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Parmigiani G. Benefits and Harms of Interception and Early Detection of Cancer. Hematol Oncol Clin North Am 2024; 38:731-741. [PMID: 38789374 DOI: 10.1016/j.hoc.2024.04.003] [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] [Indexed: 05/26/2024]
Abstract
Strategies for early detection and interception of cancer are based on 2 synergistic elements: proactive search for asymptomatic cancer, precancer, or cancer predisposition and proactive disruption of cancer evolution. Benefits and harms of both these elements will vary widely depending on the screened populations, the types of cancers targeted, the detection modalities, and the health care delivery approaches following diagnosis. This article attempts to identify common elements that can inform the evaluation of alternative strategies across many of these scenarios.
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Affiliation(s)
- Giovanni Parmigiani
- Department of Data Science, Dana Farber Cancer Institute; Department of Biostatistics, Harvard T.H. Chan School of Public Health.
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2
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Aggarwal A, Simcock R, Price P, Rachet B, Lyratzopoulos G, Walker K, Spencer K, Roques T, Sullivan R. NHS cancer services and systems-ten pressure points a UK cancer control plan needs to address. Lancet Oncol 2024; 25:e363-e373. [PMID: 38991599 DOI: 10.1016/s1470-2045(24)00345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024]
Abstract
In this Policy Review we discuss ten key pressure points in the NHS in the delivery of cancer care services that need to be urgently addressed by a comprehensive national cancer control plan. These pressure points cover areas such as increasing workforce capacity and its productivity, delivering effective cancer survivorship services, addressing variation in quality, fixing the reimbursement system for cancer care, and balancing of the cancer research agenda. These areas have been selected based on their relative importance to ensuring sustainable cancer services, persistence as key issues in the NHS, and their impact on delivering better and more equitable and affordable patient outcomes. Many of these pressure points are not acknowledged explicitly in any current discourse. The evidence we provide points to their impact on the ability to deliver world class cancer care, but also to their amenability to affordable solutions if given the relevant prioritisation and investment. The current narrative needs to move away from a technocentric approach to improving care, to one focused on understanding the complexity of cancer services and the wider health system to drive improvements in survival, quality of life, and experience for patients.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's & St Thomas' NHS Trust, London, UK.
| | - Richard Simcock
- Department of Oncology, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bernard Rachet
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kate Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Tom Roques
- Department of Oncology, Norfolk and Norwich NHS Foundation Trust, Norwich, UK
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3
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Bosch X, Montori-Palacin E, Gomes TM, Naval-Álvarez J, Moreno P, López-Soto A. Clinical characterisation of patients diagnosed with cancer following emergency self-referral. Cancer Epidemiol 2024; 92:102609. [PMID: 38991388 DOI: 10.1016/j.canep.2024.102609] [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: 02/12/2024] [Revised: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Despite their frequency and potential impact on prognosis, cancers diagnosed via self-referral to the emergency department are poorly documented. We conducted a detailed analysis of cancer patients diagnosed following emergency self-referral and compared them with those diagnosed following emergency referral from primary care. Given the challenges associated with measuring intervals in the emergency self-referral pathway, we also aimed to provide a definition of the diagnostic interval for these cancers. METHODS A retrospective observational analysis was performed on patients diagnosed with 13 cancers, either following emergency self-referral or emergency referral from primary care. We analysed demographics, tumour stage, clinical data (including 28 presenting symptoms categorised by body systems), and diagnostic intervals by cancer site, then testing for differences between pathways. RESULTS Out of 3624 patients, 37 % were diagnosed following emergency self-referral and 63 % via emergency referral from primary care. Emergency self-referrals were associated with a higher likelihood of being diagnosed with cancers manifesting with localising symptoms (e.g., breast and endometrial cancer), whereas the likelihood of being diagnosed with cancers featuring nonspecific symptoms and abdominal pain (e.g., pancreatic and ovarian cancer) was higher among patients referred from primary care. Diagnostic intervals in self-referred patients were half as long as those in patients referred from primary care, with most significant differences for pancreatic cancer (28 [95 % CI -34 to -23] days shorter, respectively). CONCLUSION These findings enrich the best available evidence on cancer diagnosis through emergency self-referral and showed that, compared with the emergency referral pathway from primary care, these patients had a significantly increased likelihood of presenting with symptoms that are strongly predictive of cancer. Since the starting point for the diagnostic interval in these patients is their emergency presentation, comparing it with that of those referred from primary care as an emergency is likely to result in biased data.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain.
| | - Elisabet Montori-Palacin
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | | | - José Naval-Álvarez
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
| | - Alfonso López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Villarroel 170, Barcelona 08036-Spain
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Bradley PT, Lee YK, Albutt A, Hardman J, Kellar I, Odo C, Randell R, Rousseau N, Tikka T, Patterson JM, Paleri V. Nomenclature of the symptoms of head and neck cancer: a systematic scoping review. Front Oncol 2024; 14:1404860. [PMID: 38952557 PMCID: PMC11216301 DOI: 10.3389/fonc.2024.1404860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients' clinical problems more effectively and risk stratify the patient. Method The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms. Results There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings. Discussion Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician's decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign.
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Affiliation(s)
- Paula T. Bradley
- Population Health, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ying Ki Lee
- Department of Otolaryngology, Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Abigail Albutt
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - John Hardman
- Department of Otolaryngology, Barts Health NHS Trust, London, United Kingdom
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, United Kingdom
| | - Chinasa Odo
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Nikki Rousseau
- Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Theofano Tikka
- Department of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joanne M. Patterson
- School of Allied Health Professions & Nursing, Institute of Population Health / Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
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Henry M, Asuzu C, Savard S, Devault-Tousignant C, Timmermans S, Khosravi K, Amin A, Albert J, Krochmalnek T, Odiyo P, Akin-Odanye EO, Terwase J, Lounsbury D, Nichols S, Nichols S, Palmer C. Psychosocial and palliative care in African national cancer control plans: A qualitative study. Psychooncology 2024; 33:e6346. [PMID: 38743345 DOI: 10.1002/pon.6346] [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: 09/12/2023] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Low and middle income countries of Africa account for a disproportionate amount of the global health burden of cancer. Providing patients access to psychosocial oncology and palliative care through policy structures such as the National Cancer Control Plans (NCCP) is essential to improving the care provided to patients and their families. The first phase of this study sought to determine the extent to which palliative care and psychosocial oncology were integrated in NCCPs in African countries. METHODS A qualitative thematic analysis of the plans was used using Nvivo, with two-raters coding and continuous team discussions. Data were organized into an infographic map showing the coverage of themes across African countries. RESULTS Fifty-eight NCCPs and NCD plans were analyzed in the 54 countries in Africa. The findings illustrate a lack of standardization across countries' NCCPs in addressing psychosocial oncology and palliative care themes. Certain areas presented good coverage across several plans, such as barriers to access, education, awareness, and health behaviors, coordination of care, families, caregivers and community involvement, and palliative care. Other themes presented low coverage, such as doctor-patient communication, mental health, bereavement, psychosocial care, survivorship care, and traditional medicine. CONCLUSIONS One may consider further developing NCCP areas as they pertain to psychosocial oncology and palliative care to ensure their proper place on the policy agenda for a healthier Africa.
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Affiliation(s)
- Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Chioma Asuzu
- Department of Counseling and Human Development Studies, University of Ibadan, Ibadan, Nigeria
| | - Sabrina Savard
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Sydney Timmermans
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Katrina Khosravi
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Amina Amin
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Justine Albert
- Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Tara Krochmalnek
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Phillip Odiyo
- Kenya Network of Cancer Organizations, A Fresh Chapter, Nairobi, Kenya
| | | | - Joyce Terwase
- Benue State University, Makurdi, Benue State, Nigeria
| | - David Lounsbury
- Department of Epidemiology & Population Health and Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Scott Nichols
- Enloe Cancer Center, Chico, California, USA
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | | | - Charles Palmer
- School of Population and Global Health, McGill University, Montreal, Québec, Canada
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Yi T, Wagner G. Malignant tumor cells engender second membrane-lined organelles for self-protection and tumor progression. Proc Natl Acad Sci U S A 2024; 121:e2317141121. [PMID: 38294933 PMCID: PMC10861905 DOI: 10.1073/pnas.2317141121] [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: 10/04/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024] Open
Abstract
Cancer is a leading cause of mortality in humans, but the efficacy of current treatments for many cancers is limited, as they lack unique mechanistically defined targets. Here, we show that, upon malignant transformation, aggressive oncocells generate a second membrane exterior to their plasma membrane to form cytocapsulas (CCs) and cytocapsular tubes (CCTs), which all together constitute cytocapsular oncocells with pleotropic biological functions in cancer patient tissues in vivo. Proteomic and biochemical analyses revealed that the PMCA2 calcium pump is highly up-regulated in CCs and CCTs in malignant tumors but not in normal tissues, thus identifying a unique cancer biomarker and target for cancer therapy. Cytocapsular oncocells are universally present in solid cancers and appear in hematologic cancers in immune organs. Multi-cell malignant tumors are also enveloped by protective CC membranes. These cytocapsular tumors (CTs) generate numerous CCTs that form freeways for cancer cell metastasis to both neighboring and distant destinations. Entire cytocapsular tumor networks (CTNs) dominate physical cancer metastasis pathways in cancer patients in vivo. Later, CCTs invade micro blood vessels and release cytocapsular oncocells into the blood, providing a source of circulating tumor cells. CTNs interconnect cytocapsular tumors in primary and secondary cancer niches, creating larger cytocapsular tumor network systems (CTNSs). Primary and secondary CTNSs are in turn interconnected, forming dynamic and integrated CTNSs. Thus, interconnected cytocapsular oncocells, CTNs, and CTNSs coordinate cancer progression via the integrated cytocapsular membrane systems.
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Affiliation(s)
- Tingfang Yi
- Cytocapsula Research Institute, Cambridge, MA02142
- Centiver Ltd., Cambridge, MA02142
| | - Gerhard Wagner
- Cytocapsula Research Institute, Cambridge, MA02142
- Centiver Ltd., Cambridge, MA02142
- Department of Biological Chemistry and Molecular Pharmacology of Harvard Medical School, Boston, MA02115
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7
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Zakkak N, Barclay ME, Swann R, McPhail S, Rubin G, Abel GA, Lyratzopoulos G. The presenting symptom signatures of incident cancer: evidence from the English 2018 National Cancer Diagnosis Audit. Br J Cancer 2024; 130:297-307. [PMID: 38057397 PMCID: PMC10803766 DOI: 10.1038/s41416-023-02507-4] [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: 03/16/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Understanding relationships between presenting symptoms and subsequently diagnosed cancers can inform symptom awareness campaigns and investigation strategies. METHODS We used English National Cancer Diagnosis Audit 2018 data for 55,122 newly diagnosed patients, and examined the relative frequency of presenting symptoms by cancer site, and of cancer sites by presenting symptom. RESULTS Among 38 cancer sites (16 cancer groups), three classes were apparent: cancers with a dominant single presenting symptom (e.g. melanoma); cancers with diverse presenting symptoms (e.g. pancreatic); and cancers that are often asymptomatically detected (e.g. chronic lymphocytic leukaemia). Among 83 symptoms (13 symptom groups), two classes were apparent: symptoms chiefly relating to cancers of the same body system (e.g. certain respiratory symptoms mostly relating to respiratory cancers); and symptoms with a diverse cancer site case-mix (e.g. fatigue). The cancer site case-mix of certain symptoms varied by sex. CONCLUSION We detailed associations between presenting symptoms and cancer sites in a large, representative population-based sample of cancer patients. The findings can guide choice of symptoms for inclusion in awareness campaigns, and diagnostic investigation strategies post-presentation when cancer is suspected. They can inform the updating of clinical practice recommendations for specialist referral encompassing a broader range of cancer sites per symptom.
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Affiliation(s)
- N Zakkak
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - M E Barclay
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - R Swann
- National Disease Registration Service, NHS England, London, UK
- Cancer Intelligence, Cancer Research UK, London, UK
| | - S McPhail
- National Disease Registration Service, NHS England, London, UK
| | - G Rubin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - G A Abel
- Medical School, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, London, UK
| | - G Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Mwamba M, Lombe DC, Msadabwe S, Bond V, Simwinga M, Sentoogo Ssemata A, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. A Narrative Synthesis of Literature on the Barriers to Timely Diagnosis and Treatment of Cancer in Sub-Saharan Africa. Clin Oncol (R Coll Radiol) 2023; 35:e537-e548. [PMID: 37302880 DOI: 10.1016/j.clon.2023.05.011] [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: 08/31/2022] [Revised: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Poor cancer survival outcomes in sub-Saharan Africa (SSA) have been linked to delays in diagnosis and treatment. Here we present a detailed overview of the qualitative literature evaluating the barriers to receiving timely diagnosis and treatment of cancer in SSA. The PubMed, EMBASE, CINAHL, PsycINFO databases were searched to identify qualitative studies reporting on barriers to timely diagnosis of cancer in SSA published between 1995 and 2020. A systematic review methodology was applied, including quality assessment and narrative data synthesis. We identified 39 studies, of which 24 focused on breast or cervical cancer. Only one study focused on prostate cancer and one on lung cancer. When exploring factors contributing to delays, six key themes emerged from the data. The first theme was health service barriers, which included: (i) inadequate numbers of trained specialists; (ii) limited knowledge of cancer among healthcare providers; (iii) poor co-ordination of care; (iv) inadequately resourced health facilities; (v) negative attitudes of healthcare providers towards patients; (vi) high cost of diagnostic and treatment services. The second key theme was patient preference for complementary and alternative medicine; the third was the limited understanding of cancer among the population. The fourth barrier was a patient's personal and family obligations; the fifth was the perceived impact of cancer and its treatment on sexuality, body image and relationships. Finally, the sixth was the stigma and discrimination faced by patients following a diagnosis of cancer. In conclusion, health system, patient level and societal factors all influence the likelihood of timely diagnosis and treatment for cancer in SSA. The results provide a focus for targeting health system interventions, particular with regards to awareness and understanding of cancer in the region.
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Affiliation(s)
- M Mwamba
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
| | - D C Lombe
- Regional Cancer Treatment Services MidCentral District Health Board, New Zealand
| | - S Msadabwe
- Cancer Diseases Hospital, Lusaka, Zambia
| | - V Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia; London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - M Simwinga
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - A Sentoogo Ssemata
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - R Muhumuza
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - J Seeley
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - A D Mwaka
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - A Aggarwal
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK; Institute of Cancer Policy, King's College London, London, UK
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9
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Black GB, Boswell L, Harris J, Whitaker KL. What causes delays in diagnosing blood cancers? A rapid review of the evidence. Prim Health Care Res Dev 2023; 24:e26. [PMID: 37039465 PMCID: PMC10156470 DOI: 10.1017/s1463423623000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVE We undertook a rapid review of literature relating to the diagnosis of blood cancers, to find out what factors contribute to delays in diagnosis, including symptom recognition, appraisal and help-seeking behaviours. METHODS We used rapid review methodology following Tricco et al. to synthesise current literature from two electronic databases. We searched for studies about symptom appraisal help-seeking for all blood cancers published between 2001 and 2021, written in English. RESULTS Fifteen studies were included in the review, of which 10 were published in the United Kingdom. We found a number of factors associated with delays in blood cancer diagnosis. These included patient factors such as gender, age and ethnicity, as well as health system factors such as poor communication and seeing a locum clinician in primary care. A narrative synthesis of the evidence produced four types of symptom interpretation by patients: (1) symptoms compatible with normal state of health, (2) event-linked problems, (3) mild or chronic illness and (4) non-specific unwell state. These four interpretations were linked to different help-seeking behaviours. After seeking help, patients often experienced delays due to healthcare professionals' (HCPs') non-serious interpretation of symptoms, misleading blood tests, discontinuity of care and other barriers in the diagnostic pathway. CONCLUSION Blood cancers are difficult to diagnose due to non-specific heterogeneous symptoms, and this is reflected in how those symptoms are interpreted by patients and managed by HCPs. It is important to understand how different interpretations affect delays in help-seeking, and what HCPs can do to support timely follow-up for patients.
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Affiliation(s)
- Georgia B. Black
- Reader in Applied Health Research, Wolfson Institute of Population Health,
Queen Mary University of London, London,
UK
| | - Laura Boswell
- PhD student, School of Health Sciences, University of
Surrey, Guildford, UK
| | - Jenny Harris
- Senior Lecturer in Cancer Care, School of Health Sciences,
University of Surrey, Guildford,
UK
| | - Katriina L. Whitaker
- Professor of Psychology and Lead for Cancer Care, School of Health
Sciences, University of Surrey, Guildford,
UK
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10
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Rubin KH, Haastrup PF, Nicolaisen A, Möller S, Wehberg S, Rasmussen S, Balasubramaniam K, Søndergaard J, Jarbøl DE. Developing and Validating a Lung Cancer Risk Prediction Model: A Nationwide Population-Based Study. Cancers (Basel) 2023; 15:cancers15020487. [PMID: 36672436 PMCID: PMC9856360 DOI: 10.3390/cancers15020487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Lung cancer can be challenging to diagnose in the early stages, where treatment options are optimal. We aimed to develop 1-year prediction models for the individual risk of incident lung cancer for all individuals aged 40 or above living in Denmark on 1 January 2017. The study was conducted using population-based registers on health and sociodemographics from 2007-2016. We applied backward selection on all variables by logistic regression to develop a risk model for lung cancer and applied the models to the validation cohort, calculated receiver-operating characteristic curves, and estimated the corresponding areas under the curve (AUC). In the populations without and with previously confirmed cancer, 4274/2,826,249 (0.15%) and 482/172,513 (0.3%) individuals received a lung cancer diagnosis in 2017, respectively. For both populations, older age was a relevant predictor, and the most complex models, containing variables related to diagnoses, medication, general practitioner, and specialist contacts, as well as baseline sociodemographic characteristics, had the highest AUC. These models achieved a positive predictive value (PPV) of 0.0127 (0.006) and a negative predictive value (NPV) of 0.989 (0.997) with a 1% cut-off in the population without (with) previous cancer. This corresponds to 1.2% of the screened population experiencing a positive prediction, of which 1.3% would be incident with lung cancer. We have developed and tested a prediction model with a reasonable potential to support clinicians and healthcare planners in identifying patients at risk of lung cancer.
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Affiliation(s)
- Katrine H. Rubin
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Peter F. Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne Nicolaisen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Sören Möller
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Dorte E. Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
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Sarma EA, Thompson MJ, Bowles EJA, Burnett-Hartman AN, Hubbard RA, Yu O, Chubak J. Patient and tumour characteristics of screening-age adults diagnosed with screen-detected versus symptomatic colon cancer. Colorectal Dis 2022; 24:1344-1351. [PMID: 35739634 PMCID: PMC10018485 DOI: 10.1111/codi.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 02/08/2023]
Abstract
AIM International studies have shown that most colon cancers are diagnosed among people with symptoms, but research is limited in the United States. Here, we conducted a retrospective study of adults aged 50-85 years diagnosed with stage I-IIIA colon cancer between 1995 and 2014 in two US healthcare systems. METHODS Mode of detection (screening or symptomatic) was ascertained from medical records. We estimated unadjusted odds ratios (OR) and 95% confidence intervals (CI) comparing detection mode by patient factors at diagnosis (year, age, sex, race, smoking status, body mass index [BMI], Charlson score), prediagnostic primary care utilization, and tumour characteristics (stage, location). RESULTS Of 1,675 people with colon cancer, 38.4% were screen-detected, while 61.6% were diagnosed following symptomatic presentation. Screen-detected cancer was more common among those diagnosed between 2010 and 2014 versus 1995-1999 (OR 1.65, 95% CI: 1.19-2.28), and those with a BMI of 25-<30 kg/m2 (OR 1.54, 95% CI: 1.21-1.98) or ≥30 kg/m2 (OR 1.52, 95% CI: 1.18-1.96) versus <25 kg/m2 . Screen-detected cancer was less common among people aged 76-85 (OR 0.50, 95% CI: 0.39-0.65) versus 50-64, those with comorbidity scores >0 (OR 0.71, 95% CI: 0.56-0.91 for score = 1, OR 0.34, 95% CI: 0.26-0.45 for score = 2+), and those with 2+ prediagnostic primary care visits (OR 0.53, 95% CI: 0.37-0.76) versus 0 visits. The odds of screen detection were lower among patients diagnosed with stage IIA (OR 0.33, 95% CI = 0.27-0.41) or IIB (OR 0.12, 95% CI: 0.06-0.24) cancers versus stage I. CONCLUSIONS Most colon cancers among screen-eligible adults were diagnosed following symptomatic presentation. Even with increasing screening rates over time, research is needed to better understand why specific groups are more likely to be diagnosed when symptomatic and identify opportunities for interventions.
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Affiliation(s)
- Elizabeth A Sarma
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | | | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
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12
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Bosch X, Montori‐Palacin E, Martínez‐Ferrer R, Aldea A, Moreno P, López‐Soto A. Time intervals in the care pathway to cancer diagnosis during the COVID-19 pandemic: A large retrospective study from a high-volume center. Int J Cancer 2022; 152:384-395. [PMID: 36053784 PMCID: PMC9539134 DOI: 10.1002/ijc.34260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
Despite extensive research on cancer care during the COVID-19 pandemic, evidence on the impact on prediagnostic time intervals is lacking. To better understand how COVID-19 changed the pathway to diagnosis of cancer, we examined the length of intervals from symptom onset to diagnosis for 13 common cancer types with known clinical stage over 1-year nonpandemic period (March 2019 to March 2020; N = 844) and three biannual COVID periods (March 2020 to September 2021; N = 1172). We analyzed the patient interval (from first symptoms to presentation to a physician), the primary care/emergency department interval (from presentation with relevant symptoms to a primary care or emergency department physician to referral to a hospital-based diagnosis center) and the hospital interval (from referral to diagnosis). Compared to nonpandemic data, there were significant changes across COVID periods. The pandemic mostly impacted patient intervals for cancers diagnosed over the first 6 months after onset in March 2020. Overall median patient intervals were longest in the early COVID period (39 [IQR 22-64] days) and shortest in the nonpandemic period (20 [IQR 13-30] days; Kruskal-Wallis test [χ2 ], P < .0001). Differences in clinical stage between periods were relevant, with cancers from the mid-period (September 2020 to March 2021) showing the most advanced stage. A shift to later stage was plausibly a result of delayed intervals in the early COVID period. Since intervals are eventually relevant to prognosis, our results provide a baseline against which the impact of improvement strategies to minimize the negative outcomes of COVID-19-associated cancer delays can be assessed and implemented.
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Affiliation(s)
- Xavier Bosch
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain
| | - Elisabet Montori‐Palacin
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Hospital Plató Medical CenterBarcelonaSpain
| | - Rosa Martínez‐Ferrer
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Hospital Plató Medical CenterBarcelonaSpain
| | - Anna Aldea
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain
| | - Alfonso López‐Soto
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB)University of BarcelonaBarcelonaSpain,Campus Villarroel Medical CenterBarcelonaSpain,Campus Hospital Plató Medical CenterBarcelonaSpain
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13
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Spagnoli P, Jacxsens L, Vlerick P. Towards a food safety culture improvement roadmap: Diagnosis and gap analysis through a conceptual framework as the first steps. Food Control 2022. [DOI: 10.1016/j.foodcont.2022.109398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Moodley J, Harries J, Scott SE, Mwaka AD, Saji S, Walter FM. Exploring primary care level provider interpretation and management of potential breast and cervical cancer signs and symptoms in South Africa. Ecancermedicalscience 2021; 15:1298. [PMID: 34824621 PMCID: PMC8580586 DOI: 10.3332/ecancer.2021.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Women with potential breast and cervical cancer symptoms in South Africa (SA) usually self-present to primary health care (PHC) clinics. The aim of this study was to explore PHC provider interpretation and management of potential breast and cervical cancer signs and symptoms. Methods In-depth interviews with PHC providers incorporating vignettes were conducted between April and May 2019 in two sites in SA. Four vignettes (two breast and two cervical) were developed by the research team to capture aspects of provider symptom interpretation, reasoning, actions and challenges. The content of the vignettes was informed by a preceding community-based survey and qualitative interviews with symptomatic women. Interviews were audio recorded, transcribed verbatim and analysed using a thematic analysis approach. Results Twenty-four PHC providers were interviewed (12 urban, 12 rural; median age: 43 years). Four main themes relating to clinical assessment and reasoning; referral and feedback challenges; awareness of breast and cervical cancer policy guidelines and training and education needs emerged. Vignette-prompted questions relating to presenting symptoms, and possible accompanying symptoms and signs, demonstrated comprehensive proposed history taking and clinical assessment by PHC providers. Cancer was considered as a potential diagnosis by the majority of PHC providers. PHC providers also considered the possibility of infectious causes for both breast and cervical vignettes indicating they would ask questions around human immunodeficiency virus status, use of anti-retroviral therapy, and, for those with cervical symptoms, would need to rule out a sexually transmitted infection. Sexual assault was considered in assessing the cervical symptom scenarios. Providers raised issues around cumbersome booking systems and lack of feedback from referral centres. The need for provider and patient education and training to improve timely diagnosis of breast and cervical cancer was raised. Most providers were not aware of current breast or cervical cancer policy guidelines. Conclusion Clinical assessment at PHC level is complex and influenced by local health issues. Providing context-relevant training and support for PHC providers, and improving referral and feedback systems, could assist timely diagnosis of women with symptomatic breast and cervical cancer.
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Affiliation(s)
- Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa.,Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa.,South African Medical Research Council Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa.,https://orcid.org/0000-0002-9398-5202
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa.,https://orcid.org/0000-0001-7359-8419
| | - Suzanne Emilie Scott
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London SE1 9RT, UK.,https://orcid.org/0000-0001-5536-9612
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Upper Mulago Jill Road, PO Box 7072, Kampala 256, Uganda.,https://orcid.org/0000-0001-7952-2327
| | - Smiji Saji
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.,https://orcid.org/0000-0003-0002-6326
| | - Fiona Mary Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.,Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK.,https://orcid.org/0000-0002-7191-6476
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15
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Didamson OC, Abrahamse H. Targeted Photodynamic Diagnosis and Therapy for Esophageal Cancer: Potential Role of Functionalized Nanomedicine. Pharmaceutics 2021; 13:1943. [PMID: 34834358 PMCID: PMC8625244 DOI: 10.3390/pharmaceutics13111943] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 12/11/2022] Open
Abstract
Esophageal cancer is often diagnosed at the late stage when cancer has already spread and is characterized by a poor prognosis. Therefore, early diagnosis is vital for a better and efficient treatment outcome. Upper endoscopy with biopsy is the standard diagnostic tool for esophageal cancer but is challenging to diagnose at its premalignant stage, while conventional treatments such as surgery, chemotherapy, and irradiation therapy, are challenging to eliminate the tumor. Photodynamic diagnosis (PDD) and therapy (PDT) modalities that employ photosensitizers (PSs) are emerging diagnostic and therapeutic strategies for esophageal cancer. However, some flaws associated with the classic PSs have limited their clinical applications. Functionalized nanomedicine has emerged as a potential drug delivery system to enhance PS drug biodistribution and cellular internalization. The conjugation of PSs with functionalized nanomedicine enables increased localization within esophageal cancer cells due to improved solubility and stability in blood circulation. This review highlights PS drugs used for PDD and PDT for esophageal cancer. In addition, it focuses on the various functionalized nanomedicine explored for esophageal cancer and their role in targeted PDD and PDT for diagnosis and treatment.
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Affiliation(s)
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein, Johannesburg 2028, South Africa;
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16
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Erridge S, Lyratzopoulos G, Renzi C, Millar A, Lee R. Rapid Diagnostic Centres and early cancer diagnosis. Br J Gen Pract 2021; 71:487-488. [PMID: 34711557 PMCID: PMC8544161 DOI: 10.3399/bjgp21x717413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Simon Erridge
- Epidemiology of Cancer Healthcare Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London
| | - Georgios Lyratzopoulos
- ECHO Group, Department of Behavioural Science and Health, University College London, London
| | - Cristina Renzi
- ECHO Group, Department of Behavioural Science and Health, University College London, London
| | | | - Richard Lee
- The Royal Marsden and The Institute for Cancer Research National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), The Royal Marsden NHS Foundation Trust, London
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17
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Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer. Cancers (Basel) 2021; 13:cancers13205163. [PMID: 34680312 PMCID: PMC8533728 DOI: 10.3390/cancers13205163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3-76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61-0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.
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18
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Guber RS, Gonzalez Mac Donald M, Aleman MN, Luciardi MC, Mentz P, Wierna A, Ansonnaud C, Garcia V, Ansonnaud AM, Soria A. Evaluation of salivary protein patterns among a rural population exposed and non-exposed to arsenic-contaminated drinking water in areas of Tucumán (Argentina): a pilot study. J Appl Oral Sci 2021; 29:e20200939. [PMID: 34495104 PMCID: PMC8425895 DOI: 10.1590/1678-7757-2020-0939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arsenic contamination in the environment and groundwater is a major global public health problem. Several researchers suggest that the toxicity of arsenic could be related to oral cancer development, usually resulting from potentially malignant lesions. During pathological processes, salivary proteins suffer modifications, which could lead to the discovery of new biomarkers. OBJECTIVE To analyze the protein profile in human saliva samples from a rural population exposed to high levels of arsenic in drinking water and its association with potentially malignant lesions. METHODOLOGY This observational, analytic and cross-sectional design included 121 patients from the state of Graneros (Tucumán, Argentina). Arsenic concentration in drinking water was determined and, according to the values obtained, individuals were divided into 2 groups: exposed group and non-exposed group. Saliva samples were obtained, and total protein concentration was measured by Bradford method. Finally, Laemmli SDS-polyacrylamide gel electrophoresis was conducted to obtain the protein profile. RESULTS Total protein concentration in saliva was lower in the exposed group than in the non-exposed group. Average areas of 20 and 42 KDa bands were significantly lower in exposed group than non-exposed group. CONCLUSION Chronic intake of high arsenic concentrations in drinking water produces changes in the salivary protein profile, which is associated with the presence of potentially malignant lesions.
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Affiliation(s)
- Rosa Silvina Guber
- Universidad Nacional de Tucumán, Facultad de Bioquímica, Química y Farmacia, Argentina
| | | | | | | | - Paula Mentz
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | - Alicia Wierna
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | - Carlos Ansonnaud
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | - Veronica Garcia
- Universidad Nacional de Tucumán, Facultad de Odontología, Argentina
| | | | - Analía Soria
- Universidad Nacional de Tucumán, Facultad de Bioquímica, Química y Farmacia, Argentina
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Balasubramaniam K, Rasmussen S, Haastrup PF, Suadicani K, Søndergaard J, Jarbøl DE. Women's barriers for contacting general practice when experiencing gynecological cancer symptoms: a population-based study. BMC FAMILY PRACTICE 2021; 22:167. [PMID: 34399693 PMCID: PMC8369740 DOI: 10.1186/s12875-021-01518-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A prerequisite for general practitioners (GPs) being able to refer patients with gynecological cancer alarm symptoms for further investigations is that individuals present the symptoms to the GP. Not all symptoms are presented to the GP, and knowledge of barriers for healthcare-seeking is sparse. The aim of this study was to analyze associations between age, socioeconomic status, and common barriers ("being too embarrassed", "being too busy", "worried about wasting the doctors time" and "worried what the GP might find") towards GP contact with gynecological alarm symptoms. METHODS Nationwide population-based study in Denmark based on a random sample of 51 090 women aged 20 years or older. A web-based questionnaire regarding experience of four predefined alarm symptoms of gynecological cancer, decisions about contact to GPs, and barriers towards GP contact was distributed. Information about socioeconomic status was collected from Statistics Denmark. RESULTS A total of 26 466 women (54.5%) completed the questionnaire. The proportion of women with no contact to the GP varied between 64.6% and 78.1% for postmenopausal bleeding and pain during intercourse, respectively. Between 32.3% (bleeding during intercourse) and 45.3% (postmenopausal bleeding) of the women reported no barriers for GP contact. The proportions of reported barriers ranged from 7.5% for being too embarrassed (pelvic pain) to 26.8% for being too busy (bleeding during intercourse). Women aged 40-59 years had lower odds of reporting "being too embarrassed" and "worried about wasting the GP´s time", while women aged 60 + years of age had lower odds of reporting "being too busy" compared to the youngest age group. Women in the highest income groups had lower odds of reporting "being too embarrassed" and "wasting the GP´s time" compared to those with a low income, while those with high educational level had lower odds of reporting "being too embarrassed" and "worried what the GP might find" compared to those with low educational level. CONCLUSIONS More than half of the respondents with no contact to the GP, reported one or more barriers towards GP contact. Lower age and socioeconomic status were significantly associated with higher odds of reporting barriers. As this may explain the differences in healthcare seeking behavior, healthcare planners, policy makers and clinicians should be aware of these findings.
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Affiliation(s)
- Kirubakaran Balasubramaniam
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark.
| | - Sanne Rasmussen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Peter Fentz Haastrup
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | | | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark
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