scholarly journals Using cancer risk algorithms to improve risk estimates and referral decisions

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Olga Kostopoulou ◽  
Kavleen Arora ◽  
Bence Pálfi

Abstract Background Cancer risk algorithms were introduced to clinical practice in the last decade, but they remain underused. We investigated whether General Practitioners (GPs) change their referral decisions in response to an unnamed algorithm, if decisions improve, and if changing decisions depends on having information about the algorithm and on whether GPs overestimated or underestimated risk. Methods 157 UK GPs were presented with 20 vignettes describing patients with possible colorectal cancer symptoms. GPs gave their risk estimates and inclination to refer. They then saw the risk score of an unnamed algorithm and could update their responses. Half of the sample was given information about the algorithm’s derivation, validation, and accuracy. At the end, we measured their algorithm disposition. We analysed the data using multilevel regressions with random intercepts by GP and vignette. Results We find that, after receiving the algorithm’s estimate, GPs’ inclination to refer changes 26% of the time and their decisions switch entirely 3% of the time. Decisions become more consistent with the NICE 3% referral threshold (OR 1.45 [1.27, 1.65], p < .001). The algorithm’s impact is greatest when GPs have underestimated risk. Information about the algorithm does not have a discernible effect on decisions but it results in a more positive GP disposition towards the algorithm. GPs’ risk estimates become better calibrated over time, i.e., move closer to the algorithm. Conclusions Cancer risk algorithms have the potential to improve cancer referral decisions. Their use as learning tools to improve risk estimates is promising and should be further investigated.

2021 ◽  
Author(s):  
Olga Kostopoulou ◽  
Kavleen Arora ◽  
Bence Palfi

Background: Cancer risk calculators were introduced to clinical practice in the last decade, but they remain underused. We aimed to test their potential to improve risk assessment and 2-week-wait referral decisions. Methods: 157 GPs were presented with 23 vignettes describing patients with possible colorectal cancer symptoms. GPs gave their intuitive risk estimate and inclination to refer. They then saw the risk score of an algorithm (QCancer was not named) and could update their responses. Half of the sample was given information about the algorithm's derivation, validation, and accuracy. At the end, we measured their algorithm disposition. Results: GPs changed their inclination to refer 26% of the time and switched decisions entirely 3% of the time. Post-algorithm decisions improved significantly vis-a-vis the 3% NICE threshold (OR 1.45 [1.27, 1.65], p<.001). The algorithm's impact was greater where GPs had underestimated risk. GPs who received information about the algorithm had more positive disposition towards it. A learning effect was observed: GPs' intuitive risk estimates became better calibrated over time, i.e., moved closer to QCancer. Conclusions: Cancer risk calculators have the potential to improve 2-week-wait referral decisions. Their use as learning tools to improve intuitive risk estimates is promising and should be further investigated.


2021 ◽  
Author(s):  
George Kafatos ◽  
Victoria Banks ◽  
Peter Burdon ◽  
David Neasham ◽  
Caroline Anger ◽  
...  

Background: The literature on biomarker testing for metastatic colorectal cancer (mCRC) in Europe is scarce. This study aimed to estimate the percentage of mCRC patients from five European countries tested for biomarkers over time. Materials & methods: An oncology database was retrospectively analyzed; evaluated biomarkers were RAS, BRAF and microsatellite instability (MSI). The patients were drug treated during 2018 and tested for relevant biomarkers in 2013–2018. Results: RAS testing was conducted in >90% of mCRC patients from 2014 onwards. BRAF testing increased from 31% of mCRC patients in 2013 to 67% in 2018. MSI testing increased from 10 to 41%. There was no notable trend over time for RAS and BRAF mutation or MSI-high prevalence. Conclusion: Biomarker testing among patients diagnosed with mCRC was increased over time. This study demonstrates the quick uptake of biomarker testing in clinical practice. These findings are significant as biomarker-based drugs are becoming more common.


2013 ◽  
pp. 1-3
Author(s):  
L. DEMOUGEOT ◽  
G. ABELLAN VAN KAN ◽  
B. VELLAS ◽  
P. DE SOUTO BARRETO

Frailty is commonly regarded as a pre-disability condition of older persons. Its importance in theelderly should be more carefully taken into account in the clinical practice. To implement interventions aimed atpreventing disability in frail older adults, screening tools for the early detection of this syndrome are needed. Inthis context, the Gérontopôle Frailty Screening Tool (GFST) has been recently proposed as an instrument forassisting general practitioners in the detection of non-disabled frail older adults. In the present paper, we brieflydiscuss about the difficulties of translating knowledge from the frailty research field to the clinical practice. Suchdifficulties are illustrated by presenting the evolution of the GFST over time. The use of frailty screening tools,such as the GFST, in the clinical practice is necessary to support the identification of older persons at risk ofadverse events and promote the implementation of individualized strategies against disability.


2017 ◽  
Vol 41 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Isaac M. Lipkus ◽  
Constance M. Johnson ◽  
Sathya Amarasekara ◽  
Wei Pan ◽  
John A. Updegraff

2010 ◽  
Vol 103 (12) ◽  
pp. 1875-1884 ◽  
Author(s):  
E Theodoratou ◽  
H Campbell ◽  
A Tenesa ◽  
R Houlston ◽  
E Webb ◽  
...  

Author(s):  
Mark Natanson

Colon and rectal cancers are usually combined under the same term "colorectal cancer". It should be noted that the lesion of the colon is much more common. Colorectal cancer ranks fourth in the overall structure of oncological pathology in terms of prevalence, and in some countries even comes third after lung and stomach cancer. Risk factors that contribute to the development of colorectal cancer include bowel polyps, ulcerative colitis and Crohn's disease, and a genetic predisposition. Most often, neoplastic transformation occurs at the site of an adenoma or dysplastic lesion of the intestinal mucosa. Due to the high risk of neoplastic process in a sufficiently large number of elderly people, it is recommended that every person over the age of 50 should undergo compulsory screening to detect latent cancer. The simplest, but at the same time insufficiently informative method is a blood culture test - analysis for the presence of blood in the feces. Method of total colonoscopy and double-contrast radiography is distinguished by a higher information content, but at the same time a higher cost. It is recommended to have these examinations every three to five years after the age of 50 years without clinical manifestations, and after the age of 40 for those at risk for colorectal cancer.


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