Cancer suspicion, referral to cancer patient pathway and primary care interval: a survey and register study exploring 10 different types of abdominal cancer

2021 ◽  
Author(s):  
Nanna H Jessen ◽  
Henry Jensen ◽  
Charles W Helsper ◽  
Alina Z Falborg ◽  
Henning Glerup ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Kidney Cancer ◽  
Cancer Type ◽  
Diagnostic Strategies ◽  
Patient Pathways ◽  
Different Types ◽  
Cancer Types ◽  
Serious Disease

Abstract Background Abdominal cancers represent 30% of all diagnosed cancers. Nevertheless, it is unknown if the general practitioner’s (GP’s) initial cancer suspicion varies for different abdominal cancer types and how this is associated with referrals to standardized cancer patient pathways (CPPs). Objectives To explore initial cancer suspicion in GPs and to investigate how this was associated with GP referrals to CPPs and the duration of the primary care interval (PCI) in 10 different abdominal cancer types. Methods We conducted a cohort study on 1104 incident abdominal cancer patients diagnosed in Denmark in 2016 using a combination of survey and register-based data. Poisson regression was used to estimate associations between GP cancer suspicion, CPP referral and PCI duration. Results The GPs initially suspected cancer or other serious disease in 46–78% of cases, lowest in kidney cancer, and referred 35–65% to a CPP, lowest in oesophageal cancer. The GP’s suspicion at the first presentation was strongly associated with referral to a CPP. The median (0–11 days) and 75th percentile (3–32 days) PCIs varied between the abdominal cancer types. The likelihood of a long PCI was more than 3-fold higher when the GP did not initially suspect cancer. Conclusion In up to half of abdominal cancer patients, there is no initial suspicion of cancer or serious disease. CPPs were used in only one-third to two-thirds of patients, depending on cancer type. For kidney cancer, as well as several abdominal cancers, we need better diagnostic strategies to support GPs to enable effective and efficient referral.

scholarly journals COVID-19 increases age- and sex-controlled 21-day fatality rates for patients with melanoma, hematologic malignancies, uterine cancer, or kidney cancer

2021 ◽  
Author(s):  
Haiquan Li ◽  
Edwin Baldwin ◽  
Xiang Zhang ◽  
Colleen Kenost ◽  
Wenting Luo ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Kidney Cancer ◽  
Distant Metastasis ◽  
Uterine Cancer ◽  
Hematologic Malignancies ◽  
Hazard Ratio ◽  
Cancer Type ◽  
Increased Risk ◽  
Cancer Types ◽  
The Impact

AbstractIntroductionPrior research has reported an increased risk of fatality for cancer patients, but most studies investigated the risk by comparing cancer patients to non-cancer patients among COVID-19 infections. Only a few studies have compared the impact of a COVID-19 infection to non-infection with matched cancer patients and types.Methods & MaterialsWe conducted survival analyses of 4,606 cancer patients with COVID-19 test results from March 16 to October 11, 2020 in UK Biobank and estimated the overall hazard ratio of fatality with and without COVID-19 infection. We also examined the hazard ratios of thirteen specific cancer types with at least 100 patients.ResultsCOVID-19 resulted in an overall hazard ratio of 7.76 (95% CI: [5.78, 10.40], p<10−10) by studying the survival rate of 4,606 cancer patients for 21-days after the tests. The hazard ratio was shown to vary among cancer type, with over a 10-fold increase in fatality rate (false discovery rate≤0.02) for melanoma, hematologic malignancies, uterine cancer, and kidney cancer using a stratified analysis on each of the cancer types. Although COVID-19 imposed a higher risk for localized cancers compared to distant metastasis ones, those of distant metastasis yielded higher fatality rates due to their multiplicative effects.ConclusionThe results highlight the importance of timely care for localized and hematological cancer patients and the necessity to vaccinate uninfected patients as soon as possible, particularly for the cancer types influenced most by COVID-19.

Exploration of the MSI landscape in Chinese pan-cancer patient by Next-Generation Sequencing.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14576-e14576
Author(s):  
Xinlu Liu ◽  
Jiasheng Xu ◽  
Jian Sun ◽  
Deng Wei ◽  
Xinsheng Zhang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Correlation Analysis ◽  
Cancer Patients ◽  
Cancer Type ◽  
Multiple Tumor ◽  
Treatment Plans ◽  
Cancer Types ◽  
Chinese Cancer Patients ◽  
Colorectal Cancer Patients ◽  
Pan Cancer

e14576 Background: Clinically, MSI had been used as an important molecular marker for the prognosis of colorectal cancer and other solid tumors and the formulation of adjuvant treatment plans, and it had been used to assist in the screening of Lynch syndrome. However, there were currently few reports on the incidence of MSI-H in Chinese pan-cancer patients. This study described the occurrence of MSI in a large multi-center pan-cancer cohort in China, and explored the correlation between MSI and patients' TMB, age, PD-L1 expression and other indicators. Methods: The study included 8361 patients with 8 cancer types from multiple tumor centers. Use immunohistochemistry to detect the expression of MMR protein (MLH1, MSH2, MSH6 and PMS2) in patients with various cancer types to determine the MSI status and detect the expression of PD-L1 in patients. Through NGS technology, 831 genes of 8361 Chinese cancer patients were sequenced and the tumor mutation load of the patients was calculated. The MSI mutations of patients in 8 cancer types were analyzed and the correlation between MSI mutations of patients and the patient's age, TMB and PD-L1 expression was analyzed. Results: The test results showed that MSI patients accounted for 1.66% of pan-cancers. Among them, MSI-H patients accounted for the highest proportion in intestinal cancer, reaching 7.2%. The correlation analysis between MSI and TMB was performed on patients of various cancer types. The results showed that: in each cancer type, MSI-H patients had TMB greater than 10, and 26.83% of MSI-H patients had TMB greater than 100 in colorectal cancer patients. The result of correlation analysis showed that there was no significant correlation between the patient's age and the risk of MSI mutation ( P> 0.05). In addition to PAAD and LUAD, the expression of PD-L1 in MSI-H patients was higher than that in MSS patients in other cancer types( P< 0.05). The correlation analysis between PD-L1 expression and TMB in patients found that in colorectal cancer, the higher the expression of PD-L1, the higher the patient's TMB ( P< 0.05). Conclusions: In this study, we explored the incidence of MSI-H in pan-cancer patients in China and found that the TMB was greater than 10 in patients with MSI-H. Compared with MSS patients, MSI-H patients have higher PD-L1 expression, and the higher the PD-L1 expression in colorectal cancer, the higher the TMB value of patients.

scholarly journals Chemotherapy for Late-Stage Cancer Patients: Meta-Analysis of Complete Response Rates

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 232 ◽  
Author(s):  
Martin L. Ashdown ◽  
Andrew P. Robinson ◽  
Steven L. Yatomi-Clarke ◽  
M. Luisa Ashdown ◽  
Andrew Allison ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Late Stage ◽  
Meta Analysis ◽  
Complete Response ◽  
Drug Regimen ◽  
Cancer Type ◽  
Late Stage Cancer ◽  
Pubmed Database ◽  
Wide Range ◽  
Cancer Types

Complete response (CR) rates reported for cytotoxic chemotherapy for late-stage cancer patients are generally low, with few exceptions, regardless of the solid cancer type or drug regimen. We investigated CR rates reported in the literature for clinical trials using chemotherapy alone, across a wide range of tumour types and chemotherapeutic regimens, to determine an overall CR rate for late-stage cancers. A total of 141 reports were located using the PubMed database. A meta-analysis was performed of reported CR from 68 chemotherapy trials (total 2732 patients) using standard agents across late-stage solid cancers—a binomial model with random effects was adopted. Mean CR rates were compared for different cancer types, and for chemotherapeutic agents with different mechanisms of action, using a logistic regression. Our results showed that the CR rates for chemotherapy treatment of late-stage cancer were generally low at 7.4%, regardless of the cancer type or drug regimen used. We found no evidence that CR rates differed between different chemotherapy drug types, but amongst different cancer types small CR differences were evident, although none exceeded a mean CR rate of 11%. This remarkable concordance of CR rates regardless of cancer or therapy type remains currently unexplained, and motivates further investigation.

scholarly journals Prevalence and Outcome of COVID-19 Infection in Cancer Patients: A National Veterans Affairs Study

2020 ◽  
Author(s):  
Nathanael R Fillmore ◽  
Jennifer La ◽  
Raphael E Szalat ◽  
David P Tuck ◽  
Vinh Nguyen ◽  
...  
Keyword(s):  
African American ◽  
Cancer Patients ◽  
Hematologic Malignancy ◽  
Statistical Tests ◽  
Veterans Affairs ◽  
Attributable Mortality ◽  
Cancer Type ◽  
The Us ◽  
Charlson Comorbidity Score ◽  
Cancer Types

Abstract Background Emerging data suggest variability in susceptibility and outcome to coronavirus disease 2019 (COVID-19) infection. Identifying risk factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations. Methods We analyzed electronic health records of the US Veterans Affairs Healthcare System and assessed the prevalence of COVID-19 infection in cancer patients. We evaluated the proportion of cancer patients tested for COVID-19 who were positive, as well as outcome attributable to COVID-19, and stratified by clinical characteristics including demographics, comorbidities, cancer treatment, and cancer type. All statistical tests are 2-sided. Results Of 22 914 cancer patients tested for COVID-19, 1794 (7.8%) were positive. The prevalence of COVID-19 was similar across age. Higher prevalence was observed in African American (15.0%) compared with White (5.5%; P &lt; .001) and in patients with hematologic malignancy compared with those with solid tumors (10.9% vs 7.8%; P &lt; .001). Conversely, prevalence was lower in current smokers and patients who recently received cancer therapy (&lt;6 months). The COVID-19–attributable mortality was 10.9%. Higher attributable mortality rates were observed in older patients, those with higher Charlson comorbidity score, and in certain cancer types. Recent (&lt;6 months) or past treatment did not influence attributable mortality. Importantly, African American patients had 3.5-fold higher COVID-19–attributable hospitalization; however, they had similar attributable mortality as White patients. Conclusion Preexistence of cancer affects both susceptibility to COVID-19 infection and eventual outcome. The overall COVID-19–attributable mortality in cancer patients is affected by age, comorbidity, and specific cancer types; however, race or recent treatment including immunotherapy do not impact outcome.

scholarly journals Incidentally diagnosed cancer and commonly preceding clinical scenarios: a cross-sectional descriptive analysis of English audit data

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028362 ◽  
Author(s):  
Minjoung Monica Koo ◽  
Greg Rubin ◽  
Sean McPhail ◽  
Georgios Lyratzopoulos
Keyword(s):  
Primary Care ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Cancer Site ◽  
Cross Sectional ◽  
Incidental Diagnosis ◽  
Audit Data ◽  
Clinical Scenarios ◽  
Incidental Cancer

ObjectivesCancer can be diagnosed in the absence of tumour-related symptoms, but little is known about the frequency and circumstances preceding such diagnoses which occur outside participation in screening programmes. We aimed to examine incidentally diagnosed cancer among a cohort of cancer patients diagnosed in England.DesignCross-sectional study of national primary care audit data on an incident cancer patient population.SettingWe analysed free-text information on the presenting features of cancer patients aged 15 or older included in the English National Audit of Cancer Diagnosis in Primary Care (2009–2010). Patients with screen-detected cancers or prostate cancer were excluded. We examined the odds of incidental cancer diagnosis by patient characteristics and cancer site using logistic regression, and described clinical scenarios leading to incidental diagnosis.ResultsAmong the studied cancer patient population (n=13 810), 520 (4%) patients were diagnosed incidentally. The odds of incidental cancer diagnosis increased with age (p<0.001), with no difference between men and women after adjustment. Incidental diagnosis was most common among patients with leukaemia (23%), renal (13%) and thyroid cancer (12%), and least common among patients with brain (0.9%), oesophageal (0.5%) and cervical cancer (no cases diagnosed incidentally). Variation in odds of incidental diagnosis by cancer site remained after adjusting for age group and sex.There was a range of clinical scenarios preceding incidental diagnoses in primary or secondary care. These included the monitoring or management of pre-existing conditions, routine testing before or after elective surgery, and the investigation of unrelated acute or new conditions.ConclusionsOne in 25 patients with cancer in our population-based cohort were diagnosed incidentally, through different mechanisms across primary and secondary care settings. The epidemiological, clinical, psychological and economic implications of this phenomenon merit further investigation.

scholarly journals Individual utilisation thresholds and exploring how GPs’ knowledge of their patients affects diagnosis: a qualitative study in primary care

2017 ◽  
Vol 67 (658) ◽  
pp. e361-e369 ◽  
Author(s):  
Matthias Michiels-Corsten ◽  
Stefan Bösner ◽  
Norbert Donner-Banzhoff
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Help Seeking ◽  
Family Background ◽  
Diagnostic Reasoning ◽  
Medical Attention ◽  
Diagnostic Strategies ◽  
Help Seeking Behaviour ◽  
The Media ◽  
Serious Disease

BackgroundOne of the tenets of general practice is that continuity of care has a beneficial effect on patient care. However, little is known about how continuity can have an impact on the diagnostic reasoning of GPs.AimTo explore GPs’ diagnostic strategies by examining GPs’ reflections on their patients’ individual thresholds for seeking medical attention, how they arrive at their estimations, and which conclusions they draw.Design and settingQualitative study with 12 GPs in urban and rural practices in Germany.MethodAfter each patient consultation GPs were asked to reflect on their diagnostic reasoning for that particular case. Qualitative and quantitative analyses of consultations and interview content were undertaken.ResultsA total of 295 primary care consultations were recorded, 134 of which contained at least one diagnostic episode. When elaborating on known patients, GPs frequently commented on how ‘early’ or ‘late’ in an illness progression a patient tended to consult. The probability of serious disease was accordingly regarded as high or low. This influenced GPs’ behaviour regarding further investigations or referrals, as well as reassurance and watchful waiting. GPs’ explanations for a patient’s utilisation threshold comprised medical history, the patient’s characteristics, family background, the media, and external circumstances.ConclusionThe concept of an individual threshold for the utilisation of primary care would explain how GPs use their knowledge of individual patients and their previous help-seeking behaviour for their diagnostic decision making. Whether the assumption behind this concept is valid, and whether its use improves diagnostic accuracy, remains to be investigated.

scholarly journals Cancer-associated pathways and biomarkers of venous thrombosis

Blood ◽  
2017 ◽  
Vol 130 (13) ◽  
pp. 1499-1506 ◽  
Author(s):  
Yohei Hisada ◽  
Nigel Mackman
Keyword(s):  
Cancer Patients ◽  
Brain Cancer ◽  
Cancer Type ◽  
Increased Risk ◽  
Different Types ◽  
Multiple Biomarkers ◽  
Podoplanin Expression ◽  
Potential Factors ◽  
Cancer Associated Thrombosis ◽  
Pai 1

Abstract Cancer patients have an increased risk of venous thromboembolism (VTE). In this review, we summarize common and cancer type–specific pathways of VTE in cancer patients. Increased levels of leukocytes, platelets, and tissue factor–positive (TF+) microvesicles (MVs) are all potential factors that alone or in combination increase cancer-associated thrombosis. Patients with lung or colorectal cancer often exhibit leukocytosis. Neutrophils could increase VTE in cancer patients by releasing neutrophil extracellular traps whereas monocytes may express TF. Thrombocytosis is often observed in gastrointestinal, lung, breast, and ovarian cancer and this could decrease the threshold required for VTE. Soluble P-selectin has been identified as a biomarker of cancer-associated thrombosis in a general cancer population and may reflect activation of the endothelium. P-selectin expression by the endothelium may enhance VTE by increasing the recruitment of leukocytes. Studies in patients with pancreatic or brain cancer suggest that elevated levels of PAI-1 may contribute to VTE. Although elevated levels of TF+ MVs have been observed in patients with different types of cancer, an association between TF+ MVs and VTE has been observed only in pancreatic cancer. Podoplanin expression is associated with VTE in patients with brain cancer and may activate platelets. Future studies should measure multiple biomarkers in each cancer type to determine whether combinations of biomarkers can be used as predictors of VTE. A better understanding of the pathways that increase VTE in cancer patients may lead to the development of new therapies to reduce the morbidity and mortality associated with thrombosis.

scholarly journals Prevalence and outcome of Covid-19 infection in cancer patients: a national VA study

2020 ◽  
Author(s):  
Nathanael R Fillmore ◽  
Jennifer La ◽  
Raphael E Szalat ◽  
David P Tuck ◽  
Vinh Nguyen ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Hematologic Malignancy ◽  
Current Smoker ◽  
Attributable Mortality ◽  
Veterans Administration ◽  
Cancer Type ◽  
Morbidity Score ◽  
Co Morbidity ◽  
The Us ◽  
Cancer Types

Background: Emerging data suggest variability in susceptibility and outcome to Covid-19 infection. Identifying the risk-factors associated with infection and outcomes in cancer patients is necessary to develop healthcare recommendations. Methods: We analyzed electronic health records of the US National Veterans Administration healthcare system and assessed the prevalence of Covid-19 infection in cancer patients. We evaluated the proportion of cancer patients tested for Covid-19 and their confirmed positivity, with clinical characteristics, and outcome, and stratified by demographics, comorbidities, cancer treatment and cancer type. Results: Of 22914 cancer patients tested for Covid-19, 1794 (7.8%) were positive. The prevalence of Covid-19 was similar across all ages. Higher prevalence was observed in African-American (AA) (15%) compared to white (5.5%; P<.001), in Hispanic vs non-Hispanic population and in patients with hematologic malignancy compared to those with solid tumors (10.9% vs 7.7%; P<.001). Conversely, prevalence was lower in current smoker patients, patients with other co-morbidities and having recently received cancer therapy (<6 months). The Covid-19 attributable mortality was 10.9%. Highest mortality rates were observed in older patients, those with renal dysfunction, higher Charlson co-morbidity score and with certain cancer types. Recent (<6 months) or past treatment did not influence mortality. Importantly, AA patients had 3.5-fold higher Covid-19 attributable hospitalization, however had similar mortality rate as white patients. Conclusion: Pre-existence of cancer affects both susceptibility to Covid-19 infection and eventual outcome. The overall Covid-19 attributable mortality in cancer patients is affected by age, co-morbidity and specific cancer types, however, race or recent treatment including immunotherapy does not impact outcome.

scholarly journals Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015–2016

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yngvar Nilssen ◽  
Odd Terje Brustugun ◽  
Morten Tandberg Eriksen ◽  
Erik Skaaheim Haug ◽  
Bjørn Naume ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Waiting Time ◽  
Low Income ◽  
Breast Cancer Patients ◽  
Prostate Cancer Diagnosis ◽  
Patient Pathways ◽  
Region Of Residence

Abstract Background Cancer patient pathways (CPPs) were implemented in 2015 to reduce waiting time, regional variation in waiting time, and to increase the predictability of cancer care for the patients. The aims of this study were to see if the national target of 70% of all cancer patients being included in a CPP was met, and to identify factors associated with CPP inclusion. Methods All patients registered with a colorectal, lung, breast or prostate cancer diagnosis at the Cancer Registry of Norway in the period 2015–2016 were linked with the Norwegian Patient Registry for CPP information and with Statistics Norway for sociodemographic variables. Multivariable logistic regression examined if the odds of not being included in a CPP were associated with year of diagnosis, age, sex, tumour stage, marital status, education, income, region of residence and comorbidity. Results From 2015 to 2016, 30,747 patients were diagnosed with colorectal, lung, breast or prostate cancer, of whom 24,429 (79.5%) were included in a CPP. Significant increases in the probability of being included in a CPP were observed for colorectal (79.1 to 86.2%), lung (79.0 to 87.3%), breast (91.5 to 97.2%) and prostate cancer (62.2 to 76.2%) patients (p < 0.001). Increasing age was associated with an increased odds of not being included in a CPP for lung (p < 0.001) and prostate cancer (p < 0.001) patients. Colorectal cancer patients < 50 years of age had a two-fold increase (OR = 2.23, 95% CI: 1.70–2.91) in the odds of not being included in a CPP. The odds of no CPP inclusion were significantly increased for low income colorectal (OR = 1.24, 95%CI: 1.00–1.54) and lung (OR = 1.52, 95%CI: 1.16–1.99) cancer patients. Region of residence was significantly associated with CPP inclusion (p < 0.001) and the probability, adjusted for case-mix ranged from 62.4% in region West among prostate cancer patients to 97.6% in region North among breast cancer patients. Conclusions The national target of 70% was met within 1 year of CPP implementation in Norway. Although all patients should have equal access to CPPs, a prostate cancer diagnosis, older age, high level of comorbidity or low income were significantly associated with an increased odds of not being included in a CPP.

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