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Jones O, Young H, Clarke H, Crosbie EJ, Sivalingam VN. The Womb Cancer Awareness Measure (WCAM): development of an instrument to assess public awareness of endometrial cancer. Int J Gynecol Cancer 2024; 34:73-79. [PMID: 38088173 PMCID: PMC10850626 DOI: 10.1136/ijgc-2023-004796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To develop and test a novel instrument to assess public awareness of endometrial cancer symptoms and risk factors in a UK population. METHODS A 36-item questionnaire was developed through literature review and extraction from cancer awareness materials. The Womb Cancer Awareness Measure (WCAM) was tested for content validity in 65 self-identified female research participants and 10 endometrial cancer experts prior to UK-wide field testing using social media. Test-retest reliability was assessed over 2 weeks, construct validity was assessed by comparing womb cancer experts and non-medical academics, and sensitivity to change was assessed by comparing scores of participants who read an endometrial cancer leaflet with those given a control leaflet. RESULTS Fifty-two percent of the items in the test-retest reliability showed >80% agreement. Construct validity was demonstrated; endometrial cancer experts achieved higher scores (median 79 (IQR 18)) than non-medical academics (median 50 (IQR 18)) (p<0.001). The WCAM was sensitive to change; volunteers who read an endometrial cancer leaflet showed greater awareness (median 73 (IQR 9)) than those who read the control leaflet (median 59 (IQR 9)) (p<0.001). Knowledge of endometrial cancer red flag symptoms and risk factors was poor in the 847 UK-based participants. CONCLUSIONS Our findings support the validity and reliability of the Womb Cancer Awareness Measure in assessing public awareness of endometrial cancer. In a UK population sample, knowledge of warning symptoms and risk factors was low, highlighting the need for public awareness campaigns.
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Affiliation(s)
- Olivia Jones
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Hannah Young
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Helen Clarke
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Emma J Crosbie
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Department of Colposcopy and Gynaecological Oncology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vanitha N Sivalingam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Gynaecology, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
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2
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Fonseca-Montaño MA, Blancas S, Herrera-Montalvo LA, Hidalgo-Miranda A. Cancer Genomics. Arch Med Res 2022; 53:723-731. [PMID: 36460546 DOI: 10.1016/j.arcmed.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
In the past decade, genomics has fundamentally changed our view of cancer biology, allowing comprehensive analyses of mutations, copy number alterations, structural variants, gene expression and DNA methylation profiles in large-scale studies across different cancer types. Efforts like The Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC) have fostered international collaborations for cancer genomic analyses and have generated public databases that give scientists around the world access to thoroughly curated data, which have been extensively used as a tool for further hypothesis driven research on several aspects of cancer biology. In parallel, some of these findings are being translated into specific clinical benefits for cancer patients. In this review, we provide a brief historical description of the evolution of international public cancer genome projects and related databases, as well as we discuss about their impact on general cancer research.
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Affiliation(s)
- Marco A Fonseca-Montaño
- Instituto Nacional de Medicina Genómica, Ciudad de México, México; Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Susana Blancas
- Instituto Nacional de Medicina Genómica, Ciudad de México, México; Cátedras Consejo Nacional de Ciencia y Tecnología, Ciudad de México, México; Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | | | - Alfredo Hidalgo-Miranda
- Instituto Nacional de Medicina Genómica, Ciudad de México, México; Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Ciudad de México, México.
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3
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Yu XQ, Dasgupta P, Baade P. Quantifying the absolute number of cancer deaths that would be avoided if cancers were diagnosed prior to progressing to distant metastasis, New South Wales, Australia 1985-2014. Int J Cancer 2022; 150:1760-1769. [PMID: 35037243 DOI: 10.1002/ijc.33931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022]
Abstract
This study measures the impact of diagnosing cancers early before they metastasise on reducing the burden of cancer death. A cohort of 716,501 people aged 15-89 years diagnosed with a solid cancer in New South Wales, Australia, during 1985-2014 were followed-up to December 2015. Crude probabilities of cancer death by stage at diagnosis were calculated for all solid cancers combined and five individual cancers using flexible parametric relative survival models. These probabilities were used to estimate the number of avoided cancer deaths within 10 years of diagnosis in three 10-year diagnostic periods if all cases with known distant stage were instead diagnosed at an earlier stage. Cancers known to be diagnosed at distant stage comprised ~16% of all solid cancers diagnosed during 2005-2014. Assuming all these cases were instead diagnosed at regional stage, an annual average of 2,064 cancer deaths would have been potentially avoided within 10 years of diagnosis. This equated to ~21% of modelled observed deaths. Alternatively, if half of all known distant cases diagnosed during 2005-2014 were diagnosed as regional and half as localised, the average number of deaths avoided per year would increase to 2,677 (~28%). Estimates varied by diagnostic period, sex, and cancer type, reflecting both the different stage distributions for the cancer types, and the respective survival differences between cancer stages. While prevention is the most effective pillar of cancer control, these findings quantify the potential benefits of diagnosing all cancer types when they are less advanced to reduce the burden of cancer mortality.
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Affiliation(s)
- Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Peter Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
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Hosseini K, Ranjbar M, Pirpour Tazehkand A, Asgharian P, Montazersaheb S, Tarhriz V, Ghasemnejad T. Evaluation of exosomal non-coding RNAs in cancer using high-throughput sequencing. J Transl Med 2022; 20:30. [PMID: 35033106 PMCID: PMC8760667 DOI: 10.1186/s12967-022-03231-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022] Open
Abstract
Clinical oncologists need more reliable and non-invasive diagnostic and prognostic biomarkers to follow-up cancer patients. However, the existing biomarkers are often invasive and costly, emphasizing the need for the development of biomarkers to provide convenient and precise detection. Extracellular vesicles especially exosomes have recently been the focus of translational research to develop non-invasive and reliable biomarkers for several diseases such as cancers, suggesting as a valuable source of tumor markers. Exosomes are nano-sized extracellular vesicles secreted by various living cells that can be found in all body fluids including serum, urine, saliva, cerebrospinal fluid, and ascites. Different molecular and genetic contents of their origin such as nucleic acids, proteins, lipids, and glycans in a stable form make exosomes a promising approach for various cancers' diagnoses, prediction, and follow-up in a minimally invasive manner. Since exosomes are used by cancer cells for intercellular communication, they play a critical role in the disease process, highlighting the importance of their use as clinically relevant biomarkers. However, regardless of the advantages that exosome-based diagnostics have, they suffer from problems regarding their isolation, detection, and characterization of their contents. This study reviews the history and biogenesis of exosomes and discusses non-coding RNAs (ncRNAs) and their potential as tumor markers in different types of cancer, with a focus on next generation sequencing (NGS) as a detection method. Moreover, the advantages and challenges associated with exosome-based diagnostics are also presented.
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Affiliation(s)
- Kamran Hosseini
- Department of Molecular Medicine, Faculty of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ranjbar
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Pirpour Tazehkand
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parina Asgharian
- Department of Pharmacognosy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheila Montazersaheb
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Tarhriz
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Tohid Ghasemnejad
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis. PLoS One 2021; 16:e0252529. [PMID: 34086757 PMCID: PMC8177459 DOI: 10.1371/journal.pone.0252529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal. METHODS Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson's chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0). RESULTS Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55-140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients' admission until treatment ranged from 42-61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61-12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals. CONCLUSIONS Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.
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Filho MFB, Santana MED, Mendes CP, Jesus Costa DD, Santos CAASD, Araújo MFMD, Oliveira Serra MAAD. Cultural, social, and healthcare access factors associated with delays in gastric cancer presentation, diagnosis, and treatment: A cross-sectional study. J Cancer Policy 2021; 28:100277. [DOI: 10.1016/j.jcpo.2021.100277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
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Sanchez JA, Portillo S, Zarka MA, Snedden D, Pyle D, Goodman H, Hayes DF. Improving Oncology-Pathology Collaboration in Resource-Limited Settings: An American Society of Clinical Oncology/College of American Pathologists Initiative. Am Soc Clin Oncol Educ Book 2021; 41:199-220. [PMID: 34010051 DOI: 10.1200/edbk_320037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Accurate pathologic evaluation is essential for proper diagnosis and treatment of patients with cancer. ASCO and the College of American Pathologists have successfully collaborated over the last 15 years to improve collaboration between clinical oncologists and pathologists and to standardize pathologic assay techniques. Cancer is an increasingly recognized societal burden in low- and middle-income countries. In 2015, ASCO and the College of American Pathologists implemented an initiative to identify countries that could benefit from peer insights by jointly convening an international workshop among members of both organizations and pathologists and clinical oncologists from Haiti, Honduras, Vietnam, and Uganda. Honduras was chosen as a pilot site, and representatives of ASCO, the College of American Pathologists, and the Honduras pathology and clinical oncology communities have identified areas in which collaboration might be productive. Multiple barriers, including high poverty levels, poor cancer awareness educational programs, lack of human resources, and delayed diagnosis and treatment, have resulted in a higher cancer mortality rate in Honduras compared with high/moderate-income countries and are shared by other low-income countries. ASCO and the College of American Pathologists member faculty supported a symposium led by Honduras colleagues for interested Honduran pathologists and oncologists. The Honduran communities are now working to establish national resource-appropriate guidelines for both pathology and clinical oncology. Taken together, these efforts indicate that barriers to meet the needs of the clinical oncologists in a low-income country such as Honduras are challenging but not insurmountable.
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Affiliation(s)
| | - Silvia Portillo
- National Institute for Cardio Pulmonary Diseases, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Matthew A Zarka
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ
| | | | - Doug Pyle
- American Society of Clinical Oncology, Alexandria, VA
| | - Harris Goodman
- Alameda Health System, College of American Pathologists, Oakland, CA
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor MI
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8
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Zhao Y, Yu YQ, You S, Zhang CM, Wu L, Zhao W, Wang XM. Long Non-Coding RNA MALAT1 as a Detection and Diagnostic Molecular Marker in Various Human Cancers: A Pooled Analysis Based on 3255 Subjects. Onco Targets Ther 2020; 13:5807-5817. [PMID: 32606791 PMCID: PMC7311208 DOI: 10.2147/ott.s250796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Accumulating studies have explored the potential diagnostic value of lncRNA MALAT1 in various cancers. However, there are still inconsistent results in diagnostic accuracy and reliability in individual studies. The aim of this pooled study was to summarize the overall diagnostic capacity of lncRNA MALAT1 in cancer detection and diagnosis. Methods Eligible studies satisfying the inclusion criteria were screened and selected from the online database. All statistical analyses were performed using Stata 14.0. Results A total of 17 eligible studies were included in this pooled analysis, with 1777 cases and 1478 controls. The overall results were shown as follows: sensitivity, 0.74 (95% CI=0.65-0.81), specificity, 0.79 (95% CI=0.73-0.84), positive likelihood ratio (PLR), 3.48 (95% CI=2.79-4.32), negative likelihood, 0.33 (95% CI=0.25-0.44), diagnostic score, 2.34 (95% CI=1.99-2.69), diagnostic odds ratio, 10.41 (95% CI=7.33-14.78) and area under the curve, 0.83 (95% CI=0.80-0.86). Deeks' funnel plot asymmetry test (p = 0.66) suggested no potential publication bias. Conclusion All these results indicate that lncRNA MALAT1 achieves a relatively moderate accuracy in cancer detection and diagnosis, and could serve as a diagnostic biomarker for cancers.
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Affiliation(s)
- Yue Zhao
- Department of Hepatobiliary Surgery, Zhongshan Hospital, Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian 361004, People's Republic of China.,Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Germany
| | - Ya-Qi Yu
- Department of Hepatobiliary Surgery, Zhongshan Hospital, Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian 361004, People's Republic of China
| | - Song You
- Mengchao Hepatobiliary Hospital of Fujian Medical University, The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, People's Republic of China
| | - Chang-Mao Zhang
- Faculty of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Liang Wu
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, People's Republic of China
| | - Wenxiu Zhao
- Department of Hepatobiliary Surgery, Zhongshan Hospital, Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian 361004, People's Republic of China
| | - Xiao-Min Wang
- Department of Hepatobiliary Surgery, Zhongshan Hospital, Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian 361004, People's Republic of China
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Makler A, Asghar W. Exosomal biomarkers for cancer diagnosis and patient monitoring. Expert Rev Mol Diagn 2020; 20:387-400. [PMID: 32067543 PMCID: PMC7071954 DOI: 10.1080/14737159.2020.1731308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
Introduction: In recent years, extensive research has been conducted on using exosomes as biomarkers for cancer detection. Exosomes are 40-150 nm-sized extracellular vesicles released by all cell types, including tumor cells. Exosomes are stable in body fluids due to their lipid bilayer member and often contain DNA, RNA, and proteins. These exosomes can be harvested from blood, plasma, serum, urine, or saliva and analyzed for tumor-relevant mutations. Thus, exosomes provide an alternative to current methods of tumor detection.Areas covered: This review discusses the use of exosomal diagnostics in various tumor types as well as their examination in various clinical trials. The authors also discuss the limitations of exosome-based diagnostics in the clinical setting and provide examples of several studies in which the development and usage of microfluidic chips and nano-sensing devices have been utilized to address these obstacles.Expert commentary: In recent years, exosomes and their contents have exhibited potential as novel tumor detection markers despite the labor involved in their harvest and isolation. Despite this, much work is being done to optimize exosome capture and analysis. Thus, their roles as biomarkers in the clinical setting appear promising.
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Affiliation(s)
- Amy Makler
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431
| | - Waseem Asghar
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL 33431
- Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431
- Department of Biological Sciences (courtesy appointment), Florida Atlantic University, Boca Raton, FL 33431
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Cheewakriangkrai C, Kietpeerakool C, Charoenkwan K, Pattanittum P, John D, Aue‐aungkul A, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer. Cochrane Database Syst Rev 2020; 3:CD013253. [PMID: 32168393 PMCID: PMC7069600 DOI: 10.1002/14651858.cd013253.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Diagnosis of endometrial (womb) cancer is normally made at an early stage, as most women with the disease experience abnormal vaginal bleeding, which prompts them to seek medical advice. However, delays in presentation and referral can result in delay in diagnosis and management, which can lead to unfavourable treatment outcomes. This is particularly a problem for pre- and peri-menopausal women. Providing educational information to women and healthcare providers regarding symptoms relating to endometrial cancer may raise awareness of the disease and reduce delayed treatment. OBJECTIVES To assess the effectiveness of health education interventions targeting healthcare providers, or individuals, or both, to promote early presentation and referral for women with endometrial cancer symptoms. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), both individually randomised and cluster-RCTs. In the absence of RCTs we planned to include well-designed non-randomised studies (NRS) with a parallel comparison assessing the benefits of any type of health education interventions. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated whether potentially relevant studies met the inclusion criteria for the review, but none were found. MAIN RESULTS A comprehensive search of the literature yielded the following results: CENTRAL (1022 references), MEDLINE (2874 references), and Embase (2820 references). After de-duplication, we screened titles and abstracts of 4880 references and excluded 4864 that did not meet the review inclusion criteria. Of the 16 references that potentially met the review inclusion, we excluded all 16 reports after reviewing the full texts. We did not identify any ongoing trials. AUTHORS' CONCLUSIONS There is currently an absence of evidence to indicate the effectiveness of health education interventions involving healthcare providers or individuals or both to promote early presentation and referral for women with endometrial cancer symptoms. High-quality RCTs are needed to assess whether health education interventions enhance early presentation and referral. If health education interventions can be shown to reduce treatment delays in endometrial cancer, further studies would be required to determine which interventions are most effective.
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Affiliation(s)
- Chalong Cheewakriangkrai
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadMuangChiang MaiThailand50200
| | - Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai UniversityDepartment of Obstetrics and Gynecology110 Intawaroros RoadMuangChiang MaiThailand50200
| | - Porjai Pattanittum
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Public Health FacultyMitraparp RoadMueng DistrictKhon KaenKhon KaenThailand40002
| | | | - Apiwat Aue‐aungkul
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Koo MM, Swann R, McPhail S, Abel GA, Elliss-Brookes L, Rubin GP, Lyratzopoulos G. Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study. Lancet Oncol 2020; 21:73-79. [PMID: 31704137 PMCID: PMC6941215 DOI: 10.1016/s1470-2045(19)30595-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis. METHODS In this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I-III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms. FINDINGS We analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1-3; eight of 584 patients) for abnormal mole to 80% (71-87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the "any other symptom" category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV. INTERPRETATION Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease. FUNDING UK Department of Health's Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis; and Cancer Research UK.
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Affiliation(s)
- Minjoung Monica Koo
- University College London, London, UK; National Cancer Registration and Analysis Service, Public Health England, London, UK.
| | - Ruth Swann
- National Cancer Registration and Analysis Service, Public Health England, London, UK; Cancer Research UK, London, UK
| | - Sean McPhail
- University College London, London, UK; National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Gary A Abel
- University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Greg P Rubin
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Georgios Lyratzopoulos
- University College London, London, UK; National Cancer Registration and Analysis Service, Public Health England, London, UK
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Harris M, Thulesius H, Neves AL, Harker S, Koskela T, Petek D, Hoffman R, Brekke M, Buczkowski K, Buono N, Costiug E, Dinant GJ, Foreva G, Jakob E, Marzo-Castillejo M, Murchie P, Sawicka-Powierza J, Schneider A, Smyrnakis E, Streit S, Taylor G, Vedsted P, Weltermann B, Esteva M. How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis. BMJ Open 2019; 9:e030169. [PMID: 31551382 PMCID: PMC6773305 DOI: 10.1136/bmjopen-2019-030169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND National European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis. OBJECTIVES This study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved. DESIGN In an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data. SETTING A primary care study, with participating centres in 20 European countries. PARTICIPANTS A total of 1352 PCPs answered the final survey question, with a median of 48 per country. RESULTS The main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these. CONCLUSIONS To achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, UK
- Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Sweden
| | - Ana Luísa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK
- CINTESIS (Centre for Health Technology and Services Research) and MEDCIDS (Department of Community Medicine, Information and Health Decision Sciences), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | | | - Nicola Buono
- Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
| | - Emiliana Costiug
- Family Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | | | - Eva Jakob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
| | - Mercè Marzo-Castillejo
- Unitat de Suport a la Recerca, IDIAP Jordi Gol, Institut Català de la Salut, Barcelona, Spain
| | - Peter Murchie
- Division of Applied Health Sciences - Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | | | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, München, Germany
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sven Streit
- Berner Institut für Hausarztmedizin (BIHAM), University of Bern, Bern, Switzerland
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Magdalena Esteva
- Research Unit, Majorca Primary Health Care Department, Balearic Islands Health Research Institute (IdISBa), Preventive Activities and Health Promotion Network, Carlos III Institute of Health (RedIAPP-RETICS), Palma de Mallorca, Spain
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13
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Sánchez JA, Handal MG, Vílchez Rodriguez JF, Mejía SI, Pagoaga AP. Time Intervals From Onset of Clinical Manifestations to Treatment in Patients With Cancer at Hospital General San Felipe, Tegucigalpa, Honduras. J Glob Oncol 2019; 5:1-7. [PMID: 31162986 PMCID: PMC6613713 DOI: 10.1200/jgo.19.00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE In cancer, clinical staging is related to outcomes, and this is linked to the evolution of the disease over time. In Honduras, cancer mortality is high, and time intervals from onset of symptoms to treatment of cancer are not known. We conducted a cross-sectional study to determine these intervals. PATIENTS AND METHODS This investigation was carried out from April 25 to August 30, 2018, and included 202 patients at the main cancer referral center in Honduras. For the purposes of the study, information was obtained from patients, their caregiver, medical records, or treatment cards. Patients older than age 18 years were included after informed consent was signed. RESULTS The mean time interval from onset of symptoms to cancer treatment was 232 days. Different intervals of time were identified, and the mean of these intervals was calculated in days as follows: 68 days from onset of symptoms to first medical evaluation; 146 days from first evaluation to oncologist consultation; 26 days from cancer specialist to the pathology report; and 86 days from the histopathologic diagnosis to the beginning of treatment. Once diagnosis was established, the average elapsed times to chemotherapy, radiotherapy, surgery, and chemoradiotherapy were 88, 102, 76, and 154 days, respectively (P < .05, when surgery is compared against chemotherapy and radiotherapy). CONCLUSION The mean time interval from symptom presentation to treatment in patients with cancer is more than 7 months. This could explain the advanced stages of disease seen at the time of treatment in Honduras, which decrease chance of cure and increase the mortality rate of cancer). Appropriate intervention to decrease these intervals must be taken to reduce mortality.
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Affiliation(s)
- José A Sánchez
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Mayra G Handal
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | | | - Sinthia I Mejía
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Annye P Pagoaga
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
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14
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Lin C, Clark R, Tu P, Tu R, Hsu YJ, Nien HC. The disconnect in hepatitis screening: participation rates, awareness of infection status, and treatment-seeking behavior. J Glob Health 2019; 9:010426. [PMID: 31073398 PMCID: PMC6486119 DOI: 10.7189/jogh.09.010426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Over 325 million people in the world are infected with hepatitis B or C virus. Chronic hepatitis is responsible for 78% of cases of hepatocellular carcinoma and an estimated 1.3 million preventable deaths a year. As “silent killers”, liver diseases are often asymptomatic and go undiagnosed until their terminal stage. Knowledge of infection status via screening is thus a vital part of preventing spread and seeking early treatment. Recently there has been a worldwide push to eliminate hepatitis. The objective of this study is to assess hepatitis B and C self-reported awareness of infection status vs correct awareness (compared to blood test results) and follow-up rates in Taiwan to inform global health promotion efforts that utilize screening interventions to prevent chronic liver diseases. Methods De-identified data from a Liver Foundation’s nationwide community-outreach free blood screening programs was utilized, including 50 909 participants’ data from 74 sites with a questionnaire (demographics, screening history, hepatitis awareness, monitoring behavior) and blood test results. Chi square tests were applied using R programing to examine the impacts of demographic variables on infection prevalence, awareness, and behavior relating to hepatitis. Results Among all participants, 41.1% indicated having had a hepatitis screening, of which only 60.8% knew their results. Around 69.7% and 66.5% self-reported awareness of their hepatitis B and C status respectively; 12.8% and 26.4% of individuals who tested positive for HBsAg and Anti-HCV respectively incorrectly thought they were not infected. Of those who self-reported awareness of their positive infection, 43.4% and 26.6% did not follow up with a health care professional for monitoring or treatment; the top reasons were “no symptoms”, “too busy”, and “don’t know where to follow up”. Rural populations showed higher infection prevalence but lower screening rates and self-reported awareness. Conclusions Intervention programs must address the substantial number of people that do not recall if they were screened or do not know the results of a screening. Discrepancies between self-reported awareness, correct awareness, and follow-up and disparities across demographic groups deserve further scrutiny. Global hepatitis eradication initiatives should reconsider how screening, test results, and education are presented in order to improve awareness and prevent chronic infection that could develop into life-threatening liver diseases.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, North Caroloina, USA.,Joint first authors
| | - Rachel Clark
- Policy and Organizational Management Program, Duke University, Durham, North Caroloina, USA.,Joint first authors
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, North Caroloina, USA
| | - Rungting Tu
- College of Management, Shen-Zhen University, Shenzhen, China
| | - Ya-Jung Hsu
- Liver Disease Prevention and Treatment Research Foundation, Taipei, Taiwan
| | - Hsiao-Ching Nien
- Liver Disease Prevention and Treatment Research Foundation, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Cheewakriangkrai C, Kietpeerakool C, Aue-aungkul A, Charoenkwan K, Pattanittum P, John D, Lumbiganon P. Health education interventions to promote early presentation and referral for women with symptoms of endometrial cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chalong Cheewakriangkrai
- Faculty of Medicine, Chiang Mai University; Department of Obstetrics and Gynecology; 110 Intawaroros Road Muang Chiang Mai Thailand 50200
| | - Chumnan Kietpeerakool
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Apiwat Aue-aungkul
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Kittipat Charoenkwan
- Faculty of Medicine, Chiang Mai University; Department of Obstetrics and Gynecology; 110 Intawaroros Road Muang Chiang Mai Thailand 50200
| | - Porjai Pattanittum
- Khon Kaen University; Department of Epidemiology and Biostatistics, Public Health Faculty; Mitraparp Road Mueng District Khon Kaen Khon Kaen Thailand 40002
| | | | - Pisake Lumbiganon
- Khon Kaen University; Department of Obstetrics and Gynaecology, Faculty of Medicine; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
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16
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Langton S, Rijken JA, Bankhead CR, Plüddemann A, Leemans CR. Referrals for head and neck cancer in England and The Netherlands: an international qualitative study of the views of secondary-care surgical specialists. Br J Oral Maxillofac Surg 2019; 57:116-124. [PMID: 30661829 DOI: 10.1016/j.bjoms.2018.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/30/2018] [Indexed: 02/04/2023]
Abstract
One-year survival after head and neck cancer in England has been reported to be worse than that in Europe, despite five-year conditional survival being similar, which implies that patients present later in England. One country with better rates is The Netherlands. There are many possible causes, one of which may be the system of referral from primary to secondary care. We have compared the views of secondary care specialists in the two countries about their systems for referral, and identified aspects that might have an impact on outcomes. We organised semistructured qualitative interviews of surgical specialists in head and neck cancer in England and The Netherlands (n=12 in each). The most common theme was communication between primary care and specialists. Surgeons in England identified this as the aspect most lacking under the English "two-week" rule, while Dutch specialists felt that the good communication in their system was one of its best points. Other themes included the educational needs of primary care practitioners, criticism of "tick box" referrals in England, and too many patients referred who do not have cancer. Overall, specialists in both countries identified good aspects of their respective referral systems, but those in England felt strongly that the "two-week" rule/NICE guidance system could be improved with better direct communication between primary and secondary care, which might improve the speed and quality of referrals, reduce unnecessary ones, and assist in educating primary care physicians. It is not clear whether such improvements would improve survival, but further research and piloting of such a system should be considered in England.
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Affiliation(s)
| | - J A Rijken
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, De Boelelaan, Amsterdam, Netherlands.
| | - C R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford.
| | - A Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford.
| | - C R Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, De Boelelaan, Amsterdam, Netherlands.
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17
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Zhang Z, Xie H, Liang D, Huang L, Liang F, Qi Q, Yang X. Long non-coding RNA CCAT1 as a diagnostic and prognostic molecular marker in various cancers: a meta-analysis. Oncotarget 2018; 9:23695-23703. [PMID: 29805767 PMCID: PMC5955114 DOI: 10.18632/oncotarget.24923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/20/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Long non-coding RNA colon cancer-associated transcript-1 (CCAT1) is newly found to be related with diagnoses and prognosis of cancer. This meta-analysis was performed to investigate the relationship between CCAT1 expression and clinical parameters, including survival condition, lymph node metastasis and tumor node metastasis grade. MATERIALS AND METHODS The primary literatures were collected through initial search criteria from electronic databases, including PubMed, OVID Evidence-based medicine Reviews and others (up to May 12, 2017). Eligible studies were identified and selected by the inclusion and exclusion criteria. Data was extracted and computed into Hazard ratio (HR) for the assessment of overall survival, subgroup analyses were prespecified based on the digestive tract cancer or others. Analysis of different CCAT1 expression related with lymph node metastasis or tumor node metastasis grade was conducted. Risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS 9 studies were included. This meta-analysis showed that high CCAT1 expression level was related to poor overall survival, the pooled HR was 2.42 (95% confidence interval, CI: 1.86-3.16; P < 0.001; fix- effects model), similarly in the cancer type subgroups: digestive tract cancer (HR, 2.42; 95% CI, 1.79-3.29; P < 0.001; fix- effects model) and others (HR, 2.42; 95% CI, 1.42-4.13; P = 0.001; fix- effects model). The analysis showed that high CCAT1 was strongly related to positive lymph node metastasis (Odds ratio, OR: 3.24; 95% CI, 2.04-5.16; P < 0.001; fix- effects model), high tumor node metastasis stage (OR, 3.87; 95% CI, 2.53-5.92; P < 0.001; fix- effects model). CONCLUSIONS In conclusion, this meta-analysis revealed that CCAT1 had potential as a diagnostic and prognostic biomarker in various cancers.
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Affiliation(s)
- Zhihui Zhang
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518039, China
- Shantou University Medical College, Shantou 515041, China
| | - Haibiao Xie
- Shantou University Medical College, Shantou 515041, China
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518039, China
| | - Daqiang Liang
- Shantou University Medical College, Shantou 515041, China
| | - Lanbing Huang
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518039, China
| | - Feiguo Liang
- Shantou University Medical College, Shantou 515041, China
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100083, China
| | - Xinjian Yang
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518039, China
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18
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Car LT, Papachristou N, Urch C, Majeed A, Atun R, Car J, Vincent C. Prioritizing medication safety in care of people with cancer: clinicians' views on main problems and solutions. J Glob Health 2018; 7:011001. [PMID: 28685047 PMCID: PMC5475313 DOI: 10.7189/jogh.07.011001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cancer care is liable to medication errors due to the complex nature of cancer treatment, the common presence of comorbidities and the involvement of a number of clinicians in cancer care. While the frequency of medication errors in cancer care has been reported, little is known about their causal factors and effective prevention strategies. With a unique insight into the main safety issues in cancer treatment, frontline staff can help close this gap. In this study, we aimed to identify medication safety priorities in cancer patient care according to clinicians in North West London using PRIORITIZE, a novel priority-setting approach. METHODS The project steering group determined the scope, the context and the criteria for prioritization. We then invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A group of 26 clinicians from the initial cohort ranked the composite list of suggestions using predetermined criteria. RESULTS The top ranked problems focused on patients' poor understanding of treatments due to language or education difficulties, clinicians' insufficient attention to patients' psychological distress, and inadequate information sharing among health care providers. The top ranked solutions were provision of guidance to patients and their carers on what to do when unwell, pre-chemotherapy work-up for all patients and better staff training. Overall, clinicians considered improved communication between health care providers, quality assurance procedures (during prescription and monitoring stages) and patient education as key strategies for improving cancer medication safety. Prescribing stage was identified as the most vulnerable to medication safety threats. The highest ranked suggestions received the strongest agreement among the clinicians. CONCLUSIONS Clinician-identified priorities for reducing medication errors in cancer care addressed various aspects of cancer treatment. Our findings open up an opportunity to assess the congruence between health care professional suggestions, currently implemented patient safety policies and evidence base.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, Massachusetts, USA
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Catherine Urch
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, Massachusetts, USA
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK.,Health Services and Outcomes Research Programme, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, UK
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19
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Tudor Car L, El-Khatib M, Perneczky R, Papachristou N, Atun R, Rudan I, Car J, Vincent C, Majeed A. Prioritizing problems in and solutions to homecare safety of people with dementia: supporting carers, streamlining care. BMC Geriatr 2017; 17:26. [PMID: 28103810 PMCID: PMC5244548 DOI: 10.1186/s12877-017-0415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method. METHODS The project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria. RESULTS Inadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication nonadherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies. CONCLUSIONS Clinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety.
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Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mona El-Khatib
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, UK
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburg, UK
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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