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Cartwright A, Snowden JA, Whitehouse H, Scott S, Whitby L. Implementation of the updated NICE haematological cancers (NG47) improving outcomes guidelines across Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDS) in England: a UK NEQAS LI survey. J Clin Pathol 2023; 76:618-623. [PMID: 35508367 PMCID: PMC10447389 DOI: 10.1136/jclinpath-2021-208075] [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: 11/30/2021] [Accepted: 04/13/2022] [Indexed: 11/04/2022]
Abstract
AIMS Haematological malignancies represent a diverse group of diseases with complex diagnostic requirements. National Institute for Health and Care Excellence (NICE) Haematological Cancer: Improving Outcomes Guidance was published in 2003 and updated in 2016 (NG47), providing recommendations for service delivery including Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDSs). This survey assessed the implementation of NG47 guidelines, with a specific focus on implementation in relation to laboratory SIHMDS delivery. METHODS A survey was issued to the 17 SIHMDSs identified in England. The questionnaire covered laboratory configuration, information systems, integrated reporting and multidisciplinary team (MDT) working recommendations. RESULTS In the 10 responding SIHMDS, full implementation of recommendations was not achieved. Higher levels of implementation were reported in 'colocated' services compared with 'networked' SIHMDS. Increased guideline implementation was reported with longer duration since initial establishment of a SIHMDS and for laboratory based as opposed to clinical (MDT) reporting recommendations. CONCLUSIONS Our survey highlights variable implementation of NICE guidance across SIHMDS, with likely inequity of access, standardisation and quality in haemato-oncology diagnostics. Provision of a more structured framework for guideline implementation could assist in increasing compliance to meet the goals of quality and equity of access to harmonised haemato-oncology diagnostics across the NHS in England. This would provide a basis for evaluating the clinical benefits and health economic impact of the SIHMDS model on patient care and outcomes.
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Affiliation(s)
- Ashley Cartwright
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Helen Whitehouse
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stuart Scott
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Liam Whitby
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Zimta AA, Sigurjonsson OE, Gulei D, Tomuleasa C. The Malignant Role of Exosomes as Nanocarriers of Rare RNA Species. Int J Mol Sci 2020; 21:ijms21165866. [PMID: 32824183 PMCID: PMC7461500 DOI: 10.3390/ijms21165866] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/19/2022] Open
Abstract
Nowadays, advancements in the oncology sector regarding diagnosis methods allow us to specifically detect an increased number of cancer patients, some of them in incipient stages. However, one of the main issues consists of the invasive character of most of the diagnosis protocols or complex medical procedures associated with it, that impedes part of the patients to undergo routine checkups. Therefore, in order to increase the number of cancer cases diagnosed in incipient stages, other minimally invasive alternatives must be considered. The current review paper presents the value of rare RNA species isolated from circulatory exosomes as biomarkers of diagnosis, prognosis or even therapeutic intervention. Rare RNAs are most of the time overlooked in current research in favor of the more abundant RNA species like microRNAs. However, their high degree of stability, low variability and, for most of them, conservation across species could shift the interest toward these types of RNAs. Moreover, due to their low abundance, the variation interval in terms of the number of sequences with differential expression between samples from healthy individuals and cancer patients is significantly diminished and probably easier to interpret in a clinical context.
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Affiliation(s)
- Alina-Andreea Zimta
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.-A.Z.); (C.T.)
| | - Olafur Eysteinn Sigurjonsson
- The Blood Bank, Landspitali University Hospital, 121 Reykjavik, Iceland;
- School of Science and Engineering, Reykjavik University, 107 Reykjavik, Iceland
| | - Diana Gulei
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.-A.Z.); (C.T.)
- Correspondence: or
| | - Ciprian Tomuleasa
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.-A.Z.); (C.T.)
- Department of Hematology, Oncology Institute Prof. Dr. Ion Chiricuta, 400015 Cluj-Napoca, Romania
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Allart-Vorelli P, Porro B, Baguet F, Michel A, Cousson-Gélie F. Haematological cancer and quality of life: a systematic literature review. Blood Cancer J 2015; 5:e305. [PMID: 25909835 PMCID: PMC4450328 DOI: 10.1038/bcj.2015.29] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/02/2015] [Indexed: 11/11/2022] Open
Abstract
The aim of this study is to examine the impact of haematological cancers on quality of life (QoL). A review of the international literature was conducted from the databases ‘PsycInfo' and 'Medline' using the keywords: 'haematological cancer', 'quality of life', 'physical', 'psychological', 'social', 'vocational', 'professional', 'economic', 'cognitive', and 'sexual'. Twenty-one reliable studies were analysed. Among these studies, 12 showed that haematological cancer altered overall QoL, 8 papers found a deterioration of physical dimension, 8 papers reported on functional and role dimensions, 11 papers reported on the psychological component and 9 on the social component. Moreover, one study and two manuscripts, respectively, reported deteriorated sexual and cognitive dimensions. Our review demonstrates that the different dimensions of QoL are deteriorated by haematological malignancies and, probably, by the side effects of treatment.
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Affiliation(s)
- P Allart-Vorelli
- Laboratory of Psychology 'Health and Quality of Life' EA 4139, University Bordeaux Segalen, Bordeaux, France
| | - B Porro
- Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France
| | - F Baguet
- 1] Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France [2] ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention Unit - Rue des Apothicaires, Montpellier Cedex 5, France
| | - A Michel
- 1] Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France [2] MIS, Montpellier Institut du Sein - 25 rue de Clémentville, Montpellier, France
| | - F Cousson-Gélie
- 1] Department of Psychology, Epsylon EA 4556 Laboratory 'Dynamics of Human Abilities and Health Behaviors', University Paul Valéry Montpellier 3, Montpellier, France [2] ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention Unit - Rue des Apothicaires, Montpellier Cedex 5, France
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Dalley C, Basarir H, Wright JG, Fernando M, Pearson D, Ward SE, Thokula P, Krishnankutty A, Wilson G, Dalton A, Talley P, Barnett D, Hughes D, Porter NR, Reilly JT, Snowden JA. Specialist integrated haematological malignancy diagnostic services: an Activity Based Cost (ABC) analysis of a networked laboratory service model. J Clin Pathol 2015; 68:292-300. [PMID: 25631214 DOI: 10.1136/jclinpath-2014-202624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDS) were introduced as a standard of care within the UK National Health Service to reduce diagnostic error and improve clinical outcomes. Two broad models of service delivery have become established: 'co-located' services operating from a single-site and 'networked' services, with geographically separated laboratories linked by common management and information systems. Detailed systematic cost analysis has never been published on any established SIHMDS model. METHODS We used Activity Based Costing (ABC) to construct a cost model for our regional 'networked' SIHMDS covering a two-million population based on activity in 2011. RESULTS Overall estimated annual running costs were £1 056 260 per annum (£733 400 excluding consultant costs), with individual running costs for diagnosis, staging, disease monitoring and end of treatment assessment components of £723 138, £55 302, £184 152 and £94 134 per annum, respectively. The cost distribution by department was 28.5% for haematology, 29.5% for histopathology and 42% for genetics laboratories. Costs of the diagnostic pathways varied considerably; pathways for myelodysplastic syndromes and lymphoma were the most expensive and the pathways for essential thrombocythaemia and polycythaemia vera being the least. CONCLUSIONS ABC analysis enables estimation of running costs of a SIHMDS model comprised of 'networked' laboratories. Similar cost analyses for other SIHMDS models covering varying populations are warranted to optimise quality and cost-effectiveness in delivery of modern haemato-oncology diagnostic services in the UK as well as internationally.
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Affiliation(s)
- C Dalley
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - H Basarir
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - J G Wright
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Fernando
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - D Pearson
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S E Ward
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - P Thokula
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - A Krishnankutty
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - G Wilson
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - A Dalton
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - P Talley
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - D Barnett
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - D Hughes
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N R Porter
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J T Reilly
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J A Snowden
- Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Johansson U, Bloxham D, Couzens S, Jesson J, Morilla R, Erber W, Macey M. Guidelines on the use of multicolour flow cytometry in the diagnosis of haematological neoplasms. British Committee for Standards in Haematology. Br J Haematol 2014; 165:455-88. [PMID: 24620735 DOI: 10.1111/bjh.12789] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Engel-Nitz NM, Eckert B, Song R, Koka P, Hulbert EM, McPheeters J, Teitelbaum A. Diagnostic testing managed by hematopathology specialty and other laboratories: costs and patient diagnostic outcomes. BMC Clin Pathol 2014; 14:17. [PMID: 24817828 PMCID: PMC4016629 DOI: 10.1186/1472-6890-14-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/17/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Successful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests. Our retrospective analysis compared diagnostic uncertainty, resource utilization, and costs for patients with diagnostic bone marrow (BM) tests managed by commercial laboratories. METHODS Patients with BM biopsies and suspected hematologic cancer/condition were identified from claims (2005-2011) within a large US health plan (coverage ≥6 pre- and ≥3-months post-biopsy). Cohorts defined by laboratories performing BM morphologic assessment/directing testing sequence: Genoptix (GX, specialty hematology-testing laboratory), large commercial laboratories (LL), other laboratories (OL). One-year post-biopsy changes in diagnosis or treatments, tests performed, and diagnostic/treatment medical costs (measured as per-patient-per-month [PPPM]) were examined. RESULTS The study population included 1,387 GX, 4,162 LL, and 19,115 OL patients with suspected hematologic malignancy/disease and BM morphology assessment. GX had lower diagnostic uncertainty measured between 2 time periods by diagnostic stability (no conditions the same; 6.16% GX, 8.04% LL, 9.73% OL; p < 0.001) and changes (≥1 condition different; 7.88% GX, 11.19% LL, and 14.08% OL; p < 0.001), fewer repeat BM biopsies, and fewer chemotherapy changes (30-days and 60-days post-initiation). One-year PPPM costs adjusted for patient characteristics differences were $8,202 GX, $7,711 LL, and $10,302 OL (p < 0.05); adjusted PPPM costs (excluding testing period) were $6,019 GX, $6,649 LL, and $7,801 OL (p < 0.05). CONCLUSIONS Our data suggests that a hematopathology specialty laboratory may result in earlier final diagnosis, fewer subsequent diagnosis changes, reduced need for follow-on testing requiring repeat biopsy procedures, and may result in lower downstream healthcare costs. Further evaluations using medical chart abstractions or registries will be valuable.
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Affiliation(s)
- Nicole M Engel-Nitz
- Optum, Eden Prairie, MN, USA
- Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN 53344, USA
| | - Benjamin Eckert
- Novartis Molecular Diagnostics, Cambridge, MA, USA
- Present address Metamark Genetics, Cambridge, MA, USA
| | | | | | | | | | - April Teitelbaum
- Optum, Eden Prairie, MN, USA
- Present address Heme Onc Associates, Carlsbad, CA, USA
- AHT BioPharma Advisory Services, Carlsbad, CA, USA
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