 days (SD = 196 days) in patients affected by diseases of Bartholin’s gland and 300 days (SD = 116 days) in those with other specified noninflammatory disorders of vulva including atrophy, hypertrophy, and cyst. The risk of vulvar cancer was positively associated with inflammation of vagina and vulva (OR = 2.28) and other specified noninflammatory disorders of vulva (OR = 5.39). The mean potential delay of vulvar cancer diagnosis ranged from 186 to 328 days.
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Affiliation(s)
- Jennifer Muigai
- Department of Gynecology and Obstetrics, Philipps-University Marburg, Marburg, Germany
| | - Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - Konstantinos Dinas
- Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloníki, Greece
| | - Karel Kostev
- Department of Gynecology and Obstetrics, Philipps-University Marburg, Marburg, Germany.,Epidemiology, QuintilesIMS, Frankfurt am Main, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps-University Marburg, Marburg, Germany
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8
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Love AJ, Lambert P, Turner D, Lotocki R, Dean E, Popowich S, Altman AD, Nachtigal MW. Diagnostic and referral intervals for Manitoba women with epithelial ovarian cancer - the Manitoba Ovarian Cancer Outcomes (MOCO) study group: a retrospective cross-sectional study. CMAJ Open 2017; 5:E116-E122. [PMID: 28401127 PMCID: PMC5378539 DOI: 10.9778/cmajo.20160100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Epithelial ovarian cancer has the highest mortality of all gynecologic cancers. The poor survival rates are often attributed to the advanced stage at which most of these cancers are detected. We sought to examine the effects of patient demographics, comorbidities and presenting symptoms on diagnostic and referral intervals by location of first presentation (emergency department v. elsewhere) and to identify factors that affect these intervals. METHODS We performed a retrospective analysis of chart and medical record data for ovarian cancers, with the exceptions of sex cord and germ cell tumours, diagnosed between 2004 and 2010 in Manitoba, Canada. Data were collected on baseline characteristics, time to diagnosis and referral, number and type of physician visits and emergency department visits. RESULTS The final cohort consisted of 601 patients. Sixty-three percent of patients received their diagnosis within 60 days of initial presentation, and 75.2% had their cancer diagnosed within 2 physician encounters. The median diagnostic interval for all stages of patients presenting to the emergency department was 7 days, compared with 55 days for patients presenting elsewhere. Early stage patients not presenting to the emergency department had their diagnosis a median of 34.0 days later than patients with advanced disease (95% confidence interval [CI] 22.22 to 45.69, p < 0.0001). The presence of some symptoms was associated with shortened diagnostic intervals. Patients with serous, clear-cell or endometrioid histotypes were less likely to have first presentation beginning in the emergency department (odds ratio [OR] 0.40, 95% CI 0.24 to 0.64, p = 0.0001; OR 0.28, 95% CI 0.14 to 0.59, p = 0.007) than those with unclassified epithelial histotype. INTERPRETATION For this group of patients, the main factor associated with diagnostic and referral intervals is presentation to the emergency department. These patients likely required more urgent attention for their more symptomatic disease, leading to quicker diagnosis and referral patterns, despite poorer prognosis.
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Affiliation(s)
- Allison J Love
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Pascal Lambert
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Donna Turner
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Robert Lotocki
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Erin Dean
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Shaundra Popowich
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Alon D Altman
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
| | - Mark W Nachtigal
- University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man
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9
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 638] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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10
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Akyuz A, Sever N, Gürhan N, Dede M, Göktolga U. Effect of desire to have a baby on risk acceptance in Turkish infertile women. Psychol Rep 2008; 103:577-87. [PMID: 19102482 DOI: 10.2466/pr0.103.2.577-587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess whether the desire to escape the psychological condition created by infertility (to have a baby) affected risk-taking behavior, with the possible relationship between ovarian cancer and infertility as the "accepted risk" to overcome infertility. 229 infertile and 204 fertile women who were patients at the Gulhane Military Medical Academy were administered a semistructured questionnaire. Increased ovarian cancer risk was accepted by 67.2% of the infertile women in order to have baby. There was no significant relation between the woman's age, duration of infertility, knowledge of the preventability and curability of ovarian cancer, or acceptable risk. These results indicate the importance to Turkish women of overcoming infertility.
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Affiliation(s)
- Aygul Akyuz
- Department of Obstetrics and Gynecologic Nursing Nursing School, Gulhane Military Medical Academy.
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11
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AKYUZ AYGUL. EFFECT OF DESIRE TO HAVE A BABY ON RISK ACCEPTANCE IN TURKISH INFERTILE WOMEN. Psychol Rep 2008. [DOI: 10.2466/pr0.103.6.577-587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Caballero Alcántara JE, Marchal Escalona C, García Penit J, Padilla León M. [Analysis of the delay in surgical treatment of adenocarcinoma of the prostate]. Actas Urol Esp 2003; 27:286-91. [PMID: 12830550 DOI: 10.1016/s0210-4806(03)72922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The prostate cancer is an important cause of men's mortality in our society. PURPOSE To know the time of delay in to realise the surgical treatment of the prostate cancer. MATERIALS AND METHODS Analysis of 30 cases of patients treated with radical prostatectomy, cuantifying the time of delay in all the periods of the process. RESULTS Appointment in general practitioner-first appointment in urology: 21.7 days. First appointment in urology-biopsy: 22.8. Biopsy-diagnosis: 34.3. Diagnosis-appointment of anesthesiology: 28.5. Anesthesiology-radical prostatectomy: 25.7. CONCLUSIONS There are actions for to reduce the delay in to perform the diagnosis or treatment, where we can act how an improvement plan: to give poblational education in general and information to the patient in particular, to analyze the rules of medical action, to improve the coordination between level, to improve the flexibility in outpatients appointment and time waiting for diagnosis test and treatment, to correct the temporality, to create clinical units of many specialties and to improve the politics of health.
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