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Rogers I, Cooper M, Memon A, Forbes L, van Marwijk H, Ford E. The effect of comorbidities on diagnostic interval for lung cancer in England: a cohort study using electronic health record data. Br J Cancer 2024:10.1038/s41416-024-02824-2. [PMID: 39179794 DOI: 10.1038/s41416-024-02824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 07/29/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Comorbid conditions may delay lung cancer diagnosis by placing demand on general practioners' time reducing the possibility of prompt cancer investigation ("competing demand conditions"), or by offering a plausible non-cancer explanation for signs/symptoms ("alternative explanation conditions"). METHOD Patients in England born before 1955 and diagnosed with incident lung cancer between 1990 and 2019 were identified in the Clinical Practice Research Datalink and linked hospital admission and cancer registry data. Diagnostic interval was defined as time from first presentation in primary care with a relevant sign/symptom to the diagnosis date. 14 comorbidities were classified as ten "competing demand" and four "alternative explanation" conditions. Associations with diagnostic interval were investigated using multivariable linear regression models. RESULTS Complete data were available for 11870 lung cancer patients. In adjusted analyses diagnostic interval was longer for patients with "alternative explanation" conditions, by 31 and 74 days in patients with one and ≥2 conditions respectively versus those with none. Number of "competing demand" conditions did not remain in the final adjusted regression model for diagnostic interval. CONCLUSIONS Conditions offering alternative explanations for lung cancer symptoms are associated with increased diagnostic intervals. Clinical guidelines should incorporate the impact of alternative and competing causes upon delayed diagnosis.
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Affiliation(s)
- Imogen Rogers
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK.
| | - Max Cooper
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Anjum Memon
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Lindsay Forbes
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
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Mitchinson L, von Wagner C, Blyth A, Shah H, Rafiq M, Merriel SWD, Barclay M, Lyratzopoulos G, Hamilton W, Abel GA, Renzi C. Clinical decision-making on lung cancer investigations in primary care: a vignette study. BMJ Open 2024; 14:e082495. [PMID: 39174063 PMCID: PMC11340710 DOI: 10.1136/bmjopen-2023-082495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/30/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES To investigate the role of comorbid chronic obstructive pulmonary disease (COPD) and symptom type on general practitioners' (GP's) symptom attribution and clinical decision-making in relation to lung cancer diagnosis. DESIGN Vignette survey with a 2×2 mixed factorial design. SETTING A nationwide online survey exploring clinical decision-making in primary care. PARTICIPANTS 109 GPs based in the United Kingdom (UK) who were registered as responders on Dynata (an online survey platform). INTERVENTIONS GPs were presented with four vignettes which described a patient aged 75 with a smoking history presenting with worsening symptoms (either general or respiratory) and with or without a pre-existing diagnosis of COPD. PRIMARY AND SECONDARY OUTCOME MEASURES GPs indicated the three most likely diagnoses (free-text) and selected four management approaches (20 pre-coded options). Attribution of symptoms to lung cancer and referral for urgent chest X-ray were primary outcomes. Alternative diagnoses and management approaches were explored as secondary outcomes. Multivariable mixed-effects logistic regression was used, including random intercepts for individual GPs. RESULTS 422 vignettes were completed. There was no evidence for COPD status as a predictor of lung cancer attribution (OR=1.1, 95% CI=0.5-2.4, p=0.914). There was no evidence for COPD status as a predictor of urgent chest X-ray referral (OR=0.6, 95% CI=0.3-1.2, p=0.12) or as a predictor when in combination with symptom type (OR=0.9, 95% CI=0.5-1.8, p=0.767). CONCLUSIONS Lung cancer was identified as a possible diagnosis for persistent respiratory by only one out of five GPs, irrespective of the patients' COPD status. Increasing awareness among GPs of the link between COPD and lung cancer may increase the propensity for performing chest X-rays and referral for diagnostic testing for symptomatic patients.
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Affiliation(s)
- Lucy Mitchinson
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alexandra Blyth
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Heer Shah
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Meena Rafiq
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Primary Care, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Matthew Barclay
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Georgios Lyratzopoulos
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Willie Hamilton
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Gary A Abel
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Cristina Renzi
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Faculty of Medicine, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy
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Yin Y, Long X, Zhang J, Yang M. Current status and factors influencing the work readiness of middle-aged and young postoperative lung cancer patients. Medicine (Baltimore) 2024; 103:e39155. [PMID: 39093803 PMCID: PMC11296403 DOI: 10.1097/md.0000000000039155] [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: 12/22/2023] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
To identify the current status of return-to-work readiness and analyze its influencing factors among middle-aged and young postoperative lung cancer patients. From July 2022 to February 2023, a total of 144 middle-aged and young postoperative lung cancer patients who had been treated in the Department of Thoracic Surgery of West China Hospital, Sichuan University and had not returned to work were selected as the research subjects. A general information questionnaire, the Readiness for Return-To-Work (RRTW) Scale, the General Self-Efficacy Scale (GSES), and the Simplified Coping Style Questionnaire (SCSQ) were used for the survey. Univariate analysis and ordinal logistic regression analysis were used to assess the current status of work readiness and its influencing factors. The distribution of work readiness from high to low was as follows: behavioral preparation-self-assessment stage, intention stage, preintention stage, and behavioral preparation-action stage. Univariate analysis showed that age, place of residence, occupation, nature of work, average family income, scope of surgery, postoperative complications, surgical site, and primary coping strategies were statistically significant (P < .05). The ordinal logistic regression analysis revealed that patients engaged in mentally oriented work (odds ratio [OR] = 13.78, P < .001), with a monthly family income of ≥ 10,000¥ (OR = 6.28, P = .017), proactive coping strategies (OR = 4.84, P = .019), and higher self-efficacy (OR = 1.17, P < .001) had higher work readiness. Patients engaged in other industries (OR = 0.25, P = .028), agricultural, forestry, and fishing labor (OR = 0.08, P < .001), unemployed (OR = 0.12, P = .038), and with a monthly family income of < 1000¥ (OR = 0.07, P = .026) had lower work readiness. In overall, this study suggests that the work readiness of postoperative lung cancer patients needs improvement. Occupation, nature of work, average family income, primary coping strategies, and general self-efficacy are associated with return-to-work readiness among middle-aged and young postoperative lung cancer patients.
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Affiliation(s)
- Yuanyuan Yin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xingxia Long
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Jie Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Mei Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Mohammad S, Wijayaratne T, Mavilakandy A, Karim N, Theaker M, Reddy R, Tsaknis G. Is there a role for fibreoptic bronchoscopy in patients presenting with haemoptysis and negative CT? A systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e001972. [PMID: 38350978 PMCID: PMC10868274 DOI: 10.1136/bmjresp-2023-001972] [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: 07/21/2023] [Accepted: 12/12/2023] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Haemoptysis can be a feature of lung cancer and patients are typically fast-tracked for evaluation with chest radiography, contrast-enhanced CT and fibreoptic bronchoscopy (FOB). OBJECTIVE We aim to explore whether FOB should be conducted as a component of the routine evaluation of non-massive haemoptysis, especially in the context of suspected lung cancer. METHODS MEDLINE, EMBASE and Cochrane Library were searched for studies comparing FOB with CT in the evaluation of non-massive haemoptysis while reporting at least one of the listed primary outcomes. Primary outcomes include sensitivity of diagnostic modality with respect to lung cancer. Secondary outcomes include detection of other aetiologies such as infection. Results were synthesised using a random effects meta-analysis. Sensitivity analysis was performed for patient age group and year of study. Risk of bias assessment was carried out with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS A total of 2273 citations were screened and 11 studies were included, comprising a total sample size of 2015 patients with 226 confirmed cases of lung cancer. A total of 1816 and 1734 patients received a CT scan and FOB, respectively. The pooled sensitivities for detection of lung cancer using CT scan and bronchoscopy were 98% (95% CI 93.0% to 99.0%) and 86% (95% CI 63.0% to 95.0%), respectively. The sensitivity of CT was higher than that of FOB for both primary and secondary outcomes. CONCLUSION This study suggests that bronchoscopy does not offer significant additional diagnostic benefit in the evaluation of patients presenting with non-massive haemoptysis and a negative CT scan.
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Affiliation(s)
- Syed Mohammad
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Thisarana Wijayaratne
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Akash Mavilakandy
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Nawazish Karim
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Margaret Theaker
- Knowledge & Library Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Raja Reddy
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - George Tsaknis
- Department of Respiratory Medicine, Lung Cancer Service, Kettering General Hospital NHS Foundation Trust, Kettering, UK
- Department of Respiratory Sciences, University of Leicester, College of Life Sciences, Leicester, UK
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Elshami M, Sawafta N, Mansour A, Alser M, Al-Slaibi I, Abukmail H, Shurrab H, Qassem S, Usrof FD, Alruzayqat M, Aqel W, Nairoukh R, Kittaneh R, Habes YMN, Ghanim O, Aabed WA, Omar O, Daraghma M, Aljbour J, Elian REM, Zuhour A, Habes H, Al-Dadah M, Albarqi SI, Bottcher B, Abu-El-Noor N. Anticipated time to seek medical advice for possible lung cancer symptoms and barriers to timely presentation in Palestine: a national cross-sectional study. BMC Cancer 2024; 24:183. [PMID: 38326766 PMCID: PMC10848550 DOI: 10.1186/s12885-024-11935-1] [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: 09/03/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Lung cancer (LC) has poor survival outcomes mainly due to diagnosis at late stages. This study explored the anticipated time to seek medical advice for possible LC symptoms and barriers to early presentation in Palestine. METHODS This cross-sectional study recruited adult participants from hospitals, primary healthcare centers, and public spaces of 11 governorates using convenience sampling. A modified, translated-into-Arabic version of the validated LC awareness measure was used to assess LC symptom awareness, the time needed to seek medical advice and barriers to early presentation. RESULTS A total of 4762 participants were included. The proportion that would immediately seek medical advice for possible LC symptoms varied according to the symptoms' nature. For respiratory symptoms, this ranged from 15.0% for 'painful cough' to 37.0% for 'coughing up blood'. For non-respiratory symptoms, this ranged from '4.2% for 'unexplained loss of appetite' to 13.8% for 'changes in the shape of fingers or nails'. Participants with good LC symptom awareness were more likely to seek medical advice within a week of recognizing most LC symptoms. About 13.0% would delay their visit to see a doctor after recognizing an LC symptom. The most reported barriers were emotional with 'disliking the visit to healthcare facilities' (59.8%) as the leading barrier. CONCLUSION LC respiratory symptoms were more likely to prompt early seeking of medical advice. Good LC symptom awareness was associated with a higher likelihood of help-seeking within a week. Educational interventions are needed to promote LC awareness and address the perceived barriers to early presentation in low-resource settings, such as Palestine.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH, 44106, USA.
- Ministry of Health, Gaza, Palestine.
| | - Nawras Sawafta
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Ahmad Mansour
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- Ministry of Health, Ramallah, West Bank, Palestine
| | - Mohammed Alser
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
- The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Gaza, Palestine
| | | | - Hanan Abukmail
- International Medical Corps, Gaza, Palestine
- Harvard Medical School, Boston, MA, USA
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hanan Shurrab
- Faculty of Pharmacy, Al-Azhar University of Gaza, Gaza, Palestine
| | - Shahd Qassem
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Faten Darwish Usrof
- Department of a Medical Laboratory Sciences, Faculty of Health Sciences, Islamic University of Gaza, Gaza City, Palestine
| | | | - Wafa Aqel
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Roba Nairoukh
- Faculty of Dentistry, Al-Quds University, Jerusalem, Palestine
| | - Rahaf Kittaneh
- Faculty of Nursing, An Najah National University, Nablus, Palestine
| | | | - Obaida Ghanim
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Ola Omar
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Motaz Daraghma
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Jumana Aljbour
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Razan E M Elian
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Areen Zuhour
- Faculty of Medicine, Al Najah National University, Nablus, Palestine
| | - Haneen Habes
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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6
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Shin J, Kober KM, Wong ML, Yates P, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Miaskowski C. Distinct Shortness of Breath Profiles in Oncology Outpatients Undergoing Chemotherapy. J Pain Symptom Manage 2023; 65:242-255. [PMID: 36423799 PMCID: PMC11195533 DOI: 10.1016/j.jpainsymman.2022.11.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Shortness of breath is a distressing symptom that occurs in 10% to 70% of oncology patients. Despite this broad range in its occurrence, little is known about inter-individual variability in shortness of breath and associated risk factors among patients receiving chemotherapy. OBJECTIVES Identify subgroups of patients with distinct shortness of breath profiles; evaluate for differences among these subgroups in demographic and clinical characteristics; evaluate for differences among symptom dimensions of shortness of breath, and evaluate for differences in quality of life outcomes. METHODS Outpatients (n=1338) completed questionnaires six times over two chemotherapy cycles. Occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. RESULTS Four distinct shortness of breath profiles were identified (None [70.5%], Decreasing [8.2%], Increasing [7.8%], High [13.5%]). Risk factors for membership in High class included: history of smoking, self-reported diagnosis of lung disease, having lung cancer, and receipt of a higher number of cancer treatments. Compared to the None class, High class reported poorer physical, psychological, and social functioning. CONCLUSIONS Almost 14% of patients with heterogeneous types of cancer receiving chemotherapy had persistently high occurrence rates of shortness of breath for almost two months. In addition, compared to the Decreasing and Increasing classes, the High class' episodes of shortness of breath were more frequent and more severe. Clinicians need to assess all oncology patients for shortness of breath and provide targeted interventions.
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Affiliation(s)
- Joosun Shin
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Melisa L Wong
- School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health (P.Y.), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruce A Cooper
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts, USA
| | - Yvette Conley
- School of Nursing (Y.C.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon D Levine
- School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA; School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA.
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Shin J, Kober K, Wong ML, Yates P, Miaskowski C. Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients. Crit Rev Oncol Hematol 2023; 181:103870. [PMID: 36375635 DOI: 10.1016/j.critrevonc.2022.103870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common and distressing symptom for oncology patients.However, dyspnea is not well-characterized and often underestimated by clinicians. This systematic review summarizes the prevalence, intensity, distress, and impact of dyspnea in oncology patients and identifies research gaps. METHODS A search of all of the relevant databases was done from 2009 to May 2022. A qualitative synthesis of the extant literature was performed using established guidelines. RESULTS One hundred-seventeen studies met inclusion criteria. Weighted grand mean prevalence of dyspnea in patients with advanced cancer was 58.0%. Intensity of dyspnea was most common dimension evaluated, followed by the impact and distress. Depression and anxiety were the most common symptoms that co-occurred with dyspnea. CONCLUSION Numerous methodologic challenges were evident across studies. Future studies need to use valid and reliable measures; evaluate the impact of dyspnea; and determine biomarkers for dyspnea.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Division of Hematology/Oncology, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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Debieuvre D, Molinier O, Falchero L, Locher C, Templement-Grangerat D, Meyer N, Morel H, Duval Y, Asselain B, Letierce A, Trédaniel J, Auliac JB, Bylicki O, Moreau L, Fore M, Corre R, Couraud S, Cortot A. Lung cancer trends and tumor characteristic changes over 20 years (2000–2020): Results of three French consecutive nationwide prospective cohorts’ studies. Lancet Reg Health Eur 2022; 22:100492. [PMID: 36108315 PMCID: PMC9445429 DOI: 10.1016/j.lanepe.2022.100492] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Long-term changes in lung cancer (LC) patients are difficult to evaluate. We report results from the French KBP-2020 real-life cohort. Methods KBP-2020 was a prospective cohort that included all patients diagnosed with LC in 2020, in nonacademic public hospital in France. Patient and tumour characteristics were described and compared with similarly designed cohorts in 2000 and 2010. Findings In 2020, 82 centers included 8,999 patients diagnosed with LC. The proportion of women increased: 34·6% (3114/8999) compared to, 24·3% (1711/7051) and 16·0% (904/5667) in 2010 and 2000 (p<0·0001). The proportion of non-smokers was higher in 2020 (12·6%, 1129/8983) than in previous cohorts (10·9% (762/7008) in 2010; 7·2% (402/5586) in 2000, p<0·0001). In 2020, at diagnosis, 57·6% (4405/7648) of patients had a metastatic/disseminated stage non-small-cell lung cancer (NSCLC) (58·3% (3522/6046) in 2010; 42·6% (1879/4411) in 2000, p<0·0001). Compared with 2000 and 2010 data, early survival improved slightly. In 2020, 3-month mortality of NSCLC varied from 3·0% [2·2 – 3·8] for localized to 9·6% [8·1 – 11·0] for locally advanced to 29·2% [27·8 – 30·6] for metastatic and was 24·8% [22·3 – 27·3] for SCLC. Interpretation To our knowledge KBP cohorts have been the largest, prospective, real-world cohort studies involving LC patients conducted in worldwide. The trend found in our study shows an increase in LC in women and still a large proportion of patients diagnosed at metastatic or disseminated stage. Funding The study was promoted by the French College of General Hospital Pulmonologists with financial support of industrials laboratories.
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Affiliation(s)
- Didier Debieuvre
- Respiratory Medicine Department, Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Hôpital Emile Muller, Mulhouse, France
- Corresponding author at: Service de Pneumologie, GHRMSA, Hôpital Emile Muller, 20 rue du Dr Laënnec, BP 1370, 68070 Mulhouse CEDEX, France.
| | - Olivier Molinier
- Respiratory Medicine Department, Centre Hospitalier Le Mans, Le Mans, France
| | - Lionel Falchero
- Respiratory Medicine Department, L'Hôpital Nord-Ouest, Villefranche-Sur-Saône, France
| | - Chrystèle Locher
- Respiratory Medicine Department, Grand Hôpital de l'Est Francilien (GHEF), Meaux, France
| | | | - Nicolas Meyer
- Biostatistician, Public Health Department, CHU de Strasbourg, GMRC, Strasbourg, France
| | - Hugues Morel
- Respiratory Medicine Department, Centre Hospitalier Régional D'Orléans Hôpital de La Source, Orléans, France
| | - Yannick Duval
- Respiratory Medicine Department, Hôpital de Cannes Simone Veil, Cannes, France
| | - Bernard Asselain
- Methodologist, Groupe Statistique, ARCAGY - GINECO, Paris, France
| | | | - Jean Trédaniel
- Department of Thoracic Oncology, Groupe hospitalier Paris-Saint Joseph, Paris, France
| | - Jean-Bernard Auliac
- Respiratory Medicine Department, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Olivier Bylicki
- Respiratory Medicine Department, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - Lionel Moreau
- Respiratory Medicine Department, Centre Hospitalier de Colmar, Colmar, France
| | - Mathieu Fore
- Respiratory Medicine Department, Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Hôpital Emile Muller, Mulhouse, France
| | - Romain Corre
- Respiratory Medicine Department, Centre Hospitalier de Cornouaille, Quimper, France
| | - Sébastien Couraud
- Respiratory Medicine Department, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alexis Cortot
- Department of Thoracic Oncology, CHU de Lille, CNRS, Inserm, Institut Pasteur de Lille, UMR9020-U1277-CANTHER, Lille, France
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Nemlander E, Rosenblad A, Abedi E, Ekman S, Hasselström J, Eriksson LE, Carlsson AC. Lung cancer prediction using machine learning on data from a symptom e-questionnaire for never smokers, formers smokers and current smokers. PLoS One 2022; 17:e0276703. [PMID: 36269746 PMCID: PMC9586380 DOI: 10.1371/journal.pone.0276703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of the present study was to investigate the predictive ability for lung cancer of symptoms reported in an adaptive e-questionnaire, separately for never smokers, former smokers, and current smokers. PATIENTS AND METHODS Consecutive patients referred for suspected lung cancer were recruited between September 2014 and November 2015 from the lung clinic at the Karolinska University Hospital, Stockholm, Sweden. A total of 504 patients were later diagnosed with lung cancer (n = 310) or no cancer (n = 194). All participants answered an adaptive e-questionnaire with a maximum of 342 items, covering background variables and symptoms/sensations suspected to be associated with lung cancer. Stochastic gradient boosting, stratified on smoking status, was used to train and test a model for predicting the presence of lung cancer. RESULTS Among never smokers, 17 predictors contributed to predicting lung cancer with 82% of the patients being correctly classified, compared with 26 predictors with an accuracy of 77% among current smokers and 36 predictors with an accuracy of 63% among former smokers. Age, sex, and education level were the most important predictors in all models. CONCLUSION Methods or tools to assess the likelihood of lung cancer based on smoking status and to prioritize investigative and treatment measures among all patients seeking care with diffuse symptoms are much needed. Our study presents risk assessment models for patients with different smoking status that may be developed into clinical risk assessment tools that can help clinicians in assessing a patient's risk of having lung cancer.
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Affiliation(s)
- Elinor Nemlander
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Andreas Rosenblad
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Regional Cancer Centre Stockholm-Gotland, Region Stockholm, Stockholm, Sweden
- Division of Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eliya Abedi
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Simon Ekman
- Thoracic Oncology Centre, Karolinska University Hospital, Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Lars E. Eriksson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Axel C. Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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10
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Saab MM, McCarthy M, O'Driscoll M, Sahm LJ, Leahy-Warren P, Noonan B, FitzGerald S, O'Malley M, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. A systematic review of interventions to recognise, refer and diagnose patients with lung cancer symptoms. NPJ Prim Care Respir Med 2022; 32:42. [PMID: 36258020 PMCID: PMC9579201 DOI: 10.1038/s41533-022-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with lung cancer (LC) often experience delay between symptom onset and treatment. Primary healthcare professionals (HCPs) can help facilitate early diagnosis of LC through recognising early signs and symptoms and making appropriate referrals. This systematic review describes the effect of interventions aimed at helping HCPs recognise and refer individuals with symptoms suggestive of LC. Seven studies were synthesised narratively. Outcomes were categorised into: Diagnostic intervals; referral and diagnosis patterns; stage distribution at diagnosis; and time interval from diagnosis to treatment. Rapid access pathways and continuing medical education for general practitioners can help reduce LC diagnostic and treatment delay. Awareness campaigns and HCP education can help inform primary HCPs about referral pathways. However, campaigns did not significantly impact LC referral rates or reduce diagnostic intervals. Disease outcomes, such as LC stage at diagnosis, recurrence, and survival were seldom measured. Review findings highlight the need for longitudinal, powered, and controlled studies.
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Affiliation(s)
- Mohamad M Saab
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Megan McCarthy
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Michelle O'Driscoll
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brendan Noonan
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena FitzGerald
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Maria O'Malley
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Services Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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11
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Zhang G, Weng H, Li Y, Li P, Gong Y, Chen J, Wei L, Zeng L, Zeng Y, Cheng AS. Symptom clusters and their predictors in patients with lung cancer and treated with programmed cell death protein 1 immunotherapy. Asia Pac J Oncol Nurs 2022; 9:100103. [PMID: 35935261 PMCID: PMC9345784 DOI: 10.1016/j.apjon.2022.100103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The aims of this study were to examine the symptom severity and interference among patients with lung cancer treated with PD-1 immunotherapy, explore whether those symptoms were clustered together, and identify factors associated with symptom clusters. Methods A cross-sectional study was conducted. Data were collected by demographic and clinical characteristic questionnaires and the M.D. Anderson Symptom Inventory Lung Cancer Module. Symptom clusters were identified using exploratory factor analysis, and stepwise linear regression was applied to analyze the factors affecting the symptom clusters. Results A total of 148 patients with lung cancer treated with PD-1 immunotherapy participated in this study. The overall symptom burdens of these patients were mainly at a mild level. The patient symptom clusters identified in this study were a general cluster, a treatment-related cluster, a pulmonary cluster, a gastrointestinal cluster, and a neural cluster. The patients’ Karnofsky performance status (KPS) score (β = −2.758, P < 0.001) and having a history of chemotherapy (β = 4.384, P = 0.001) were significant predictors of the general cluster. Their KPS scores (β = −1.202, P < 0.001) and having a history of chemotherapy (β = −1.957, P = 0.001) were significant predictors of the pulmonary cluster. Their monthly income (β = −0.316, P = 0.030) and KPS scores (β = −0.357, P = 0.045) were significant predictors of the gastrointestinal cluster. Having a history of chemotherapy (β = 1.868, P < 0.001) was the predictor of the neural cluster. Conclusions The symptom burdens of patients with lung cancer and treated with PD-1 immunotherapy were at a mild level and appeared to be clustered. In addition, because the symptoms that comprise a cluster are interrelated, the diagnosis and management of each symptom in a cluster should not be performed in isolation, and each symptom in a cluster should be treated either simultaneously or in an orderly manner.
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Affiliation(s)
- Guolong Zhang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huiwen Weng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinghong Li
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pingdong Li
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yucui Gong
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jieya Chen
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lin Wei
- Department of Nursing, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Linghui Zeng
- School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Yingchun Zeng
- School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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12
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Bradley SH, Bhartia BS, Kennedy MP, Frank LK, Watson J. Investigating suspected lung cancer. BMJ 2022; 378:e068384. [PMID: 35831012 DOI: 10.1136/bmj-2021-068384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Saab MM, O'Driscoll M, FitzGerald S, Sahm LJ, Leahy-Warren P, Noonan B, Kilty C, O'Malley M, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. Referring patients with suspected lung cancer: a qualitative study with primary healthcare professionals in Ireland. Health Promot Int 2022; 37:6639404. [PMID: 35810412 PMCID: PMC9271233 DOI: 10.1093/heapro/daac088] [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] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is the leading cause of cancer death globally. Most cases are diagnosed late. Primary healthcare professionals are often the first point of contact for symptoms of concern. This study explored primary healthcare professionals’ experience of referring individuals with signs and symptoms suggestive of lung cancer along the appropriate healthcare pathway and explored strategies to help primary healthcare professionals detect lung cancer early. Focus groups and individual interviews were conducted with 36 general practitioners, community pharmacists, practice nurses, and public health nurses. Data were analysed thematically. Participants identified typical lung cancer signs and symptoms such as cough and coughing up blood (i.e., haemoptysis) as triggers for referral. Atypical/non-specific signs and symptoms such as back pain, pallor, and abnormal blood tests were perceived as difficult to interpret. Participants often refrained from using the word ‘cancer’ during conversations with patients. Ireland’s Rapid Access Lung Clinics were perceived as underused, with some general practitioners referring patients to these clinics only when clear and definitive lung cancer signs and symptoms are noted. Lack of communication and the resulting disruption in continuity of care for patients with suspected lung cancer were highlighted as healthcare system flaws. Education on early referral can be in the form of communications from professional organizations, webinars, interdisciplinary meetings, education by lung specialists, and patient testimonials. Lung cancer referral checklists and algorithms should be simple, clear, and visually appealing, either developed as standalone tools or embedded into existing primary care software/programmes.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Michelle O'Driscoll
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland.,School of Pharmacy, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Maria O'Malley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, T12 DC4A, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Service Executive, DO1 A3Y8, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, DO1 A3Y8, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, DO1 A3Y8, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
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14
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Saab MM, O'Driscoll M, FitzGerald S, Sahm LJ, Leahy-Warren P, Noonan B, Kilty C, Lyons N, Burns HE, Kennedy U, Lyng Á, Hegarty J. Primary healthcare professionals' perspectives on patient help-seeking for lung cancer warning signs and symptoms: a qualitative study. BMC PRIMARY CARE 2022; 23:119. [PMID: 35585504 PMCID: PMC9114293 DOI: 10.1186/s12875-022-01730-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer incidence and mortality worldwide. Prompt patient help-seeking for signs and symptoms suggestive of lung cancer is crucial for early referral, diagnosis, and survivorship. However, individuals with potential lung cancer symptoms tend to delay help-seeking. This qualitative study explored perceived barriers to patient help-seeking and strategies to enhance help-seeking for lung cancer warning signs and symptoms from the perspective of primary healthcare professionals. METHODS Semi-structured focus groups and individual interviews were conducted with 36 primary healthcare professionals. Data were collected via videoconferencing. Inductive thematic analysis was conducted. RESULTS The following two themes were created from the data: (i) perceived barriers to patient help-seeking for signs and symptoms of concern and (ii) facilitating early patient presentation for signs and symptoms of concern. Some participants believed that the high cost of a general practitioner visit, long waiting times, and previous bad experiences with the healthcare system would deter patients from seeking help for symptoms of lung cancer. Perceived patient-related barriers to help-seeking related to the different emotions associated with a potential cancer diagnosis as well as stigma, embarrassment, and guilt felt by smokers. Sociodemographic factors such as drug use, homelessness, living in rural areas, and being male and older were also perceived to impede patient help-seeking. The negative impact of the COVID-19 pandemic on cancer help-seeking also featured strongly. Participants recommended several strategies to enable patients to seek help for symptoms of concern including targeted educational campaigns focussing on symptoms (e.g., cough) rather than behaviours (e.g., smoking), accessible and free health services, and using patients' support networks. CONCLUSIONS Patient-related and healthcare system-related barriers to help-seeking for lung cancer warning signs and symptoms include cost of healthcare, cancer fear, and various sociodemographic factors. Participants suggested that increased awareness and early patient help-seeking for symptoms of concern could be achieved through targeted patient education, national campaigns, the use of community support networks, and free and accessible targeted screening services.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland.
| | - Michelle O'Driscoll
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Patricia Leahy-Warren
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
| | - Noreen Lyons
- Rapid Access Lung Clinic, Cork University Hospital, Cork, Ireland
| | - Heather E Burns
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, College Road, T12 AK54, Cork, Ireland
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15
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Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked data study. Br J Gen Pract 2022; 72:e556-e563. [PMID: 35667682 PMCID: PMC9183460 DOI: 10.3399/bjgp.2021.0563] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/21/2022] [Indexed: 10/31/2022] Open
Abstract
Background: The majority of colorectal cancer cases are diagnosed following symptomatic presentation in the United Kingdom. Aim: To identify windows of opportunity for timely investigations or referrals in patients presenting with colon and rectal cancer-relevant symptoms or abnormal blood tests. Design and setting: Retrospective cohort study using linked primary care and cancer registry data of colorectal cancer patients diagnosed in England between 2012-2015. Methods: Monthly consultation rates for relevant clinical features (change in bowel habit, rectal bleeding, abdominal pain, mass, constitutional symptoms, and other bowel symptoms) and abnormal blood test results (low haemoglobin, high platelets and inflammatory markers) up to 24 months pre-diagnosis were calculated. Poisson regression adjusted for age, sex and relevant comorbidities was used to estimate the most likely month when consultation rates increased above baseline trend. Results: 5033 colon and 2516 rectal cancer patients were included. Consultations for all examined clinical features and abnormal blood tests increased in the year pre-diagnosis. Rectal bleeding was the earliest clinical feature to increase from baseline rate: 10 months (95%CI 8.3-11.7) pre-diagnosis for colon cancer; 8 months (95%CI 6.1-9.9) for rectal cancer. Low haemoglobin, high platelets and inflammatory markers increased from as early as 9 months pre-diagnosis. Conclusion: Our study found evidence for early increase in rates of consultation for relevant clinical features and abnormal blood tests in patients with colorectal cancer, suggesting that earlier instigation of cancer-specific investigations or referrals may be warranted in some symptomatic patients.
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16
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment. PLoS One 2021; 16:e0257301. [PMID: 34506592 PMCID: PMC8432814 DOI: 10.1371/journal.pone.0257301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Timeliness in seeking care is critical for lung cancer patients' survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and "traditional healers"), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
- Department of Respiratory & Sleep Medicine, Austin Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
- School of Health, Federation University Australia, Berwick, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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17
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Interpreting negative test results when assessing cancer risk in general practice. Br J Gen Pract 2021; 71:298-299. [PMID: 34319881 PMCID: PMC8249029 DOI: 10.3399/bjgp21x716189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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18
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Saab MM, FitzGerald S, Noonan B, Kilty C, Collins A, Lyng Á, Kennedy U, O'Brien M, Hegarty J. Promoting lung cancer awareness, help-seeking and early detection: a systematic review of interventions. Health Promot Int 2021; 36:1656-1671. [PMID: 33647930 PMCID: PMC8699397 DOI: 10.1093/heapro/daab016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Lung cancer (LC) is the leading cause of cancer death. Barriers to the early presentation for LC include lack of symptom awareness, symptom misappraisal, poor relationship with doctors and lack of access to healthcare services. Addressing such barriers can help detect LC early. This systematic review describes the effect of recent interventions to improve LC awareness, help-seeking and early detection. This review was guided by the Cochrane Handbook for Systematic Reviews of Interventions. Electronic databases MEDLINE, CINAHL, ERIC, APA PsycARTICLES, APA PsycInfo and Psychology and Behavioral Sciences Collection were searched. Sixteen studies were included. Knowledge of LC was successfully promoted in most studies using educational sessions and campaigns. LC screening uptake varied with most studies successfully reducing decision conflicts using decision aids. Large campaigns, including UK-based campaign 'Be Clear on Cancer', were instrumental in enhancing LC awareness, promoting help-seeking and yielding an increase in chest X-rays and a decrease in the number of individuals diagnosed with advanced LC. Multimodal public health interventions, such as educational campaigns are best suited to raise awareness, reduce barriers to help-seeking and help detect LC early. Future interventions ought to incorporate targeted information using educational resources, face-to-face counselling and video- and web-based decision aids.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Abigail Collins
- National Cancer Control Programme, Health Service Executive, Ireland DO1 A3Y8
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Ireland DO1 A3Y8
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Ireland DO1 A3Y8
| | - Maidy O'Brien
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland T12 AK54
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Time from presentation to pre-diagnostic chest X-ray in patients with symptomatic lung cancer: a cohort study using electronic patient records from English primary care. Br J Gen Pract 2021; 71:e273-e279. [PMID: 33431382 PMCID: PMC7805412 DOI: 10.3399/bjgp20x714077] [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: 02/25/2020] [Accepted: 08/17/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND National guidelines in England recommend prompt chest X-ray (within 14 days) in patients presenting in general practice with unexplained symptoms of possible lung cancer, including persistent cough, shortness of breath, or weight loss. AIM To examine time to chest X-ray in symptomatic patients in English general practice before lung cancer diagnosis, and explore demographical variation. DESIGN AND SETTING Retrospective cohort study using routinely collected general practice, cancer registry, and imaging data from England. METHOD Patients with lung cancer who presented symptomatically in general practice in the year pre-diagnosis and who had a pre-diagnostic chest X-ray were included. Time from presentation to chest X-ray (presentation-test interval) was determined and intervals classified based on national guideline recommendations as concordant (≤14 days) or non-concordant (>14 days). Variation in intervals was examined by age, sex, smoking status, and deprivation. RESULTS In a cohort of 2102 patients with lung cancer, the median presentation-test interval was 49 (interquartile range [IQR] 5-172) days. Of these, 727 (35%) patients had presentation-test intervals of ≤14 days (median 1 [IQR 0-6] day) and 1375 (65%) had presentation-test intervals of >14 days (median 128 [IQR 52-231] days). Intervals were longer among patients who smoke (equivalent to 63% longer than non-smokers; P<0.001), older patients (equivalent to 7% longer for every 10 years from age 27; P = 0.013), and females (equivalent to 12% longer than males; P = 0.016). CONCLUSION In symptomatic primary care patients who underwent chest X-ray before lung cancer diagnosis, only 35% were tested within the timeframe recommended by national guidelines. Patients who smoke, older patients, and females experienced longer intervals. These findings could help guide initiatives aimed at improving timely lung cancer diagnosis.
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20
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Saab MM, Noonan B, Kilty C, FitzGerald S, Collins A, Lyng Á, Kennedy U, O'Brien M, Hegarty J. Awareness and help-seeking for early signs and symptoms of lung cancer: A qualitative study with high-risk individuals. Eur J Oncol Nurs 2020; 50:101880. [PMID: 33333451 DOI: 10.1016/j.ejon.2020.101880] [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] [Received: 09/16/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Lung cancer is the most common malignancy and the leading cause of cancer death globally. Lung cancer incidence and mortality are highest among socioeconomically deprived individuals. This study explored awareness and help-seeking for early signs and symptoms of lung cancer among high-risk individuals. METHODS Participation was sought from multiple community centres and organisations in high-incidence and socioeconomically deprived areas in Ireland. Semi-structured focus groups were conducted with individuals at risk for lung cancer. Data were analysed using thematic analysis. RESULTS Five focus groups were conducted with 46 participants. Two themes were identified: (i) lung cancer awareness, beliefs, and experiences and (ii) help-seeking for early signs and symptoms of lung cancer. Participants had fragmented knowledge of lung cancer and associated this malignancy with death. Symptom change, persistence, seriousness, and family history of lung cancer served as triggers to help-seeking. General practitioners were identified as the first point of contact for symptoms of concern, yet their presumed negative attitudes towards smokers served as barriers to help-seeking. Other barriers included symptom misappraisal, fear, denial, use of self-help measures, being inherently a non-help seeker, and machoism and stoicism among men. CONCLUSION Study findings offer guidance regarding lung cancer knowledge gaps and barriers to help-seeking that ought to be considered in public health interventions aimed to promote lung cancer awareness and early detection. CLINICAL IMPLICATIONS This study highlights the need for healthcare professionals to adopt a non-judgmental approach during consults for symptoms indicative of lung cancer. This can potentially help detect lung cancer early.
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Affiliation(s)
- Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland.
| | - Brendan Noonan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland
| | - Serena FitzGerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland
| | - Abigail Collins
- National Cancer Control Programme, Health Service Executive, Ireland
| | - Áine Lyng
- National Cancer Control Programme, Health Service Executive, Ireland
| | - Una Kennedy
- National Cancer Control Programme, Health Service Executive, Ireland
| | - Maidy O'Brien
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland
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