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Metcalf GAD. MicroRNAs: circulating biomarkers for the early detection of imperceptible cancers via biosensor and machine-learning advances. Oncogene 2024; 43:2135-2142. [PMID: 38839942 PMCID: PMC11226400 DOI: 10.1038/s41388-024-03076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
This review explores the topic of microRNAs (miRNAs) for improved early detection of imperceptible cancers, with potential to advance precision medicine and improve patient outcomes. Historical research exploring miRNA's role in cancer detection collectively revealed initial hurdles in identifying specific miRNA signatures for early-stage and difficult-to-detect cancers. Early studies faced challenges in establishing robust biomarker panels and overcoming the heterogeneity of cancer types. Despite this, recent developments have supported the potential of miRNAs as sensitive and specific biomarkers for early cancer detection as well as having demonstrated remarkable potential as diagnostic tools for imperceptible cancers, such as those with elusive symptoms or challenging diagnostic criteria. This review discusses the advent of high-throughput technologies that have enabled comprehensive detection and profiling of unique miRNA signatures associated with early-stage cancers. Furthermore, advancements in bioinformatics and machine-learning techniques are considered, exploring the integration of multi-omics data which have potential to enhance both the accuracy and reliability of miRNA-based cancer detection assays. Finally, perspectives on the continuing development on technologies as well as discussion around challenges that remain, such as the need for standardised protocols and addressing the complex interplay of miRNAs in cancer biology are conferred.
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Affiliation(s)
- Gavin A D Metcalf
- School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK.
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2
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Parker M, Kazemi F, Ahmed AK, Kuo CC, Nair SK, Rincon-Torroella J, Jackson C, Gallia G, Bettegowda C, Weingart J, Brem H, Mukherjee D. Exploring the impact of primary care utilization and health information exchange upon treatment patterns and clinical outcomes of glioblastoma patients. J Neurooncol 2024; 168:345-353. [PMID: 38662150 DOI: 10.1007/s11060-024-04677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE There is limited literature describing care coordination for patients with glioblastoma (GBM). We aimed to investigate the impact of primary care and electronic health information exchange (HIE) between neurosurgeons, oncologists, and primary care providers (PCP) on GBM treatment patterns, postoperative outcomes, and survival. METHODS We identified adult GBM patients undergoing primary resection at our institution (2007-2020). HIE was defined as shared electronic medical information between PCPs, oncologists, and neurosurgeons. Multivariate logistic regression analyses were used to determine the effect of PCPs and HIE upon initiation and completion of adjuvant therapy. Kaplan-Meier and multivariate Cox regression models were used to evaluate overall survival (OS). RESULTS Among 374 patients (mean age ± SD: 57.7 ± 13.5, 39.0% female), 81.0% had a PCP and 62.4% had electronic HIE. In multivariate analyses, having a PCP was associated with initiation (OR: 7.9, P < 0.001) and completion (OR: 4.4, P < 0.001) of 6 weeks of concomitant chemoradiation, as well as initiation (OR: 4.0, P < 0.001) and completion (OR: 3.0, P = 0.007) of 6 cycles of maintenance temozolomide thereafter. Having a PCP (median OS [95%CI]: 14.6[13.1-16.1] vs. 10.8[8.2-13.3] months, P = 0.005) and HIE (15.40[12.82-17.98] vs. 13.80[12.51-15.09] months, P = 0.029) were associated with improved OS relative to counterparts in Kaplan-Meier analysis and in multivariate Cox regression analysis (hazard ratio [HR] = 0.7, [95% CI] 0.5-1.0, P = 0.048). In multivariate analyses, chemoradiation (HR = 0.34, [95% CI] 0.2-0.7, P = 0.002) and maintenance temozolomide (HR = 0.5, 95%CI 0.3-0.8, P = 0.002) were associated with improved OS relative to counterparts. CONCLUSION Effective care coordination between neurosurgeons, oncologists, and PCPs may offer a modifiable avenue to improve GBM outcomes.
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Affiliation(s)
- Megan Parker
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Foad Kazemi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Cathleen C Kuo
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Christopher Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, 21287, Baltimore, MD, USA.
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3
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Vedelø TW, Sørensen JCH, Hall EOC, Delmar C. A fast transition: A case study of patients' experiences during the diagnostic and surgical treatment phase of an accelerated brain cancer pathway. Scand J Caring Sci 2024; 38:451-460. [PMID: 38433372 DOI: 10.1111/scs.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/27/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Patients receiving a brain cancer diagnosis may face cognitive decline and a poor prognosis. In addition, they suffer from a high symptom burden in a complex cancer pathway. The aim of this study was to investigate the early hospital experiences of brain tumour patients during the diagnostic and surgical treatment phase. METHODS A descriptive longitudinal single-case study design was used, and data were analysed via systematic text condensation. RESULTS The patients' experiences of being diagnosed with and treated for brain cancer were interpreted in terms of the central theme: a fast transition into an unknown journey. This theme consisted of the following subthemes: emotionally overwhelmed, putting life on hold and an unfamiliar dependency. CONCLUSIONS Patients diagnosed with brain cancer struggle with overwhelming emotions due to this sudden life-threatening diagnosis, their fear of brain surgery and their progressing dependence. Patients did not voice their feelings, fears or needs, so these may easily be overlooked and unmet. A proactive and continuous care approach throughout the diagnostic phase is needed to support these patients.
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Affiliation(s)
- Tina Wang Vedelø
- Department of Public Health, Nursing, Health Faculty, Aarhus University, Aarhus, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Christian H Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health Faculty, Aarhus University, Aarhus, Denmark
| | - Elisabeth O C Hall
- Department of Public Health, Nursing, Health Faculty, Aarhus University, Aarhus, Denmark
- Section of Health Science and Nursing, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Charlotte Delmar
- Department of Public Health, Nursing, Health Faculty, Aarhus University, Aarhus, Denmark
- VID, Oslo and Bergen, Norway
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Wheelwright SJ, Russ S, Mold F, Armes J, Harder H. Symptomatic presentation of cancer in primary care: a scoping review of patients' experiences and needs during the cancer diagnostic pathway. BMJ Open 2024; 14:e076527. [PMID: 38508614 PMCID: PMC10961516 DOI: 10.1136/bmjopen-2023-076527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The objective was to map the experiences and needs of patients presenting with symptoms of suspected cancer in the primary care interval (from when they first present to primary care to their first appointment or referral to a secondary or tertiary level healthcare facility). DESIGN This was a scoping review. INCLUSION CRITERIA Studies or reports written in English which included primary data on the primary care interval experiences and/or needs of adult patients presenting with new symptoms of suspected cancer were eligible. Studies which only included patients with secondary or recurring cancer, conference abstracts and reviews were excluded. No date limits were applied. METHODS The Joanna Briggs Institute method for Scoping Reviews guided screening, report selection and data extraction. At least two independent reviewers contributed to each stage. Medline, CINAHL, PsychInfo, Embase and Web of Science were searched and several grey literature resources. Relevant quantitative findings were qualitised and integrated with qualitative findings. A thematic analysis was carried out. RESULTS Of the 4855 records identified in the database search, 18 were included in the review, along with 13 identified from other sources. The 31 included studies were published between 2002 and 2023 and most (n=17) were conducted in the UK. Twenty subthemes across four themes (patient experience, interpersonal, healthcare professional (HCP) skills, organisational) were identified. No studies included patient-reported outcome measures. Patients wanted (1) to feel heard and understood by HCPs, (2) a plan to establish what was causing their symptoms, and (3) information about the next stages of the diagnostic process. CONCLUSIONS Scoping review findings can contribute to service planning as the cancer diagnostic pathway for symptomatic presentation of cancer evolves. The effectiveness of this pathway should be evaluated not only in terms of clinical outcomes, but also patient-reported outcomes and experience, along with the perspectives of primary care HCPs.
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Affiliation(s)
| | - Stephanie Russ
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Freda Mold
- Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK
| | - Jo Armes
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Helena Harder
- Brighton & Sussex Medical School, University of Sussex, Brighton, UK
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Koskela TH, Esteva M, Mangione M, Contreras Martos S, Hajdarevic S, Högberg C, Marzo-Castillejo M, Sawicka-Powierza J, Siliņa V, Harris M, Petek D. What would primary care practitioners do differently after a delayed cancer diagnosis? Learning lessons from their experiences. Scand J Prim Health Care 2024; 42:123-131. [PMID: 38116949 PMCID: PMC10851834 DOI: 10.1080/02813432.2023.2296117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians' (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis. DESIGN A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data. SETTING AND SUBJECTS A primary care study, with narratives from 159 PCPs in 23 European countries. MAIN OUTCOME MEASURES PCPs' narratives on the question 'If you saw this patient with cancer presenting in the same way today, what would you do differently? RESULTS The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and 'I wouldn't do anything differently'. CONCLUSION (IMPLICATIONS) To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients' clinical conditions.
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Affiliation(s)
- Tuomas H. Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Center of General Practice, Tampere University Hospital, Tampere, Finland
| | - Magdalena Esteva
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | | | - Sara Contreras Martos
- Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
| | - Senada Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Högberg
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden
| | - Mercè Marzo-Castillejo
- Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
| | | | - Vija Siliņa
- Department of Family Medicine, Riga Stradiņš University, Riga, Latvia
| | - Michael Harris
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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de la Fuente MI. Adult-type Diffuse Gliomas. Continuum (Minneap Minn) 2023; 29:1662-1679. [PMID: 38085893 DOI: 10.1212/con.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE This article highlights key aspects of the diagnosis and management of adult-type diffuse gliomas, including glioblastomas and IDH-mutant gliomas relevant to the daily practice of the general neurologist. LATEST DEVELOPMENTS The advances in molecular characterization of gliomas have translated into more accurate prognostication and tumor classification. Gliomas previously categorized by histological appearance solely as astrocytomas or oligodendrogliomas are now also defined by molecular features. Furthermore, ongoing clinical trials have incorporated these advances to tailor more effective treatments for specific glioma subtypes. ESSENTIAL POINTS Despite recent insights into the molecular aspects of gliomas, these tumors remain incurable. Care for patients with these complex tumors requires a multidisciplinary team in which the general neurologist has an important role. Efforts focus on translating the latest data into more effective therapies that can prolong survival.
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Vomer RP, Narducci D, Larick RS, York E, Terry K. Strike Out: A Case Report of Glioblastoma in a Collegiate Softball Player. Cureus 2023; 15:e44486. [PMID: 37791212 PMCID: PMC10544434 DOI: 10.7759/cureus.44486] [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] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
A 20-year-old female, right-hand-dominant Division I softball player, presented to her pre-participation exam endorsing numbness that started in her left thumb and had progressed to involve her entire hand and left medial elbow. She had no change in her physical health over the past year prior to presentation and denied injury illness or trauma to the left upper extremity or neck. She reported no change in her softball off-season training regimen or equipment. Exam exhibited decreased sensation in C6, C7, and C8 dermatomes and weakness in the C8 myotome. Magnetic resonance angiography (MRA) displayed a right parietal lobe mass which biopsy confirmed as glioblastoma multiforme (GBM). GBM, also known as glioblastoma or grade 4 astrocytoma is an aggressive form of cancer that can affect the brain and spinal cord. Despite being the most common malignant primary brain tumor in adults, current treatment is mostly palliative. Treatment for this student-athlete included surgery, radiation, and chemotherapy. The selection of aggressive treatment including excision of the tumor was largely elected due to her age. She received chemotherapy with temozolomide in conjunction with radiation for a total of nine months. Following treatment, she worked with physical therapy to help improve her functional deficits, caused both by the tumor as well as the excision. Additionally, psychological and emotional support was provided to the patient during the course of the diagnosis and treatment of her athletics career-ending diagnosis. The same support services were also extended to the entirety of her teammates as well as her family members. This case outlines the diagnosis, treatment, and challenges of GBM in a Division I softball athlete including the challenges of providing emotional support for an athlete living away from home while being diagnosed with a life and athletics-career altering condition.
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Affiliation(s)
- Rock P Vomer
- Department of Family Medicine, Mayo Clinic, Jacksonville, USA
- Department of Family Medicine, Avance Care, Raleigh, USA
| | - Dusty Narducci
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Rayghan S Larick
- Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk, USA
| | - Emma York
- Department of Family Medicine and Sports Medicine, University of South Carolina, Columbia, USA
| | - Kristin Terry
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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8
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Whitaker KL, Boswell L, Russell J, Black GB, Harris J. The relationship between patient enablement and help-seeking in the context of blood cancer symptoms. Psychooncology 2023; 32:1223-1230. [PMID: 37199519 DOI: 10.1002/pon.6170] [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: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Approaches to improve earlier diagnosis of cancer often focus on symptom awareness as a key driver of help-seeking behaviour and other psychological influences are less well understood. This is the first study to explore the role of patient enablement on help-seeking for people experiencing potential blood cancer symptoms. METHODS A cross-sectional, nationally representative survey was completed by 434 respondents (>18 years). Questions asked about symptom experiences, medical help-seeking and re-consultation. Existing patient enablement items were included in the newly developed Blood Cancer Awareness Measure. We collected data on patient socio-demographic characteristics. RESULTS Of those responding to the survey 224/434 (51.6%) reported experiencing at least one potential blood cancer symptom. Half of those experiencing symptoms (112/224) had sought medical help. Results from logistic regression analysis showed that higher scores on patient enablement were associated with being less likely to seek help (Odds Ratio [OR] 0.89, Confidence Interval [CI] 0.81-0.98) after controlling for socio-demographics. Separate analyses showed that higher enablement was associated with being more comfortable to re-consult if symptoms didn't go away or got worse (OR 1.31, CI 1.16-1.48); after a test result suggested there was nothing to worry about, but symptoms persisted (OR 1.23, CI 1.12-1.34) or to request further tests, scans or investigations (OR 1.31, CI 1.19-1.44). CONCLUSIONS Contrary to our hypotheses, patient enablement was associated with lower likelihood of help-seeking for potential blood cancer symptoms. Yet enablement appears to play an important role in likelihood of re-consulting when symptoms persist, get worse or need further investigation.
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Affiliation(s)
| | - Laura Boswell
- School of Health Sciences, University of Surrey, Surrey, UK
| | - Jessica Russell
- Department of Applied Health Research, UCL, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Georgia B Black
- Department of Applied Health Research, UCL, London, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jenny Harris
- School of Health Sciences, University of Surrey, Surrey, UK
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Zanotto A, Goodall K, Ellison M, McVittie C. 'Make Them Wonder How You Are Still Smiling': The Lived Experience of Coping With a Brain Tumour. QUALITATIVE HEALTH RESEARCH 2023; 33:601-612. [PMID: 37026898 DOI: 10.1177/10497323231167345] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A brain tumour can be a life-threatening illness and cause unique symptoms compared to other types of cancer, such as cognitive or language deficits, or changes in personality. It is an exceptionally distressing diagnosis which can affect quality of life, even for those with a low-grade tumour or many years after the diagnosis. This study sought to gain an in-depth understanding of the lived experience of adjustment to living with a brain tumour. Twelve individuals (83% female) with a primary brain tumour (83% low-grade) took part in the study. Participants were aged 29-54 years, on average 43 months following the diagnosis, and were recruited through the charitable support organisations in the United Kingdom. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). Six inter-related themes were identified: making sense of the diagnosis, seeking empowerment, feeling appreciative, taking charge of coping, learning to accept, and negotiating a new normality. Notions of empowerment, gratitude, and acceptance throughout the illness journey were prominent in the participants' narratives. Receiving sufficient information and initiating treatment were important in negotiation of control. The results highlighted what facilitates and hinders adaptive coping. Aspects which facilitated positive coping were as follows: trust in clinician, feeling in control, feeling grateful, or accepting. Participants on a 'watch and wait' approach, while feeling appreciative, perceived the lack of treatment as difficult and frustrating. Implications for patient-clinician communication are discussed, particularly for patients on a 'watch and wait' who might need additional support in adjusting.
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Affiliation(s)
- Anna Zanotto
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
- Department of Occupational Therapy Education, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Karen Goodall
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Marion Ellison
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
| | - Chris McVittie
- Division of Psychology, Sociology and Education, Queen Margaret University, Edinburgh, UK
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The Influence of Ethnicity on Survival from Malignant Primary Brain Tumours in England: A Population-Based Cohort Study. Cancers (Basel) 2023; 15:cancers15051464. [PMID: 36900254 PMCID: PMC10000771 DOI: 10.3390/cancers15051464] [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: 01/28/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND In recent years, the completeness of ethnicity data in the English cancer registration data has greatly improved. Using these data, this study aims to estimate the influence of ethnicity on survival from primary malignant brain tumours. METHODS Demographic and clinical data on adult patients diagnosed with malignant primary brain tumour from 2012 to 2017 were obtained (n = 24,319). Univariate and multivariate Cox proportional hazards regression analyses were used to estimate hazard ratios (HR) for the survival of the ethnic groups up to one year following diagnosis. Logistic regressions were then used to estimate odds ratios (OR) for different ethnic groups of (1) being diagnosed with pathologically confirmed glioblastoma, (2) being diagnosed through a hospital stay that included an emergency admission, and (3) receiving optimal treatment. RESULTS After an adjustment for known prognostic factors and factors potentially affecting access to healthcare, patients with an Indian background (HR 0.84, 95% CI 0.72-0.98), Any Other White (HR 0.83, 95% CI 0.76-0.91), Other Ethnic Group (HR 0.70, 95% CI 0.62-0.79), and Unknown/Not Stated Ethnicity (HR 0.81, 95% CI 0.75-0.88) had better one-year survivals than the White British Group. Individuals with Unknown ethnicity are less likely be diagnosed with glioblastoma (OR 0.70, 95% CI 0.58-0.84) and less likely to be diagnosed through a hospital stay that included an emergency admission (OR 0.61, 95% CI 0.53-0.69). CONCLUSION The demonstrated ethnic variations associated with better brain tumour survival suggests the need to identify risk or protective factors that may underlie these differences in patient outcomes.
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11
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Antoniou G, Conn JJA, Smith BR, Brennan PM, Baker MJ, Palmer DS. Recurrent neural networks for time domain modelling of FTIR spectra: application to brain tumour detection. Analyst 2023; 148:1770-1776. [PMID: 36967685 DOI: 10.1039/d2an02041f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
A recurrent neural network trained on time domain data can accurately identify brain tumours from serum spectral data.
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Affiliation(s)
- Georgios Antoniou
- Dxcover Limited, Suite RC534, Royal College Building, 204 George Street, Glasgow G1 1XW, UK
| | - Justin J A Conn
- Dxcover Limited, Suite RC534, Royal College Building, 204 George Street, Glasgow G1 1XW, UK
| | - Benjamin R Smith
- Dxcover Limited, Suite RC534, Royal College Building, 204 George Street, Glasgow G1 1XW, UK
| | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Midlothian, Edinburgh EH4 2XU, UK
| | - Matthew J Baker
- Dxcover Limited, Suite RC534, Royal College Building, 204 George Street, Glasgow G1 1XW, UK
- School of Medicine, Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, UK
| | - David S Palmer
- Dxcover Limited, Suite RC534, Royal College Building, 204 George Street, Glasgow G1 1XW, UK
- Department of Pure and Applied Chemistry, University of Strathclyde, Glasgow G1 1XL, UK.
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Zhu D, Wong A, Shah PP, Pomeranz HD. Neuro-ophthalmology malpractice: A review of the Westlaw Database. Med Leg J 2022; 90:200-205. [PMID: 36189929 DOI: 10.1177/00258172221109731] [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: 06/16/2023]
Abstract
BACKGROUND Neuro-ophthalmologic conditions are at a higher risk of misdiagnosis compared to other ophthalmic conditions. Increased awareness of the most common diagnostic errors in neuro-ophthalmology that lead to malpractice claims can allow ophthalmologists to further improve their diagnostic workup to reduce delays in diagnosis and management, while also mitigating the risk of litigation. METHODS Malpractice trials in the Westlaw Legal Database that involved cases of neuro-ophthalmologic diagnostic errors or failures by ophthalmologists were included in this study. RESULTS A total of 43 cases were included, all citing failure to diagnose as the main reason for litigation. The most common diagnoses missed were cerebrovascular pathologies (30.2%), intracranial tumours (27.9%) and giant cell arteritis (25.6%). The majority of verdicts were in favour of the defendants (48.8%). After adjusting for inflation, the average amount awarded was $1,952,154. CONCLUSION Nearly half of the cases resulted in a defendant verdict. Settlement and plaintiff verdicts were costly, with average awards of approximately two million inflation-adjusted dollars. Failure to diagnose cerebrovascular pathologies was the most common diagnostic error followed by failure to diagnose intracranial tumours and giant cell arteritis. It is crucial for ophthalmologists to be aware of the most common pitfalls that lead to misdiagnosis or delays in diagnosis of neuro-ophthalmologic conditions.
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Affiliation(s)
- Daniel Zhu
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Amanda Wong
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Paras P Shah
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
| | - Howard D Pomeranz
- Department of Ophthalmology, Northwell Health Eye Institute, USA; and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA
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Affiliation(s)
- Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine Houston, TX, USA
| | - Denise M Connor
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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14
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Ortega-Ortega M, Hanly P, Pearce A, Soerjomataram I, Sharp L. Paid and unpaid productivity losses due to premature mortality from cancer in Europe in 2018. Int J Cancer 2022; 150:580-593. [PMID: 34569617 DOI: 10.1002/ijc.33826] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
When someone dies prematurely from cancer this represents a loss of productivity for society. This loss can be valued and provides a measure of the cancer burden. We estimated paid and unpaid productivity lost due to cancer-related premature mortality in 31 European countries in 2018. Lost productivity was estimated for all cancers combined and 23 cancer sites, overall, by region and country. Deaths aged 15 to 64 were abstracted from GLOBOCAN 2018. Unpaid time lost (housework, caring, volunteering) was derived from Eurostat. Paid and unpaid productivity losses were valued using the human capital approach. In total, 347,149 premature cancer deaths occurred (60% male). The total value of cancer-related lost productivity was €104.6 billion. Of this, €52.9 billion (50.6%) was due to lost paid work, and €51.7 billion (49.4%) to unpaid work. Females accounted for 36.7% of paid work costs but half (51.1%) of the unpaid work costs. Costs were highest in Western Europe (€52.0 billion). The most costly cancer was lung (€21.7 billion), followed by breast (€10.6 billion). The average loss per premature death was highest for Hodgkin's lymphoma (€506 345), melanoma (€450 694), brain cancer (€428 449) and leukaemia (€378 750). Cancer-related lost productivity costs are significant. Almost half are due to unpaid work losses, indicating the importance of considering both paid and unpaid labour in assessing the cancer economic burden. The high cost per premature death of some less common cancers illustrates the potential benefits that could accrue from investment in prevention and control of these cancers.
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Affiliation(s)
- Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Madrid, Spain
| | - Paul Hanly
- School of Business, National College of Ireland, Dublin 1, Ireland
| | - Alison Pearce
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK
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15
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Reforming support systems of newly diagnosed brain cancer patients: a systematic review. J Neurooncol 2021; 156:61-71. [PMID: 34826034 PMCID: PMC8714629 DOI: 10.1007/s11060-021-03895-4] [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: 09/05/2021] [Accepted: 11/05/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite the increasing incidence of currently incurable brain cancer, limited resources are placed in patients' support systems, with reactive utilisation late in the disease course, when physical and psychological symptoms have peaked. Based on patient-derived data and emphasis on service improvement, this review investigated the structure and efficacy of the support methods of newly diagnosed brain cancer patients in healthcare systems. METHODS This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Articles from PubMed, Embase, and CENTRAL databases were screened with six pre-established eligibility criteria, including assessment within 6 months from diagnosis of a primary malignant brain tumour. Risk of bias was evaluated using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program (CASP) Qualitative Studies Checklist. RESULTS Of 5057 original articles, 14 were eligible for qualitative synthesis. Four studies were cross-sectional and ten were descriptive. Information given to patients was evaluated in seven studies, communication with patients in nine, and patient participation in treatment decisions in eight. Risk of bias was low in ten studies, moderate in two, and high in two. CONCLUSIONS Techniques promoting individualised care increased perceived support, despite poor patient-physician communication and complexity of the healthcare system. Extracted data across 14 included studies informed a set of guidelines and a four-step framework. These can help evaluate and reform healthcare services to better accommodate the supportive needs of this patient group.
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16
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Watson C, Cutrer-Párraga EA, Heath M, Miller EE, Young TA, Wilson S. Very Young Child Survivors' Perceptions of Their Father's Suicide: Exploring Bibliotherapy as Postvention Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11384. [PMID: 34769898 PMCID: PMC8582906 DOI: 10.3390/ijerph182111384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/28/2022]
Abstract
Each year in the United States, 7000 to 30,000 children experience their parent's suicide. Due to the stigma associated with suicide, feelings of guilt, and intense grief, surviving family members avoid talking about suicide. Over time, children struggle with confusion and intense emotions associated with their parent's suicide. In this study, seven adults, who reported being younger than six years old at the time of their father's suicide, participated in individual semi-structured interviews. Participants' responses highlight the challenges that young children face due to limited memories of their deceased parent. Interviews concluded with an opportunity for participants to review and express their impressions of 10 children's picture books. Participants offered impressions about how these books may or may not be helpful in supporting young child survivors. Implications for applied practice include considering how children's literature may open communication and assist children in navigating Worden's tasks of grief: (a) accepting the reality of their parent's death; (b) facing the grief and pain; (c) adapting to life changes due to their father's suicide, in particular adapting to altered family relationships; and (d) building memories of the deceased loved one, when possible, to ensure healthy attachment to the deceased parent. Participants' insights provide considerations for selecting children's literature for bibliotherapy. Due to young child survivors' increased risk for attempting and completing suicide, supporting child survivors of parent suicide not only addresses postvention needs but aligns with suicide prevention.
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Affiliation(s)
- Cortland Watson
- Maricopa Unified School District 1, 44150 W Maricopa-Casa Grande Hwy, Maricopa, AZ 85138, USA;
| | | | - Melissa Heath
- Counseling Psychology and Special Education, 340 MCKB, Brigham Young University, Provo, UT 84602, USA;
| | - Erica E. Miller
- BYU-Marriott School of Business, N. Eldon Tanner Building (TNRB) Campus, Provo, UT 84602, USA;
| | - Terrell A. Young
- Teacher Education, 205 F, McKay School of Education, Brigham Young University, Provo, UT 84602, USA;
| | - Suzanne Wilson
- Davis School District, 45 E. State St., P.O. Box 588, Farmington, UT 84025, USA;
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17
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Khalil A, Rahimi A, Luthfi A, Azizan MM, Satapathy SC, Hasikin K, Lai KW. Brain Tumour Temporal Monitoring of Interval Change Using Digital Image Subtraction Technique. Front Public Health 2021; 9:752509. [PMID: 34621723 PMCID: PMC8490781 DOI: 10.3389/fpubh.2021.752509] [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: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
A process that involves the registration of two brain Magnetic Resonance Imaging (MRI) acquisitions is proposed for the subtraction between previous and current images at two different follow-up (FU) time points. Brain tumours can be non-cancerous (benign) or cancerous (malignant). Treatment choices for these conditions rely on the type of brain tumour as well as its size and location. Brain cancer is a fast-spreading tumour that must be treated in time. MRI is commonly used in the detection of early signs of abnormality in the brain area because it provides clear details. Abnormalities include the presence of cysts, haematomas or tumour cells. A sequence of images can be used to detect the progression of such abnormalities. A previous study on conventional (CONV) visual reading reported low accuracy and speed in the early detection of abnormalities, specifically in brain images. It can affect the proper diagnosis and treatment of the patient. A digital subtraction technique that involves two images acquired at two interval time points and their subtraction for the detection of the progression of abnormalities in the brain image was proposed in this study. MRI datasets of five patients, including a series of brain images, were retrieved retrospectively in this study. All methods were carried out using the MATLAB programming platform. ROI volume and diameter for both regions were recorded to analyse progression details, location, shape variations and size alteration of tumours. This study promotes the use of digital subtraction techniques on brain MRIs to track any abnormality and achieve early diagnosis and accuracy whilst reducing reading time. Thus, improving the diagnostic information for physicians can enhance the treatment plan for patients.
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Affiliation(s)
- Azira Khalil
- Faculty of Science and Technology, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Malaysia
| | - Aisyah Rahimi
- Faculty of Science and Technology, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Malaysia
| | - Aida Luthfi
- Faculty of Science and Technology, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Malaysia
| | - Muhammad Mokhzaini Azizan
- Department of Electrical and Electronic Engineering, Faculty of Engineering and Built Environment, Universiti Sains Islam Malaysia, Bandar Baru Nilai, Malaysia
| | - Suresh Chandra Satapathy
- School of Computer Engineering, Kalinga Institute of Industrial Technology, Deemed to Be University, Bhubaneshwar, India
| | - Khairunnisa Hasikin
- Biomedical Engineering Department, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khin Wee Lai
- Biomedical Engineering Department, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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18
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Affiliation(s)
- Chris McKinnon
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Meera Nandhabalan
- Department of Clinical Oncology, Oxford University Hospitals NHS Foundation Trust
| | - Scott A Murray
- Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, University of Edinburgh, Edinburgh, UK
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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19
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Brennan PM, Butler HJ, Christie L, Hegarty MG, Jenkinson MD, Keerie C, Norrie J, O'Brien R, Palmer DS, Smith BR, Baker MJ. Early diagnosis of brain tumours using a novel spectroscopic liquid biopsy. Brain Commun 2021; 3:fcab056. [PMID: 33997782 PMCID: PMC8111062 DOI: 10.1093/braincomms/fcab056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/05/2022] Open
Abstract
Early diagnosis of brain tumours is challenging and a major unmet need. Patients with brain tumours most often present with non-specific symptoms more commonly associated with less serious diagnoses, making it difficult to determine which patients to prioritize for brain imaging. Delays in diagnosis affect timely access to treatment, with potential impacts on quality of life and survival. A test to help identify which patients with non-specific symptoms are most likely to have a brain tumour at an earlier stage would dramatically impact on patients by prioritizing demand on diagnostic imaging facilities. This clinical feasibility study of brain tumour early diagnosis was aimed at determining the accuracy of our novel spectroscopic liquid biopsy test for the triage of patients with non-specific symptoms that might be indicative of a brain tumour, for brain imaging. Patients with a suspected brain tumour based on assessment of their symptoms in primary care can be referred for open access CT scanning. Blood samples were prospectively obtained from 385 of such patients, or patients with a new brain tumour diagnosis. Samples were analysed using our spectroscopic liquid biopsy test to predict presence of disease, blinded to the brain imaging findings. The results were compared to the patient’s index brain imaging delivered as per standard care. Our test predicted the presence of glioblastoma, the most common and aggressive brain tumour, with 91% sensitivity, and all brain tumours with 81% sensitivity, and 80% specificity. Negative predictive value was 95% and positive predictive value 45%. The reported levels of diagnostic accuracy presented here have the potential to improve current symptom-based referral guidelines, and streamline assessment and diagnosis of symptomatic patients with a suspected brain tumour.
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Affiliation(s)
- Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Holly J Butler
- ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK
| | - Loren Christie
- ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK
| | - Mark G Hegarty
- ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool & The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Catriona Keerie
- Edinburgh Clinical Trials Unit, Usher Institute-University of Edinburgh, Edinburgh EH16 4UX, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute-University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Rachel O'Brien
- Emergency Medicine Research Group (EMERGE), Royal Infirmiry of Edinburgh, Edinburgh EH16 4SA, UK
| | - David S Palmer
- ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK.,Department of Pure and Applied Chemistry, Thomas Graham Building, University of Strathclyde, Glasgow G11XL, UK
| | - Benjamin R Smith
- ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK
| | - Matthew J Baker
- ClinSpec Diagnostics Limited, Royal College Building, Glasgow G1 1XW, UK
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20
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Grant R, Dowswell T, Tomlinson E, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Bulbeck H, Kernohan A, Robinson T, Lawrie TA. Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev 2020; 9:CD013564. [PMID: 32901926 PMCID: PMC8082957 DOI: 10.1002/14651858.cd013564.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.
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Affiliation(s)
- Robin Grant
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Therese Dowswell
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Eve Tomlinson
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, 1st Floor Education Centre, Royal United Hospital, Bath, UK
| | - Paul M Brennan
- Translational Neurosurgery Department, Western General Hospital, Edinburgh, UK
| | - Fiona M Walter
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David William Hunt
- Foundation School/Dept of Clinical and Experimental Medicine, Royal Surrey County Hospital/University of Surrey, Guildford, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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21
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Price SJ, Joannides A, Plaha P, Afshari FT, Albanese E, Barua NU, Chan HW, Critchley G, Flannery T, Fountain DM, Mathew RK, Piper RJ, Poon MT, Rajaraman C, Rominiyi O, Smith S, Solomou G, Solth A, Surash S, Wykes V, Watts C, Bulbeck H, Hutchinson P, Jenkinson MD. Impact of COVID-19 pandemic on surgical neuro-oncology multi-disciplinary team decision making: a national survey (COVID-CNSMDT Study). BMJ Open 2020; 10:e040898. [PMID: 32801210 PMCID: PMC7430412 DOI: 10.1136/bmjopen-2020-040898] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making. DESIGN A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020. SETTING Regional neurosurgical units outside London (as the pandemic was more advanced at time of study). PARTICIPANTS Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK. RESULTS 18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed-the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%-28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected. CONCLUSION COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments-most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures. STUDY REGISTRATION This study was registered with the Royal College of Surgeons of England's COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).
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Affiliation(s)
- Stephen John Price
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Alexis Joannides
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Fardad Taghizadeh Afshari
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Erminia Albanese
- Department of Neurosurgery, University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, Staffordshire, UK
| | - Neil U Barua
- Department of Neurosurgery, North Bristol National Health Service Trust, Bristol, UK
| | - Huan Wee Chan
- Department of Neurosurgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - Giles Critchley
- Department of Neurosurgery, Brighton and Sussex University Hospitals National Health Service Trust, Brighton, UK
| | - Thomas Flannery
- Department of Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | - Chittoor Rajaraman
- Department of Neurosurgery, Hull Royal Infirmary, Hull, Kingston upon Hull, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Stuart Smith
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Georgios Solomou
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, Dundee, UK
| | - Surash Surash
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Victoria Wykes
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Colin Watts
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | | | - Peter Hutchinson
- Neurosurgery Division, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre National Health Service Foundation Trust, Liverpool, UK
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22
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Martins A, Bennister L, Fern LA, Gerrand C, Onasanya M, Storey L, Wells M, Whelan JS, Windsor R, Woodford J, Taylor RM. Development of a patient-reported experience questionnaire for patients with sarcoma: the Sarcoma Assessment Measure (SAM). Qual Life Res 2020; 29:2287-2297. [PMID: 32227293 DOI: 10.1007/s11136-020-02481-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of the study was to develop a patient-reported outcome measure for patients with sarcoma-the Sarcoma Assessment Measure (SAM). METHODS AND RESULTS The systematic development of SAM included a three-stage, mixed-methods study using semi-structured interviews, focus groups and questionnaires, with all stages involving patients from across the United Kingdom. In-depth interviews were conducted with 121 patients (50% male; aged 13-82; with soft tissue sarcoma (62%), bone tumours (28%) and gastrointestinal stromal tumours (10%)). Content analysis of the interview transcripts identified 1415 post-diagnosis experience statements. Experience statements were reviewed, repetition was removed and sentences were refined to form 395 'items' which were included in an Item Reduction Questionnaire (IRQ) grouped as physical, emotional, social and financial wellbeing and sexuality. The IRQ was completed by 250 patients who rated each item on importance and worry. Items with a mean score above 5 (6 in the emotional domain) were removed, which reduced the list to 166 items. After review by the research team, 23 clinicians and 34 patients, 66 items were retained to test content validity. Items with a content validity ratio of < .33 were removed. Cognitive interviews were conducted with 10 patients on the final 22 items to test comprehension. Minor changes were made to four. CONCLUSION SAM comprises of 22 items reflecting physical, emotional, social, financial wellbeing and sexuality. This systematic process of using patient experience to develop the content of SAM will ensure that it measures what is important to patients.
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Affiliation(s)
- Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Lindsey Bennister
- Patient Representative, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Craig Gerrand
- London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Maria Onasanya
- Patient Representative, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Lesley Storey
- Department of Psychology, Birmingham City University, Curzon Building, Birmingham, B4 7BD, UK
| | - Mary Wells
- Nursing Directorate, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Rachael Windsor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Julie Woodford
- London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK. .,UCLH Cancer Clinical Trials Unit, 1st Floor East, 250 Euston Road, London, NW1 2PG, UK.
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23
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Peeters MCM, Dirven L, Koekkoek JAF, Gortmaker EG, Fritz L, Vos MJ, Taphoorn MJB. Prediagnostic symptoms and signs of adult glioma: the patients' view. J Neurooncol 2020; 146:293-301. [PMID: 31894516 DOI: 10.1007/s11060-019-03373-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the symptoms glioma patients experience in the year before diagnosis, either or not resulting in health care usage. This study aimed to determine the incidence of symptoms glioma patients experienced in the year prior to diagnosis, and subsequent visits to a general practitioner (GP). METHODS Glioma patients were asked to complete a 30-item study-specific questionnaire focusing on symptoms they experienced in the 12 months before diagnosis. For each indicated symptom, patients were asked whether they consulted the GP for this issue. RESULTS Fifty-nine patients completed the questionnaires, 54 (93%) with input of a proxy. The median time since diagnosis was 4 months (range 1-12). The median number of symptoms experienced in the year before diagnosis was similar between gliomas with favourable and poor prognosis, i.e. 6 (range 0-24), as were the five most frequently mentioned problems: fatigue (n = 34, 58%), mental tiredness (n = 30, 51%), sleeping disorder (n = 24, 41%), headache (n = 23, 39%) and stress (n = 20, 34%). Twenty-six (44%) patients visited the GP with at least one issue. Patients who did consult their GP reported significantly more often muscle weakness (11 vs 3, p = 0.003) than patients who did not, which remained significant after correction for multiple testing, which was not the case for paralysis in hand/leg (10 vs 4), focussing (11 vs 6) or a change in awareness (9 vs 4). CONCLUSIONS Glioma patients experience a range of non-specific problems in the year prior to diagnosis, but only patients who consult the GP report more often neurological problems.
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Affiliation(s)
- Marthe C M Peeters
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Ellen G Gortmaker
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Lara Fritz
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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24
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Fraulob I, Davies EA. How do patients with malignant brain tumors experience general practice care and support? Qualitative analysis of English Cancer Patient Experience Survey (CPES) data. Neurooncol Pract 2019; 7:313-319. [PMID: 32528712 PMCID: PMC7274186 DOI: 10.1093/nop/npz062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background English Cancer Patient Experience Survey (CPES) data show patients with brain cancer report the least-positive experiences of general practice support. We aimed to understand these findings by identifying the issues described in qualitative survey feedback and suggest how care may be improved. Methods We reviewed 2699 qualitative comments made to open questions about what was good or might be improved about National Health Service care between 2010 and 2014. We identified 84 (3%) specific comments about general practice care and used open coding and framework analysis to develop a thematic framework. Results We identified 3 key themes and 12 subthemes: first, the experience of initial diagnosis by a general practitioner (GP), including apparent complexity of making the diagnosis, apparent slowness in referral for investigation, referral made by patient or family, delay in receiving scan results, and whether the GP quickly identified the problem and referred to a specialist; second, the experience of care and support from the general practice, including lack of supportive response from the GP, lack of follow-up care from the GP, lack of family involvement by the GP, lack of GP knowledge about management, and whether the GP responded in a supportive way to the diagnosis; and third, the experience of overall coordination in care, including lack of communication between the hospital and general practice and good communication about the care plan. Conclusion Qualitative responses from patients with brain cancer reveal their needs for better emotional and practical support within primary care. Suggestions include increasing the speed of initial referral for investigation, the depth of discussion about diagnostic difficulties, and developing coordinated care plans with cancer centers.
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Affiliation(s)
- Isabell Fraulob
- School of Population Health and Environmental Sciences, King's College London, UK
| | - Elizabeth A Davies
- Cancer Epidemiology, Population and Global Health, School of Cancer and Pharmaceutical Sciences, King's College London, UK
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Ozawa M, Brennan PM, Zienius K, Kurian KM, Hollingworth W, Weller D, Grant R, Hamilton W, Ben-Shlomo Y. The usefulness of symptoms alone or combined for general practitioners in considering the diagnosis of a brain tumour: a case-control study using the clinical practice research database (CPRD) (2000-2014). BMJ Open 2019; 9:e029686. [PMID: 31471440 PMCID: PMC6720478 DOI: 10.1136/bmjopen-2019-029686] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To evaluate the utility of different symptoms, alone or combined, presented to primary care for an adult brain tumour diagnosis. DESIGN AND SETTING Matched case-control study, using the data from Clinical Practice Research Datalink (2000-2014) from primary care consultations in the UK. METHOD All presentations within 6 months of the index diagnosis date (cases) or equivalent (controls) were coded into 32 symptom groups. Sensitivity, specificity, positive predictive values (PPVs) and positive likelihood ratios were calculated for symptoms and combinations of symptoms with headache and cognitive features. Diagnostic odds ratios were calculated using conditional logistic regression, adjusted for age group, sex and Charlson comorbidity. Stratified analyses were performed for age group, sex and whether the tumour was of primary or secondary origin. RESULTS We included 8,184 cases and 28,110 controls. Seizure had the highest PPV of 1.6% (95% CI 1.4% to 1.7%) followed by weakness 1.5% (1.3 to 1.7) and confusion 1.4% (1.3 to 1.5). Combining headache with other symptoms increased the PPV. For example, headache plus combined cognitive symptoms PPV 7.2% (6.0 to 8.6); plus weakness 4.4% (3.2 to 6.2), compared with headache alone PPV 0.1%. The diagnostic ORs were generally larger for patients <70 years; this was most marked for confusion, seizure and visual symptoms. CONCLUSION We found seizure, weakness and confusion had relatively higher predictive values than many other symptoms. Headache on its own was a weak predictor but this was enhanced when combined with other symptoms especially in younger patients. Clinicians need to actively search for other neurological symptoms such as cognitive problems.
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Affiliation(s)
- Mio Ozawa
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Paul M Brennan
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Karolis Zienius
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | | | | | - David Weller
- General Practice, University of Edinburgh, Edinburgh, UK
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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Scott SE, Penfold C, Saji S, Curtis S, Watts C, Hamilton W, Joannides AJ, Walter FM. 'It was nothing that you would think was anything': Qualitative analysis of appraisal and help seeking preceding brain cancer diagnosis. PLoS One 2019; 14:e0213599. [PMID: 30901334 PMCID: PMC6430370 DOI: 10.1371/journal.pone.0213599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background The patient’s interpretation of the events and decisions leading up to consultation with a healthcare professional for symptoms of brain cancer is under researched. The aim of this study was to document responses to noticing the changes preceding a diagnosis of brain cancer and living with them, focusing on appraisal of changes and the decision to seek (and re-seek) help, with attention to the psychological processes underpinning the appraisal and help-seeking intervals. Method In this qualitative study set in Eastern and NW England, in-depth interviews with adult patients recently diagnosed with primary brain cancer and their family members were analysed thematically, using the Model of Pathways to Treatment as a conceptual framework. Results 39 adult patients were interviewed. Regarding the appraisal interval, cognitive heuristics were found to underpin explanations of changes/symptoms. The subtlety and normality of changes often suggested nothing serious was wrong. Common explanations included stress or being busy at work, or age and these did not seem to warrant a visit to a doctor. Explanations and the decision to seek help were made within the social context, with friends, family and work colleagues contributing to appraisal and help-seeking decisions. Regarding the help-seeking interval, barriers to seeking help reflected components of Social Cognitive Theory, and included having other priorities, outcome expectations (e.g. ‘feeling silly’, not sure much can be done about it, not wanting to waste doctors’ time) and accessibility of a preferred healthcare professional. Conclusion Application of psychological theory facilitated understanding of the influences on cognition and behaviour. The study highlights implications for theory, awareness campaigns and potential opportunities promoting more timely help-seeking.
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Affiliation(s)
- Suzanne E. Scott
- Centre for Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
- * E-mail:
| | - Clarissa Penfold
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Smiji Saji
- Clinical School, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Curtis
- Centre for Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Willie Hamilton
- Willie Hamilton, St Luke’s Campus, University of Exeter, Exeter, United Kingdom
| | - Alexis J. Joannides
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
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