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Damhus CS, Brodersen JB, Nielsen GL. Diagnostic flow for all patients referred with non-specific symptoms of cancer to a diagnostic centre in Denmark: A descriptive study. Eur J Gen Pract 2024; 30:2296108. [PMID: 38179994 PMCID: PMC10773629 DOI: 10.1080/13814788.2023.2296108] [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: 01/13/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Since 2012, Cancer Patient Pathways for Non-specific Symptoms and Signs of Cancer (NSSC-CPP) have been implemented in Scandinavia and UK. OBJECTIVES This study aimed to describe the diagnostic flow for all patients referred from 1 January to 30 June 2020 to the NSSC-CPP in the Diagnostic Centre in Farsø (DC-F), Denmark. METHODS During the study period, we prospectively recorded information on the diagnostic flow, including: pathway trajectory, symptoms and findings leading to referral, diagnostic procedures and diagnoses at the end of DC Farsø work-up and within 6-months for all patients referred to the NSSC-CPP in DC Farsø using electronic patient files and the Danish National Patient Registry (DNPR). RESULTS Of the 314 referrals to DC Farsø, 227 had diagnostic work-up in DC Farsø, the remaining were redirected to other CPPs (n = 11), outpatient clinics (n = 45) or redirected to general practice (n = 25). Of total referrals, 25 (8%) received a malignant diagnosis, 20 (6%) a non-malignant but clinically relevant diagnosis with initiation of treatment, 16 (5%) a non-malignant diagnosis but no treatment needed and in 253 (81%) referrals no severe new condition was diagnosed. Two (1%) additional malignancies were diagnosed within a 6-month follow-up period. CONCLUSION By tracking all patients referred to the NSSC-CPP in DC Farsø, including those redirected, this is the first study to describe the diagnostic flow for all patients referred to a diagnostic centre in Denmark. This knowledge is important for further organisation and planning of the NSSC-CPP.
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Affiliation(s)
- Christina Sadolin Damhus
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice in Region Zealand, Denmark
| | - John Brandt Brodersen
- The Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice in Region Zealand, Denmark
- Department of Community Medicine, General Practice Research Unit, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Gunnar Lauge Nielsen
- Department of Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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2
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Thompson JJ, McGovern J, Roxburgh CSD, Edwards J, Dolan RD, McMillan DC. The relationship between LDH and GLIM criteria for cancer cachexia: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 199:104378. [PMID: 38754770 DOI: 10.1016/j.critrevonc.2024.104378] [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: 10/12/2023] [Revised: 04/02/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Cancer cachexia is a clinical condition characterized by recognizable "sickness behaviors" accompanied by loss of lean body tissue. The Global Leadership on Malnutrition (GLIM) has proposed phenotypic (unintentional weight loss, low body mass index and low muscle mass) and aetiologic (reduced food intake and inflammation or disease burden) diagnostic criteria. Recent work has suggested serum lactate dehydrogenase (LDH) might represent a 3rd aetiologic criteria. Little is known of its relationship with GLIM. A systematic review and meta-analysis of their comparative prognostic value and association was performed. METHODS A search of electronic databases (PubMed, Medline, Ovid, Cochrane) up to February 2023 was used to identify studies that compared the prognostic value of LDH and components of the GLIM criteria in cancer. An analysis of the relationship between LDH and the components of GLIM was undertaken where this data was available. RevMan 5.4.1 was used to perform a meta-analysis for each diagnostic criteria that had 3 or more studies which reported hazard ratios with a 95 per cent confidence interval for overall survival (OS). RESULTS A total of 119 studies were reviewed. Advanced lung cancer was the most studied population. Included in the meta-analysis were 6 studies (n=2165) on LDH and weight loss, 17 studies (n=7540) on LDH and low BMI, 5 studies (n=758) on LDH and low muscle mass, 0 studies on LDH and food intake and 93 studies (n=32,190) on LDH and inflammation. There was a significant association between elevated serum LDH and each of low BMI (OR 1.39, 1.09 - 1.77; p=0.008), elevated NLR (OR 2.04, 1.57 - 2.65; p<0.00001) and elevated CRP (OR 2.58, 1.81 - 3.67; p<0.00001). There was no association between elevated serum LDH and low muscle mass. Only one study presented data on the association between LDH and unintentional weight loss. Elevated LDH showed a comparative OS (HR 1.86, 1.57 - 2.07; p<0.00001) to unintentional weight loss (HR 1.57, 1.23 - 1.99; p=0.0002) and had a similar OS (HR 2.00, 1.70 - 2.34; p<0.00001) to low BMI (HR 1.57, 1.29-2.90; p<0.0001). LDH also showed an OS (HR 2.25, 1.76 - 2.87; p<0.00001) congruous with low muscle mass (HR 1.93, 1.14 - 3.27; p=0.01) and again, LDH conferred as poor an OS (HR 1.77, 1.64-1.90; p<0.00001) as elevated NLR (HR 1.61, 1.48 - 1.77; p<0.00001) or CRP (HR 1.55, 1.43 - 1.69; p<0.00001). CONCLUSION Current literature suggests elevated serum LDH is associated with inflammation in cancer (an aetiologic GLIM criterion), however more work is required to establish the relationship between LDH and the phenotypic components of GLIM. Additionally, elevated serum LDH appears to be a comparative prognosticator of overall survival in cancer when compared to the GLIM criteria.
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Affiliation(s)
- Joshua J Thompson
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
| | - Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Campbell S D Roxburgh
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Joanne Edwards
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
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Grønnemose RB, Hansen PS, Worsøe Laursen S, Gerke O, Kjellberg J, Lykkegaard J, Thye-Rønn C, Høilund-Carlsen PF, Thye-Rønn P. Risk of cancer and serious disease in Danish patients with urgent referral for serious non-specific symptoms and signs of cancer in Funen 2014-2021. Br J Cancer 2024; 130:1304-1315. [PMID: 38409600 PMCID: PMC11014902 DOI: 10.1038/s41416-024-02620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In 2011, as the first European country, Denmark introduced the non-organ-specific cancer patient pathway (CPP) for patients presenting with non-specific symptoms and signs of cancer (NSSC). The proportion of patients with cancer over time is unknown. METHODS A retrospective cohort study of all patients with a NSSC-CPP investigational course in the province of Funen to the Diagnostic Centre in Svendborg from 2014 to 2021 was performed to evaluate the proportion of patients with cancer and serious disease over time. RESULTS A total of 6698 patients were referred to the NSSC-CPP of which 20.2% had cancer. While the crude referral rate increased from 114 per 100,000 people in 2014 and stabilised to around 214 in 2017-2021, the cancer detection rate of the total yearly new cancers in Funen diagnosed through the NSSC-CPP in DC Svendborg increased from 3 to 6%. CONCLUSIONS With now high and stable conversion and crude referral rates, the NSSC-CPP is one of the largest CPPs in Denmark as measured by the number of new cancer cases found. Similar urgent referral programmes in other countries might fill an unmet medical need for patients presenting with serious non-specific symptoms and signs of cancer in general practice.
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Affiliation(s)
| | - Per Syrak Hansen
- Diagnostic Centre, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jakob Kjellberg
- VIVE, The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - Jesper Lykkegaard
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Clara Thye-Rønn
- Diagnostic Centre, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
| | | | - Peter Thye-Rønn
- Diagnostic Centre, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark.
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de Chiffre JMD, Ormstrup TE, Kusk MW, Hess S. Patients from general practice with non-specific cancer symptoms: a retrospective study of symptoms and imaging. BJGP Open 2024; 8:BJGPO.2023.0058. [PMID: 37604580 PMCID: PMC11169995 DOI: 10.3399/bjgpo.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/10/2023] [Accepted: 07/23/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Patients with non-specific symptoms or signs of cancer (NSSC) present a challenge as they are a heterogeneous population who are not candidates for fast-track work-up in an organ-specific cancer pre-planned pathway (CPP). Denmark has a cancer pre-planned pathway for this population (NSSC-CPP), but several issues remain unclarified, for example, distribution and significance of symptoms and findings, and choice of imaging. AIM To investigate symptoms, cancer diagnoses, and diagnostic yield of computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients on NSSC-CPP to improve the overall diagnostic process. DESIGN & SETTING A retrospective medical chart review in a 1-year consecutive cohort (2020). METHOD A total of 802 referrals were reviewed for diagnostic imaging in patients with NSSP from general practices, specialist practices, or the local hospital diagnostic centre responsible for NSSC-CPP. RESULTS The study included 248 patients; 21% had cancer, most frequently gastrointestinal cancer (27%). The most frequent symptom was weight loss (56%). CT had a sensitivity of 85%, specificity of 87%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 96%. For 18F-FDG-PET/CT, the numbers were sensitivity 82%, specificity 62%, PPV 33%, and NPV 94%. Patients frequently underwent subsequent examinations following initial imaging. CONCLUSION The findings were in accordance with the literature. Patients with NSSC had a cancer prevalence of 21%, most frequently gastrointestinal. The most frequent symptom was weight loss and, even as the only symptom, it is a potential marker for cancer. CT and 18F-FDG-PET/CT were sensitive with high NPV, whereas PPV was superior in CT. Better stratification by symptoms or findings is an obvious focus point for future studies to further optimise the NSSC-CPP work-up strategy.
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Affiliation(s)
- Jonas Michele Dorph de Chiffre
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Tina Elisabeth Ormstrup
- Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Martin Weber Kusk
- Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
- IRIS - Imaging Research Initiative Southwest, University Hospital of Southern Denmark, Esbjerg, Denmark
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark
- IRIS - Imaging Research Initiative Southwest, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
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5
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Videmark AN, Christensen IJ, Feltoft CL, Villadsen M, Borg FH, Jørgensen BM, Bojesen SE, Kistorp C, Ugleholdt R, Johansen JS. Combined plasma C‐reactive protein, interleukin 6 and
YKL
‐40 for detection of cancer and prognosis in patients with serious nonspecific symptoms and signs of cancer. Cancer Med 2022; 12:6675-6688. [PMID: 36440611 PMCID: PMC10067028 DOI: 10.1002/cam4.5455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND METHODS Inflammation is a hallmark of cancer and its progression. Plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6) and YKL-40 reflect inflammation, and are elevated in patients with cancer. This study investigated whether plasma CRP, IL-6 and YKL-40 had diagnostic value in 753 patients referred with nonspecific signs and symptoms of cancer to a diagnostic outpatient clinic. RESULTS In total, 111 patients were diagnosed with cancer within 3 months and 30 after 3 months. CRP, IL-6 and YKL-40 were elevated in 44%, 60% and 45% of the cancer patients, and in 15%, 33% and 25% of the patients without cancer. Elevated levels of all three markers were associated with risk of cancer within 3 months: CRP (odds ratio (OR) 4.41, 95% confidence interval (CI) 2.86-6.81), IL-6 (OR = 2.89, 1.91-4.37) and YKL-40 (OR = 2.42, 1.59-3.66). Multivariate explorative analyses showed that increasing values were associated with the risk of getting a cancer diagnosis (continuous scale: CRP (OR = 1.28, 1.12-1.47), carcinoembryonic antigen (CEA) (OR = 1.61, 1.41-1.98), CA19-9 (OR = 1.15, 1.03-1.29), age (OR = 1.29, 1.02-1.63); dichotomized values: CRP (OR = 2.54, 1.39-4.66), CEA (OR = 4.22, 2.13-8.34), age (OR = 1.42, 1.13-1.80)). CRP had the highest diagnostic value (area under the curve = 0.69). Combined high CRP, IL-6 and YKL-40 was associated with short overall survival (HR = 3.8, 95% CI 2.5-5.9, p < 0.001). CONCLUSION In conclusion, plasma CRP, IL-6 and YKL-40 alone or combined cannot be used to identify patients with cancer, but high levels were associated with poor prognosis. CRP may be useful to indicate whether further diagnostic evaluation is needed when patients present with nonspecific signs and symptoms of cancer.
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Affiliation(s)
- Alex N. Videmark
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
| | - Ib J. Christensen
- Department of Gastroenterology Copenhagen University Hospital ‐ Amager and Hvidovre Hvidovre Denmark
| | - Claus L. Feltoft
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
| | - Mette Villadsen
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
| | - Frederikke H. Borg
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
| | - Barbara M. Jørgensen
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
| | - Stig E. Bojesen
- Department of Clinical Biochemistry Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Caroline Kistorp
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Endocrinology Copenhagen University Hospital ‐ Rigshospitalet Copenhagen Denmark
| | - Randi Ugleholdt
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Julia S. Johansen
- Department of Medicine Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Oncology Copenhagen University Hospital ‐ Herlev and Gentofte Herlev Denmark
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6
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Jensen E, Kristensen JK, Bjerglund RT, Johnsen SP, Thomsen JL. The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review. BMC Cancer 2022; 22:574. [PMID: 35606715 PMCID: PMC9125836 DOI: 10.1186/s12885-022-09535-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-specific symptoms are common and often sign of a non-serious disease. Because of this, patients with non-specific symptoms of cancer (NSSC) present a challenge for general practitioners (GP). Studies describing characteristics of patients with NSSC have been done after fast-track pathways were created to diagnose and treat patients with NSSC. This study reviews characteristics of patients with NSSC and their patient pathways. MATERIALS AND METHODS Database searches of Embase, Cochrane, PubMed, Cinahl and Web of Science were performed. Search terms used were cancer, patient pathway, and NSSC with their synonyms. The flow diagram Preferring Reporting Items for Systematic Review was applied to the systematic search. The Newcastle-Ottawa Assessment Scale (NOS) was used to compare the quality of the included studies. RESULTS Twelve studies met the inclusion criterias. All studies were considered to be of high methodological quality. Patient Pathway: 11-35% of patients were diagnosed with cancer. Median number of days through diagnostic process was 7-10. PATIENT CHARACTERISTICS The most prevalent cancers included hematological-(14-30%), gastrointestinal-(13-23%) and lung cancers (13%). Rheumatological, musculoskeletal and gastrointestinal diseases were among the most common non-malignant diseases diagnosed. Weight loss, fatigue, pain and loss of appetite were the most common symptoms. Cardiovascular diseases, lung diseases, diabetes and previous diagnosed cancer were the most common comorbidities. Mean age of included patients was 60-72 years. CONCLUSION Limited number of studies were found and they lacked sufficient heterogenic data to conduct a metaanalysis. Symptoms, diagnoses, age and gender were described with some heterogenic results. Further studies should be conducted to gather broader knowledge about patients with NSSC.
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Affiliation(s)
- Ellen Jensen
- Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,The Quality Unit for General Practice in the North Region of Denmark (Nord-KAP), Aalborg, Denmark.
| | - Jette Kolding Kristensen
- Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke Tveden Bjerglund
- Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Service Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Janus Laust Thomsen
- Center for General Practice, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Piper TB, Nielsen HJ, Christensen IJ. Serological cancer-associated protein biomarker levels at bowel endoscopy: Increased risk of subsequent primary malignancy. Tumour Biol 2022; 44:1-16. [PMID: 35180141 DOI: 10.3233/tub-211501] [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: 11/15/2022] Open
Abstract
BACKGROUND It was previously shown in three subpopulations that subjects not identified with colorectal cancer (CRC) at bowel endoscopy, but with increased serological cancer-associated protein biomarker levels had an increased risk of being diagnosed with subsequent malignant diseases. OBJECTIVE The aim of the present study was to perform a pooled analysis of subjects from the three subpopulations and subsequently validate the results in an independent study. The study population denoted the training set includes N = 4,076 subjects with symptoms attributable to CRC and the independent validation set N = 3,774 similar subjects. METHODS Levels of CEA, CA19-9, TIMP-1 and YKL-40 were determined in blood samples collected prior to diagnostic bowel endoscopy. Follow-up of subjects not diagnosed with CRC at endoscopy, was ten years and identified subjects diagnosed with primary intra- or extra-colonic malignant diseases. The primary analysis was time to a newly diagnosed malignant disease and was analyzed with death as a competing risk in the training set. Subjects with HNPCC or FAP were excluded. The cumulated incidence was estimated for each biomarker and in a multivariate model. The resulting model was then validated on the second study population. RESULTS In the training set primary malignancies were identified in 515 (12.6%) of the 4,076 subjects, who had a colorectal endoscopy with non-malignant findings. In detail, 33 subjects were subsequently diagnosed with CRC and 482 subjects with various extra-colonic cancers. Multivariate additive analysis of the dichotomized biomarkers demonstrated that CEA (HR = 1.50, 95% CI:1.21-1.86, p < 0.001), CA19-9 (HR = 1.41, 95% CI:1.10-1.81, p = 0.007) and TIMP-1 (HR = 1.25 95% CI: 1.01-1.54, p = 0.041) were significant predictors of subsequent malignancy. The cumulated incidence at 5 years landmark time was 17% for those subjects with elevated CEA, CA19-9 and TIMP-1 versus 6.7% for those with low levels of all. When the model was applied to the validation set the cumulated 5-year incidence was 10.5% for subjects with elevated CEA, CA19-9 and TIMP-1 and 5.6% for subjects with low levels of all biomarkers. Further analysis demonstrated a significant interaction between TIMP-1 and age in the training set. The age dependency of TIMP-1 indicated a greater risk of malignancy in younger subjects if the biomarker was elevated. This observation was validated in the second set. CONCLUSION Elevated cancer-associated protein biomarker levels in subjects with non-malignant findings at large bowel endoscopy identifies subjects at increased risk of being diagnosed with subsequent primary malignancy. CEA, CA19-9 and TIMP-1 were significant predictors of malignant disease in this analysis. TIMP-1 was found dependent on age. The results were validated in an independent symptomatic population.
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Affiliation(s)
- Thomas B Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Damhus CS, Siersma V, Birkmose AR, Dalton SO, Brodersen J. Use and diagnostic outcomes of cancer patient pathways in Denmark - is the place of initial diagnostic work-up an important factor? BMC Health Serv Res 2022; 22:130. [PMID: 35101051 PMCID: PMC8802524 DOI: 10.1186/s12913-022-07545-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The Cancer Patient Pathway for Non-specific Symptoms and Signs of Cancer (NSSC-CPP) has been implemented in Denmark with regional and intra-regional differences. In some places, the initial diagnostic work-up (often including a CT scan) is performed by general practitioners (GPs) and in others by hospitals. Variations may influence the use of Organ Specific Cancer Patient Pathways (OS-CPPs) and prognostic outcomes for the patients. Therefore, the aims were: 1) To analyse how a CT scan referred from GP or hospital is followed by OS-CPPs and NSSC-CPPs at the national and regional level, and 2) To analyse, nationally and regionally, the diagnostic outcomes of persons referred to CT scan by either GP or hospital six months after and mortality one year after CT scan. Methods A nationwide population-based study including individuals with a first CT scan in 2013-2016, either referred from GP or hospital. Results Overall, individuals with a CT scan referred from GPs were more likely to start a NSSC-CPP or an OS-CPP than individuals with a CT scan referred by hospitals. Across the five Regions in Denmark, CT scans referred by GPs were associated with reduced odds of total mortality in all regions; (North, OR=0.78 [0.73 0.83], Central, OR=0.92 [0.87 0.96], South, OR=0.85 [0.81 0.89], Capital, OR=0.96 [0.91 1.00] and Zealand, OR=0.85 [0.79 0.90]) and increased odds of cancer-specific mortality in four regions, ORs ranging from 1.15-1.51 with no difference in Region North (1.00 [0.91 1.10]). Conclusion No obvious association between more CT scans and CPPs and reduced diagnoses and mortality was observed. The different diagnostic models might not explain the prognostic outcomes, but the different use of CT scans in, and between Regions play a large role in the differences in incidence and mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07545-x.
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Affiliation(s)
- Christina Sadolin Damhus
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark. .,Primary & eHealth Care, Region Zealand, Alléen 15, 4180, Sorø, Denmark. .,Survivorship & Inequality in Cancer, the Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Anna Rubach Birkmose
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship & Inequality in Cancer, the Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Ringstedgade 61, 4700, Næstved, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Primary & eHealth Care, Region Zealand, Alléen 15, 4180, Sorø, Denmark
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9
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Andersen MB, Ebbesen D, Thygesen J, Kruis M, Gu Q, Dharaiya E, Rasmussen F. Economic impact of spectral body imaging in diagnosis of patients suspected for occult cancer. Insights Imaging 2021; 12:190. [PMID: 34928439 PMCID: PMC8688640 DOI: 10.1186/s13244-021-01116-0] [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: 05/09/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Based on prior studies spectral CT has shown a higher sensitivity for malignant lesions than conventional CT at the cost of lower specificity. For the radiologists, it also offers a higher degree of certainty in the diagnosis of benign lesions. The objective of this study was to evaluate the economic impact of spectral CT in patients suspected of occult cancer in a medical center in Denmark. Methods This study was a secondary analysis using de-identified data from a prospective study of patients receiving a contrast-enhanced spectral CT scan. Based on suggested follow-up examinations on both spectral CT and contrast-enhanced CT, costs from a payer’s perspective were determined using unit costs obtained from national databases. Results The dataset contained 400 patients. Overall, 203 follow-up procedures were eliminated based on spectral data reading. The largest reduction in suggested follow-up procedures was found for the kidney (83%), followed by the liver (66%), adrenal glands (60%), and pancreas (42%). The total estimated costs for suggested follow-up procedures based on spectral data reading were €155,219, 25.2% (€52,384) less than that of conventional CT reading. Conclusion Our results provide support for spectral body imaging as an advanced imaging modality for suspected occult cancer. A substantial number of follow-up diagnostic procedures could be eliminated based on spectral data reading, which would result in significant cost savings. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01116-0.
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Affiliation(s)
- Michael Brun Andersen
- Department of Radiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark. .,Department of Radiology, Zealand University Hospital, Roskilde, Denmark. .,Department of Radiology, Aarhus University Hospital, Skejby, Denmark.
| | - Dyveke Ebbesen
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
| | - Jesper Thygesen
- Central Denmark Region, Department of Clinical Engineering, Aarhus University Hospital, Skejby, Denmark
| | | | - Qing Gu
- Philips Healthcare, Cleveland, USA
| | | | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
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Holtedahl K, Borgquist L, Donker GA, Buntinx F, Weller D, Campbell C, Månsson J, Hammersley V, Braaten T, Parajuli R. Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care. BMC FAMILY PRACTICE 2021; 22:148. [PMID: 34238248 PMCID: PMC8268573 DOI: 10.1186/s12875-021-01452-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. METHOD Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher's exact test was used to analyse differences between groups. RESULTS Almost all symptoms recorded could indicate colorectal cancer. 'Rectal bleeding' had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had 'Rectal bleeding' at the initial consultation, but three of the 18 did so at a later consultation. 'Abdominal pain, lower part', 'Constipation' and 'Distended abdomen, bloating' were less specific and also less sensitive than 'Rectal bleeding', and with PPV between 0.7% and 1.9%. CONCLUSIONS Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.
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Affiliation(s)
- Knut Holtedahl
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Breivika, Tromsø, Norway
| | - Lars Borgquist
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Gé A. Donker
- Netherlands Institute of Health Services Research, Otterstraat 118, Utrecht, 3513 the Netherlands
| | - Frank Buntinx
- Department of General Practice, KU Leuven, Oude Markt 13, 3000 Leuven, Belgium
- Maastricht University, P.O. Box 616, Maastricht, 6200 The Netherlands
| | - David Weller
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Christine Campbell
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Jörgen Månsson
- Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Box 100, 40530 Gothenburgh, Sweden
| | - Victoria Hammersley
- Usher Institute of Population Health Sciences and Medical Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Tonje Braaten
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Breivika, Tromsø, Norway
| | - Ranjan Parajuli
- Faculty of Nursing and Health Sciences, Nord University, P.O.Box 1490, 8049 Bodø, Norway
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Abstract
PURPOSE Some consider fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) clinically useful in patients presenting with nonspecific symptoms of malignancy, weight loss most commonly encountered. However, the appropriateness of such FDG-PET/CT studies remains to be clarified. This study evaluated the clinical value of FDG-PET/CT in patients referred primarily for weight loss. METHODS From 2010 to 2017 in one academic center, 252 subjects underwent 254 FDG-PET/CT studies for weight loss as primary indication and retrospectively studied. Eighteen subjects were excluded due to ongoing active malignancy, weight loss not ultimately being the main indication for the FDG-PET/CT, technically inadequate FDG-PET/CT and insufficient follow-up. The FDG-PET/CT scans were considered clinically beneficial when true positive for the cause of weight loss that other investigations missed or would have missed, clinically neutral when true negative and clinically detrimental when false positive leading to additional investigations or false negative. RESULTS Ultimately 234 unique subjects (236 FDG-PET/CT studies) were included. The average subject weight loss prior to the PET was 12 kg and average follow-up time post FDG-PET/CT scan was 3.4 years. The FDG-PET/CT scans were true positive in 24 studies (10%) with 8 studies (3%) clinically beneficial; false positive in 38 studies (16%) of which 26 led to 35 additional procedures and false negative in 13 studies (6%). In total, 39 (17%) FDG-PET/CT studies were clinically detrimental. The other 149 (63%) studies were true negative, clinically neutral. CONCLUSION FDG-PET/CT appears to have limited value in assessing subjects with weight loss as the leading clinical indication, proving to be five times more often detrimental than beneficial.
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Describing the potential of non-specific symptoms-based pathways for diagnosing less common cancers. Br J Gen Pract 2021; 71:e846-e853. [PMID: 34097639 PMCID: PMC8463131 DOI: 10.3399/bjgp.2020.1108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/07/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although less common cancers account for over half of all cancer diagnoses in England, their relative scarcity and complex presentation, often with non-specific symptoms, means that patients often experience multiple primary care consultations, longer times to diagnosis and poorer clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem. AIM To examine the less common cancers identified during the MDC pilots and consider if such an approach improves the diagnosis of these cancers. DESIGN AND SETTING A service evaluation of five MDC pilot projects in England to 31st March 2019. METHOD Data items were collected by pilot sites in near-real time, based mainly on the English cancer outcomes and services dataset, with additional project specific items. Simple descriptive and comparative statistics were used, including chi-squared tests for proportions and t-tests for means where appropriate. RESULTS From 5,134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. Over 30 different less common tumour types were diagnosed within this cohort. 23% of MDC patients with less common cancers had ≥3 more GP consultations before referral and, at programme level, a median time of 57 days was recorded from GP urgent referral to treatment for these tumour types. CONCLUSION A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.
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Damhus CS, Siersma V, Dalton SO, Brodersen J. Non-specific symptoms and signs of cancer: different organisations of a cancer patient pathway in Denmark. Scand J Prim Health Care 2021; 39:23-30. [PMID: 33629891 PMCID: PMC7971193 DOI: 10.1080/02813432.2021.1880094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE We aimed to investigate the Non-specific Symptoms and Signs of Cancer-Cancer Patient Pathway (NSSC-CPP) in order to describe organisational and clinical practice similarities and differences in the diagnostic work-up of suspected cancer in Denmark. MATERIAL AND METHODS A questionnaire on the organisation and practice pertaining to the NSSC-CPP was completed by all 21 diagnostic units in the five healthcare regions in Denmark. RESULTS The questionnaire responses revealed regional and intraregional differences in the organisation and clinical practice of the NSSC-CPP. CT scan was the most often used imaging in the NSSC-CPP but there was no consensus whether the CT scan should be ordered and evaluated by general practitioners (GPs) or by the diagnostic units. Two regions were consistent but had different modalities regarding referrals from GPs. Three regions had intra-regional differences. The units reported on different types and frequency of forum for patient plan discussion and how to end a NSSC-CPP. CONCLUSION The NSSC-CPP is implemented with great regional and intra-regional differences in Denmark. GPs face different requirements when referring to the NSSC-CPP, which indicates that the division of role and responsibility between GPs and the diagnostic units is not well defined.KEY POINTSIn Denmark, the cancer patient pathway for non-specific symptoms and signs of cancer (NSSC-CPP) has been implemented with variations, but little is known about these different modalities. This study showed that both at a regional and an intra-regional level:•General practitioners meet different implementation of national guidelines in the diagnostic units when referring to the NSSCP-CPP•The suitable patient group for the NSSC-CPP is not well defined•Quality criteria are needed to monitor, evaluate and improve the diagnostic work-up for patients with non-specific symptoms and signs of cancer.
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Affiliation(s)
- Christina Sadolin Damhus
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Primary Health Care Research Unit, Region Zealand, Denmark
- Survivorship and Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- CONTACT Christina Sadolin Damhus The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Primary Health Care Research Unit, Region Zealand, Denmark
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Sundquist J, Palmér K, Rydén S, Sävblom C, Ji J, Stenman E. Time Intervals Under the Lens at Sweden's First Diagnostic Center for Primary Care Patients With Nonspecific Symptoms of Cancer. A Comparison With Matched Control Patients. Front Oncol 2020; 10:561379. [PMID: 33330029 PMCID: PMC7735559 DOI: 10.3389/fonc.2020.561379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Fast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries. Our objective was to analyze time intervals in the diagnostic routes of patients diagnosed with cancer at Sweden’s first Diagnostic Center (DC) for nonspecific symptoms and compare with time intervals of matched control patients. Methods Adult patients with nonspecific symptoms that could not be explained by an initial investigation in primary care were eligible for referral to the DC. Patients diagnosed with cancer were matched with patients at another hospital within the same healthcare organization. We aimed for two control patients per DC-patient and matched on tumor type, age and sex. Five time intervals were compared: 1) patient interval (first symptom—primary care contact), 2) primary care interval (first visit—referral to the DC/secondary care), 3) diagnostic interval (first visit—cancer diagnosis), 4) information interval (cancer diagnosis—patient informed) and 5) treatment interval (cancer diagnosis—treatment start). Comparisons between groups and matched cohort analyses were made. Results Sixty-four patients (22.1%) were diagnosed with cancer at the DC, of which eight were not matchable. Forty-two patients were matched with two controls and 14 were matched with one control. There were no significant differences in patient-, primary care-, or diagnostic intervals between the groups. The information interval was shorter at the DC compared to the control group (difference between matched pairs 7 days, p = 0.001) and the treatment interval was also shorter at the DC with significant differences in the matched analysis (difference between matched pairs 13 days, p = 0.049). The findings remained the same in four sensitivity analyses, made to compensate for differences between the groups. Conclusions Up to diagnosis, we could not detect significant differences in time intervals between the DC and the control group. However, the shorter information and treatment intervals at the DC should be advantageous for these patients who will get timely access to treatment or palliative care. Due to limitations regarding comparability between the groups, the results must be interpreted with caution and further research is warranted. Trial registration ClinicalTrials.gov-ID: NCT01709539. Registration-date: October 18, 2012.
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Affiliation(s)
- Jan Sundquist
- Center for Primary Health Care Research, Skåne Regional Council, Lund University, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, Shimane University, Shimane, Japan
| | - Karolina Palmér
- Center for Primary Health Care Research, Skåne Regional Council, Lund University, Malmö, Sweden
| | - Stefan Rydén
- Regional Cancer Centre South, Skåne Regional Council, Kristianstad, Sweden
| | - Charlotta Sävblom
- Regional Cancer Centre Stockholm Gotland, Stockholm Regional Council, Stockholm, Sweden
| | - Jianguang Ji
- Center for Primary Health Care Research, Skåne Regional Council, Lund University, Malmö, Sweden
| | - Emelie Stenman
- Center for Primary Health Care Research, Skåne Regional Council, Lund University, Malmö, Sweden
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First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer. Br J Cancer 2020; 123:722-729. [PMID: 32624574 PMCID: PMC7462853 DOI: 10.1038/s41416-020-0947-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Patients with non-specific symptoms often experience longer times to diagnosis and poorer clinical outcomes than those with site-specific symptoms. This paper reports initial results from five multidisciplinary diagnostic centre (MDC) projects in England, piloting rapid referral for patients with non-specific symptoms. Methods The evaluation covered MDC activity from 1st December 2016 to 31st July 2018, with projects using a common dataset. Logistical regression analyses were conducted, with a diagnosis of any cancer as the dependent variable. Exploratory analysis was conducted on presenting symptoms and diagnoses of cancer, and on comparisons within these groupings. Results In total, 2961 patients were referred into the MDCs and 241 cancers were diagnosed. The pathway detected cancers across a broad range of tumour sites, including several rare and less common cancers. An association between patient age and cancer was identified (p < 0.001). GP ‘clinical suspicion’ was identified as a strong predictor of cancer (p = 0.006), with a reduced association with cancer observed in patients with higher numbers of GP consultation before referral (p = 0.008). Conclusions The MDC model diagnoses cancer in patients with non-specific symptoms, with a conversion rate of 8%, demonstrating the diagnostic potential of a non-site-specific symptomatic referral pathway.
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Møller M, Juvik B, Olesen SC, Sandstrøm H, Laxafoss E, Reuter SB, Bodtger U. Diagnostic property of direct referral from general practitioners to contrast-enhanced thoracoabdominal CT in patients with serious but non-specific symptoms or signs of cancer: a retrospective cohort study on cancer prevalence after 12 months. BMJ Open 2019; 9:e032019. [PMID: 31892651 PMCID: PMC6955522 DOI: 10.1136/bmjopen-2019-032019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe the diagnostic properties of thoracoabdominal contrast-enhanced CT (ceCT), when general practitioners (GPs) managed referral to ceCT through the non-specific symptoms or signs of cancer-cancer patient pathway (NSSC-CPP). DESIGN Retrospective cohort study including patients from a part of Denmark. SETTING Department of Internal Medicine at a university hospital. PARTICIPANTS In total, 529 patients underwent ceCT. PRIMARY AND SECONDARY OUTCOMES Our primary objective was to estimate the negative and positive likelihood ratios for being diagnosed with cancer within 1 year after ceCT. Our secondary outcomes were prevalence and final diagnoses of malignancy (including temporal trends since implementation of NSSC-CPP in 2012), the prevalence of revision of CT scans and referral patterns based on ceCT results. RESULTS In total, 529 subjects underwent ceCT and malignancy was identified in 104 (19.7%) patients; 101 (97.1%) during initial workup and 3 patients during the subsequent 12 months follow-up.Eleven patients had a false-negative ceCT, and revision classified the ceCT as 'probable/possible malignancy' in eight (73%) patients. The negative predictive value was 98% and positive predictive value 63%. Negative and positive likelihood ratios for malignancy was 0.1 and 7.9, respectively. CONCLUSION Our study shows that ceCT as part of GP-coordinated workup has a low negative likelihood ratio for identifying malignancy; this is important since identifying patients for further workup is vital.
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Affiliation(s)
- Marie Møller
- Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Bue Juvik
- Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Stine Chabert Olesen
- Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Hanne Sandstrøm
- Radiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Erling Laxafoss
- Orthopedic Surgery, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Simon Bertram Reuter
- Respiratory Medicine, Nastved Hospital, Nastved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Uffe Bodtger
- Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
- Respiratory Medicine, Nastved Hospital, Nastved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Mortality of patients examined at a diagnostic centre: A matched cohort study. Cancer Epidemiol 2018; 55:130-135. [DOI: 10.1016/j.canep.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 01/22/2023]
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Forster AS, Renzi C, Lyratzopoulos G. Diagnosing cancer in patients with 'non-alarm' symptoms: Learning from diagnostic care innovations in Denmark. Cancer Epidemiol 2018; 54:101-103. [PMID: 29702426 PMCID: PMC6002621 DOI: 10.1016/j.canep.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Alice S Forster
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, United Kingdom.
| | - Cristina Renzi
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, United Kingdom
| | - Georgios Lyratzopoulos
- Research Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, United Kingdom
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