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Makris KI, Clark DL, Buffie AW, Steen EH, Ramsey DJ, Singh H. Missed Opportunities to Promptly Diagnose and Treat Adrenal Tumors. J Surg Res 2022; 276:174-181. [PMID: 35366423 DOI: 10.1016/j.jss.2022.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Adrenal mass management guidelines are insufficiently applied, and timeliness of treatment is unknown. We evaluated missed opportunities to promptly diagnose and treat adrenal tumors that ultimately required adrenalectomy. METHODS From the Veterans Affairs Corporate Data Warehouse, we identified patients who underwent adrenalectomy (2010-2016) in the South-Central Veterans Affairs HealthCare Network and reviewed their records. Diagnostic timeliness was assessed by the interval between initial (index) imaging with adrenal abnormality and the next diagnostic step. Workup was defined as early (interval ≤6 mo) or late (>6 mo). Adrenalectomy was considered prompt when the interval between index imaging and adrenalectomy was ≤12 mo and delayed when this was >12 mo. We quantified diagnostic and treatment delays and assessed factors associated with delayed adrenalectomy. RESULTS During the study period, 84 patients underwent adrenalectomy: male (86.9%), White (57.1%), with a mean age of 58.7 y (±8.8). Of those, 25 (29.8%) had late workup, and 36 (42.9%) had delayed surgery (median interval: 44 mo, range 14-282). Late hormonal workup occurred in 24 of 36 (66.7%) patients with delayed surgery, compared with one of 48 (2.1%, P < 0.001) with prompt surgery. CONCLUSIONS Missed opportunities in prompt diagnosis and treatment were common in patients with adrenal masses ultimately requiring adrenalectomy. Late hormonal workup is associated with delayed adrenalectomy. Interventions are needed to aid clinicians to recognize the presence, promptly evaluate, and make guideline-informed decisions on the management of an adrenal mass.
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Affiliation(s)
- Konstantinos I Makris
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Baylor College of Medicine, Houston, Texas.
| | | | | | - Emily H Steen
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - David J Ramsey
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Baylor College of Medicine, Houston, Texas
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Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, Kahan Z, Mardiak J, Pieńkowski T, Semiglazova T, Stamatovic L, Timcheva C, Vasovic S, Vrbanec D, Zaborek P. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health 2013; 24:761-7. [PMID: 24029456 DOI: 10.1093/eurpub/ckt131] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient- and system-related delays in commencing breast cancer treatment in different countries. METHODS A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy). RESULTS The average patient-related delay time and total delay time were 4.7 (range: 3.4-6.2) weeks and 14.4 (range: 11.5-29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3-24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times. CONCLUSIONS The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.
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Affiliation(s)
- Jacek Jassem
- 1 Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Vahit Ozmen
- 2 Department of Surgery, Istanbul University, Istanbul, Turkey
| | - Florin Bacanu
- 3 Departament of Clinical Oncology, Sf Maria Hospital, Bucharest, Romania
| | - Monika Drobniene
- 4 Radiotherapy and Drug Therapy Center, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Janis Eglitis
- 5 Department of Breast Surgery, Oncology Centre of Latvia, Riga East University Hospital, Riga, Latvia
| | | | - Zsuzsanna Kahan
- 7 Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Jozef Mardiak
- 8 2nd Department of Oncology, National Cancer Institute and Medical School of Comenius University, Bratislava, Slovak Republic
| | - Tadeusz Pieńkowski
- 9 Department of Oncology and Surgery, Medical Centre of Postgraduate Education, Otwock, Poland
| | - Tatiana Semiglazova
- 10 Department of Medical Oncology, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - Ljiljana Stamatovic
- 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia
| | - Constanta Timcheva
- 12 Department of Chemotherapy, Specialized Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - Suzana Vasovic
- 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia
| | - Damir Vrbanec
- 13 Department of Medical Oncology, Clinic of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Piotr Zaborek
- 14 Collegium of World Economy, Warsaw School of Economics, Warsaw, Poland
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