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Alsaadi D, Clements N, Gabuniya N, Francis N, Chand M. Exhaled volatile organic compounds in the detection of colorectal cancer: a systematic review and meta-analysis. EXCLI JOURNAL 2024; 23:795-810. [PMID: 38983779 PMCID: PMC11231457 DOI: 10.17179/excli2024-7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/23/2024] [Indexed: 07/11/2024]
Abstract
There is an apparent need for novel non-invasive colorectal cancer (CRC) screening tests that are more acceptable to patients and can reliably detect CRC or reduce the number of unnecessary colonoscopies performed in cancer-free patients. An emerging number of studies demonstrate the potential value of exhaled volatile organic compounds (VOCs) as a diagnostic and triaging test for CRC. A systematic appraisal and meta-analysis of the published evidence was done to determine whether exhaled VOCs can be used in the detection and screening of CRC. Nine electronic databases were searched from inception of the databases until August 2020. Quantitative and descriptive data of CRC patients and healthy control (HC) participants who underwent VOCs breath analysis was extracted. In addition, where possible, sampling methods, analytical platforms, processors, and specific breath biomarkers found in each study were recorded. Fourteen articles were included in the systematic review with 491 colorectal patients and 754 HC participants (n=1245). Sub-group meta-analysis was conducted on nine of those articles and the pooled sensitivity was estimated to be 0.89 (95 % CI = 0.80-0.99) whereas specificity was 0.83 (95 % CI = 0.74-0.92). Heterogeneity of pooled sensitivity and specificity was estimated as I2=11.11 %. Although this study was limited by small sample size and different analytical platforms, the proposed future framework resolves such limitations and standardizes future research. It is reasonable to deduce that VOCs breath analysis is certainly a field of research that can progress to replace traditional methods within the framework of CRC screening and diagnosis.
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Affiliation(s)
- Daniah Alsaadi
- The Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Clinical Research Facility Galway, Galway University Hospital, National University of Ireland, Galway, Republic of Ireland
| | - Nicolle Clements
- Clinical Research Facility Galway, Galway University Hospital, National University of Ireland, Galway, Republic of Ireland
| | - Natiya Gabuniya
- The Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Plastic and Reconstructive Surgery Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Nader Francis
- The Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, United Kingdom
| | - Manish Chand
- The Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Esteva M, Leiva A, Ramos-Monserrat M, Espí A, González-Luján L, Macià F, Murta-Nascimento C, Sánchez-Calavera MA, Magallón R, Balboa-Barreiro V, Seoane-Pillado T, Pertega-Díaz S. Relationship between time from symptom's onset to diagnosis and prognosis in patients with symptomatic colorectal cancer. BMC Cancer 2022; 22:910. [PMID: 35996104 PMCID: PMC9394014 DOI: 10.1186/s12885-022-09990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Controversy exists regarding the relationship of the outcome of patients with colorectal cancer (CRC) with the time from symptom onset to diagnosis. The aim of this study is to investigate this association, with the assumption that this relationship was nonlinear and with adjustment for multiple confounders, such as tumor grade, symptoms, or admission to an emergency department. METHODS This multicenter study with prospective follow-up was performed in five regions of Spain from 2010 to 2012. Symptomatic cases of incident CRC from a previous study were examined. At the time of diagnosis, each patient was interviewed, and the associated hospital and clinical records were reviewed. During follow-up, the clinical records were reviewed again to assess survival. Cox survival analysis with a restricted cubic spline was used to model overall and CRC-specific survival, with adjustment for variables related to the patient, health service, and tumor. RESULTS A total of 795 patients had symptomatic CRC and 769 of them had complete data on diagnostic delay and survival. Univariate analysis indicated a lower HR for death in patients who had diagnostic intervals less than 4.2 months. However, after adjustment for variables related to the patient, tumor, and utilized health service, there was no relationship of the diagnostic delay with survival of patients with colon and rectal cancer, colon cancer alone, or rectal cancer alone. Cubic spline analysis indicated an inverse association of the diagnostic delay with 5-year survival. However, this association was not statistically significant. CONCLUSIONS Our results indicated that the duration of diagnostic delay had no significant effect on the outcome of patients with CRC. We suggest that the most important determinant of the duration of diagnostic delay is the biological profile of the tumor. However, it remains the responsibility of community health centers and authorities to minimize diagnostic delays in patients with CRC and to implement initiatives that improve early diagnosis and provide better outcomes.
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Affiliation(s)
- Magdalena Esteva
- Department of Primary Care, Primary Care Research Unit, Majorca, Baleares Health Service [IbSalut]. Escola Graduada 3, 07001, Palma, Spain. .,Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Edificio S, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain. .,Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.
| | - Alfonso Leiva
- Department of Primary Care, Primary Care Research Unit, Majorca, Baleares Health Service [IbSalut]. Escola Graduada 3, 07001, Palma, Spain.,Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Edificio S, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain.,Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.,Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS) , Madrid, Spain.,University of the Balearic Islands (UIB), Carretera de Valldemossa, km 7.5, 07122, Palma, Spain
| | - María Ramos-Monserrat
- Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Edificio S, Carretera de Valldemossa, 79, 07120, Palma, Majorca, Spain.,Preventive Activities and Health Promotion Research Network (REDIAPP), Barcelona, Spain.,Research Network On Chronicity, Primary Care, and Health Promotion (RICAPPS) , Madrid, Spain.,Balearic Islands Public Health Department, C/ Jesus 38A, 07010, Palma, Spain
| | - Alejandro Espí
- Department of Surgery, University of Valencia, Avenida Blasco Ibáñez 15, 46010, Valencia, Spain
| | - Luis González-Luján
- Serrería II Primary Care Centre, Valencia Institute of Health, Pedro de Valencia 26, 46022, Valencia, Spain
| | - Francesc Macià
- Epidemiology and Evaluation Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | | | - María A Sánchez-Calavera
- Department of Medicine, University of Zaragoza, Building A, 50009, Saragossa, Spain.,Las Fuentes Norte Health Center, Calle Dr. Iranzo 69, 50002, Saragossa, Spain
| | - Rosa Magallón
- University of the Balearic Islands (UIB), Carretera de Valldemossa, km 7.5, 07122, Palma, Spain.,Department of Medicine, University of Zaragoza, Building A, 50009, Saragossa, Spain.,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Saragossa, Spain.,Centro de Salud Arrabal, Andador Aragüés del Puerto, 3, 50015, Saragossa, Spain
| | - Vanesa Balboa-Barreiro
- Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), As Xubias, 15006. A, Coruña, Spain
| | - Teresa Seoane-Pillado
- Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), As Xubias, 15006. A, Coruña, Spain
| | - Sonia Pertega-Díaz
- Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), As Xubias, 15006. A, Coruña, Spain
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3
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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: 30] [Impact Index Per Article: 10.0] [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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Andersson E, Nyhlin N, van Nieuwenhoven MA. The effectiveness of the colorectal cancer referral pathway - identification of colorectal cancer in a Swedish region. Scand J Gastroenterol 2021; 56:552-558. [PMID: 33749502 DOI: 10.1080/00365521.2021.1899276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION To shorten the time for diagnosis of suspected colorectal cancer (CRC), a standardized colorectal cancer referral pathway (CCRP) was introduced in Sweden in September 2016. However, the effects of the CCRP are still uncertain, and CRC is also found in patients undergoing a routine colonoscopy. OBJECTIVE To identify all CRC-cases in the Region Örebro County and to investigate via which diagnostic pathway they were diagnosed. Furthermore, to investigate the reasons for and possible effect of not being included in the CCRP for cases found via colonoscopy. METHODS Review of medical records of patients with CRC referred to the department of surgery in the Region Örebro County in 2016-2018 (n = 459). RESULTS In CRC-cases found through colonoscopy (n = 347), 37.5% were diagnosed via a routine waiting list and 62.5% within the CCRP. No difference in tumor stage or tumor grade was found between the two groups. The non-CCRP showed a longer time to diagnosis than the CCRP group (21.5 days, IQR 7-43 vs. 13 days, IQR 8-17 (p < .001), respectively). Non-rectal cancer was more common in the non-CCRP group (81.5% vs. 57.6%, p < .001). The non-CCRP group had lower median Hb-value (106, IQR 87-129 vs. 117, IQR 101-136, p = .001). 85% of the non-CCRP group was found to meet one or more CCRP referral criteria, with bleeding anemia being the dominant criterion to meet. CONCLUSION The CCRP did not appear to improve prognostic outcomes for CRC-patients. ClinicalTrials.gov Identifier: NCT04585516.
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Affiliation(s)
- Emilia Andersson
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nils Nyhlin
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Michiel A van Nieuwenhoven
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Orchard P, Arvind N, Wint A, Kynaston J, Lyons A, Loveday E, Pullyblank A. Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway. BMJ Qual Saf 2020; 30:467-474. [PMID: 32527979 DOI: 10.1136/bmjqs-2019-009975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 04/13/2020] [Accepted: 05/03/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The 2-week wait referral pathway for suspected colorectal cancer was introduced in England to improve time from referral from a general practitioner (GP) to diagnosis and treatment. Patients are required to be seen by a hospital clinician within 2 weeks if their symptoms meet the criteria set by the National Institute for Health and Care Excellence (NICE) and to start cancer treatment within 62 days. To achieve this, many hospitals have introduced a straight-to-test (STT) strategy requiring hospital-based triage of referrals. We describe the impact and learning from a new pathway which has removed triage and moved the process of requesting tests from hospital to GPs in primary care. METHOD An electronic STT pathway was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. The hospital identified referrals as being on a cancer pathway and dealt with all ongoing management. Routinely collected cancer data were used to identify time to cancer diagnosis compared with national data RESULTS: 11357 patients were referred via the new pathway over 3 years. Time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway. CONCLUSION We have changed the way patients with suspected colorectal cancer are managed within the National Health Service by giving GPs the ability to order tests electronically within a monitored cancer pathway halving time from referral to diagnosis.
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Affiliation(s)
| | | | - Alison Wint
- NHS South Gloucestershire Clinical Commissioning Group, Bristol, UK
| | - James Kynaston
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Ann Lyons
- North Bristol NHS Trust, Bristol, UK
| | | | - Anne Pullyblank
- North Bristol NHS Trust, Bristol, UK.,West of England Academic Health Science Network, Bristol, UK
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6
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Mozdiak E, Weldeselassie Y, McFarlane M, Tabuso M, Widlak MM, Dunlop A, Tsertsvadze A, Arasaradnam RP. Systematic review with meta-analysis of over 90 000 patients. Does fast-track review diagnose colorectal cancer earlier? Aliment Pharmacol Ther 2019; 50:348-372. [PMID: 31286552 DOI: 10.1111/apt.15378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/13/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site-specific fast-track (2-week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. AIMS To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2-week wait pathway. METHODS A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta-analysis; heterogeneity was assessed by I2 . RESULTS Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9-8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4-15.6), B = 36.7% (95% CI 30.8-42.8), C = 35.7% (95% CI: 30.8-40.8) and D = 11.1% (95% CI 7.3-15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2-62.8). CONCLUSIONS Only 7.7% of patients referred by the 2-week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non-2-week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2-week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.
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Affiliation(s)
- Ella Mozdiak
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | | | - Maria Tabuso
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Monika M Widlak
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Amber Dunlop
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alexander Tsertsvadze
- The University of Warwick, Coventry, UK.,Faculty of Health and Life Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Ramesh P Arasaradnam
- University Hospitals Coventry and Warwickshire, Coventry, UK.,The University of Warwick, Coventry, UK.,Centre for Applied Biological Sciences, Coventry University, Coventry, UK
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7
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Fallon M, Adil MT, Ahmed K, Whitelaw D, Rashid F, Jambulingam P. Impact of ‘two-week wait’ referral pathway on the diagnosis, treatment and survival in upper and lower gastrointestinal cancers. Postgrad Med J 2019; 95:470-475. [DOI: 10.1136/postgradmedj-2019-136507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/25/2019] [Accepted: 05/04/2019] [Indexed: 02/03/2023]
Abstract
BackgroundThe ‘two-week wait’(2WW) referral pathway was introduced in the United Kingdom to reduce waiting times for treatment of cancer. There has been a debate regarding the efficacy of 2WW pathway since its implementation.MethodsA singleinstitutional analysis of upper gastrointestinal(UGI) and lower gastrointestinal(LGI) malignancies treated between 1April 2015 and 31March 2017 was undertaken to analyse the impact of 2WWreferral pathway on the diagnosis, treatment and survival.Results2WW referral does not achieve an earlier diagnosis compared with non-2WW routes of referral in UGI (χ2(3)=2.6, p=0.458) and LGI (χ2(3)=0.884, p=0.829) malignancies. 2WW referral does not lead to an improvement in curative treatment in UGI (OR1.48, 95%CI0.68to3.21, p=0.321) and LGI (OR1.59, 95%CI0.97to2.62, p=0.067) malignancies. No improvement in survival is seen in UGI (HR0.99, 95%CI0.56to1.75, p=0.963) and LGI (HR1.10, 95%CI0.60to1.99, p=0.764) malignancies by virtue of 2WW referral. Emergency presentation is the most common presenting route in UGI malignancy(40%) and is associated with poor survival (HR0.55, 95%CI0.30to0.97, p=0.045).Non-emergency route of presentation is associated with higher rates of curative treatment in UGI malignancies (OR3.49, 95%CI1.57to7.76, p=0.002). Lower rate of curative treatment (OR 0.27, 95%CI0.16to0.43, p<0.001) and poor survival (HR0.44, 95%CI0.26to0.76, p=0.003) is also observed in emergency presentation of LGI malignancy(29%) which is the secondmost common route of presentation in this group.Conclusion2WW referral does not achieve early diagnosis nor does it lead to an improvement in the rate of curative treatment in UGI and LGI malignancies. No improvement in short-term survival is seen in UGI malignancies nor in LGI malignancies on multivariate analysis by virtue of 2WW referral.
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Christopher J, Flint TR, Ahmed H, Dhir N, Li R, Macfarland K, Ng D, Ng J, O'Neill C, Te Water Naudé A, Sloan K, Hall NR, Powar MP. Straight-to-test for the two-week-wait colorectal cancer pathway under the updated NICE guidelines reduces time to cancer diagnosis and treatment. Ann R Coll Surg Engl 2019; 101:333-339. [PMID: 31042431 DOI: 10.1308/rcsann.2019.0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The 2015 National Institute for Health and Care Excellence guidelines widened the referral criteria for the two-week-wait pathway for suspected lower gastrointestinal cancer. We implemented a straight-to-test protocol to accommodate the anticipated increase in referrals. We evaluated the impact of these changes for relevant pathway metrics and clinical outcomes using a retrospective cohort study with historic controls. MATERIALS AND METHODS We analysed data from all patients referred to a teaching hospital via the two-week-wait pathway for suspected lower gastrointestinal cancer under the previous guidelines between 1 March and 31 August 2015 compared with the same period in 2016, when the updated guidelines and straight-to-test protocol had been implemented. RESULTS In the 2015 cohort, there were 64 cancer diagnoses from 664 referrals (9.6% pick-up) compared with 58 cancer diagnoses from 954 referrals in the 2016 cohort (6.1% pick-up). Our straight-to-test protocol reduced the median time to cancer diagnosis by 12.5 days (P < 0.001) and reduced the median time to cancer treatment by 7.5 days (P < 0.05) An increased proportion of non-colorectal cancers were diagnosed in 2016 compared with 2015, (37.9% vs 17.2%, P < 0.05) and more adenomas were removed in 2016 compared with 2015 (377 vs 193). DISCUSSION AND CONCLUSION Our straight-to-test protocol has resulted in a reduction in times to cancer diagnosis and cancer treatment, despite an increase in the number of referrals. The new referral criteria have considerable resource implications, but their implementation did not result in an increase in the total number of cancers diagnosed.
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Affiliation(s)
| | - T R Flint
- Queen Elizabeth Hospital, King's Lynn NHS Trust, King's Lynn, Norfolk, UK
| | - H Ahmed
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - N Dhir
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - R Li
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Dzs Ng
- Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK
| | - Jmk Ng
- Royal Free Hospital, London, UK
| | - C O'Neill
- Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | | | - K Sloan
- Colorectal Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - N R Hall
- Colorectal Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - M P Powar
- Colorectal Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK
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9
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The effect of time from diagnosis to surgery on oncological outcomes in patients undergoing surgery for colon cancer: A systematic review. Eur J Surg Oncol 2018; 44:1479-1485. [PMID: 30251641 DOI: 10.1016/j.ejso.2018.06.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 01/05/2023] Open
Abstract
Many countries have implemented cancer pathways with strict time limits dictating the pace of diagnostic testing and treatment. There are concerns that prehabilitation may worsen long-term oncological outcomes if surgery is delayed. We aimed to systematically review the literature investigating the association between increased time between diagnosis of colon cancer and surgical treatment, with special focus on survival outcomes. METHODS Through a systematic search and analysis of the databases PubMed (1966-2017), EMBASE (1974-2017), CINHAL (1981-2017), and The Cochrane Library performed on June 7th, 2017, the effect of treatment delays on overall survival in colon cancer patients was reviewed. Treatment delay was defined as time from diagnosis to initiation of surgical treatment. All patients included were diagnosed with colon cancer and treated with elective curative surgery without neoadjuvant chemotherapy. This review was prospectively registered on the PROSPERO database of systematic review protocols with registration number CRD42017059774. RESULTS Five observational studies including 13,514 patients were included. The treatment delay intervals ranged from 1 to ≥56 days. Four of the five studies found no association between time elapsed from diagnosis to surgery and reduced overall survival. One study found a clinically insignificant association between longer treatment delays and overall survival. Three studies investigated the effect on disease specific survival and found no negative associations. CONCLUSION The available data showed no association between treatment delay and reduced overall survival in colon cancer patients.
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10
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Zarcos-Pedrinaci I, Téllez T, Rivas-Ruiz F, Padilla-Ruiz MDC, Alcaide J, Rueda A, Baré ML, Suárez-Varela MMM, Briones E, Sarasqueta C, Fernández-Larrea N, Escobar A, Quintana JM, Redondo M. Factors Associated with Prolonged Patient-Attributable Delay in the Diagnosis of Colorectal Cancer. Cancer Res Treat 2018; 50:1270-1280. [PMID: 29334608 PMCID: PMC6192933 DOI: 10.4143/crt.2017.371] [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: 08/09/2017] [Accepted: 12/29/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The delayed diagnosis of colorectal cancer (CRC) may be attributable to sociodemographic characteristics, to aspects of tumour histopathology or to the functioning of the health system. We seek to determine which of these factors most influences prolonged patient-attributable delay (PPAD) in the diagnosis and treatment of CRC. Materials and Methods A prospective, multicentre observational study was conducted in 22 Spanish hospitals. In total, 1,785 patients were recruited to the study between 2010 and 2012 and underwent elective or urgent surgery. PPAD is considered to occur when the time elapsed between a patient presenting the symptom and him/her seeking attention from the primary care physician or hospital emergency department exceeds 180 days. A bivariate analysis was performed to assess differences in variables segmented by tumour location and patient delay. Multivariate logistic regression analysis was performed on the outcome variable, PPAD. Results The rate of PPAD among this population was 12.1%. PPAD was significantly associated with altered bowel rhythm (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.02 to 1.83) and with adenocarcinoma histology, in comparison with mucinous adenocarcinoma (OR, 2.03; 95% CI, 1.11 to 3.71). Other sociocultural factors and clinicopathological features were not independent predictors of PPAD. Conclusion Many patients do not consider altered bowel rhythm an alarming symptom, warranting a visit to the doctor. PPAD could be reduced by improving health education, raising awareness of CRC-related symptoms.
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Affiliation(s)
- Irene Zarcos-Pedrinaci
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Marbella, Spain.,Department of Oncohemathology, Costa del Sol Hospital, Marbella, Spain
| | - Teresa Téllez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Marbella, Spain
| | - Francisco Rivas-Ruiz
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Marbella, Spain
| | - María Del Carmen Padilla-Ruiz
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Marbella, Spain
| | - Julia Alcaide
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Department of Oncohemathology, Costa del Sol Hospital, Marbella, Spain
| | - Antonio Rueda
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Marbella, Spain.,Department of Oncohemathology, Costa del Sol Hospital, Marbella, Spain
| | - María Luisa Baré
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Clinical Epidemiology and Cancer Screening, Corporació Sanitaria ParcTaulí, Sabadell, Spain
| | - María Manuela Morales Suárez-Varela
- Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Eduardo Briones
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Epidemiology Unit, Sevilla District, Andalusian Regional Health Service, Sevilla, Spain
| | - Cristina Sarasqueta
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Donostia University Hospital, Biodonostia Health Research Institute, Donostia, Spain
| | - Nerea Fernández-Larrea
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Area of Environmental Epidemiology and Cancer, National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
| | - Antonio Escobar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Basurto University Hospital, Bilbao, Spain
| | - José María Quintana
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Galdakao-Usansolo Hospital, Galdakao-Usansolo Hospital, Galdakao, Spain
| | - Maximino Redondo
- Research Network on Health Services in Chronic Diseases (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Marbella, Spain
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11
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Sothisrihari SR, Wright C, Hammond T. Should preoperative optimization of colorectal cancer patients supersede the demands of the 62-day pathway? Colorectal Dis 2017; 19:617-620. [PMID: 28493352 DOI: 10.1111/codi.13713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/24/2017] [Indexed: 02/08/2023]
Affiliation(s)
| | - C Wright
- Department of Anaesthetics, Broomfield Hospital, Chelmsford, UK
| | - T Hammond
- Department of Colorectal Surgery, Broomfield Hospital, Chelmsford, UK
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