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 Patient–physician relationship and use of gut feeling in cancer diagnosis in primary care: a cross-sectional survey of patients and their general practitioners

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027288 ◽  
Author(s):  
Anette Fischer Pedersen ◽  
Christina Maar Andersen ◽  
Mads Lind Ingeman ◽  
Peter Vedsted
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Secondary Outcome ◽  
Diagnostic Process ◽  
Patient Encounter ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physician Relationship ◽  
High Degree

ObjectivesTo examine whether the quality of the patient–physician relationship, assessed by the general practitioner (GP) and the patient, associates with GPs’ use of gut feeling (GF) in cancer diagnosis.DesignCross-sectional questionnaire survey of cancer patients and their GPs.SettingDanish primary care.ParticipantsNewly diagnosed cancer patients and their GPs. Patients completed a questionnaire and provided the name of the GP to whom they have presented their symptoms. The named GP subsequently received a questionnaire.Primary and secondary outcome measuresGPs’ use of GF in the diagnostic process for the particular patient. GPs who answered that they used their GF ‘to a high degree’ or ‘to a very high degree’ were categorised as ‘used their GF to a great extent’. GPs who answered that they used their GF ‘to some degree’, ‘to a limited degree’ or ‘not at all’ were categorised as ‘limited or no use of GF’.ResultsGPs were less likely to use GF when they assessed relational aspects of the patient encounter as difficult compared with less difficult (OR=0.67; 95% CI 0.46 to 0.97). The physician-reported level of empathy was positively associated with use of GF (OR=2.60; 95% CI 1.60 to 4.22). The lower use of GF in difficult encounters was not modified by level of empathy.ConclusionsExperiencing relational aspects of patient encounter as difficult acted as a barrier for the use of GF in cancer diagnosis. Although physician-rated empathy increased use of GF, high empathy did not dissolve the low use of GF in difficult encounters. As diagnosis of cancer is a key challenge in primary care, it is important that GPs are aware that the sensitivity of cancer-related GF is compromised by a difficult patient–physician relationship.

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

scholarly journals Cross-sectional study using primary care and cancer registration data to investigate patients with cancer presenting with non-specific symptoms

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033008 ◽  
Author(s):  
Clare Pearson ◽  
Veronique Poirier ◽  
Karen Fitzgerald ◽  
Greg Rubin ◽  
Willie Hamilton
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Cross Sectional Study ◽  
Cancer Registration ◽  
Sectional Study ◽  
Cross Sectional ◽  
Site Specific ◽  
Registration Data ◽  
Referral Criteria ◽  
Specific Symptoms

IntroductionPatients presenting to primary care with site-specific alarm symptoms can be referred onto urgent suspected cancer pathways, whereas those with non-specific symptoms currently have no dedicated referral routes leading to delays in cancer diagnosis and poorer outcomes. Pilot Multidisciplinary Diagnostic Centres (MDCs) provide a referral route for such patients in England.ObjectivesThis work aimed to use linked primary care and cancer registration data to describe diagnostic pathways for patients similar to those being referred into MDCs and compare them to patients presenting with more specific symptoms.MethodsThis cross-sectional study linked primary care data from the National Cancer Diagnosis Audit (NCDA) to national cancer registration and Route to Diagnosis records. Patient symptoms recorded in the NCDA were used to allocate patients to one of two groups - those presenting with symptoms mirroring referral criteria of MDCs (non-specific but concerning symptoms (NSCS)) and those with at least one site-specific alarm symptom (non-NSCS). Descriptive analyses compared the two groups and regression analysis by group investigated associations with long primary care intervals (PCIs).ResultsPatients with NSCS were more likely to be diagnosed at later stage (32% stage 4, compared with 21% in non-NSCS) and via an emergency presentation (34% vs 16%). These patients also had more multiple pre-referral general practitioner consultations (59% vs 43%) and primary care-led diagnostics (blood tests: 57% vs 35%). Patients with NSCS had higher odds of having longer PCIs (adjusted OR: 1.24 (1.11 to 1.36)). Patients with lung and urological cancers also had higher odds of longer PCIs overall and in both groups.ConclusionsDifferences in the diagnostic pathway show that patients with symptoms mirroring the MDC referral criteria could benefit from a new referral pathway.

scholarly journals Cancer Patient Perspectives on Sharing of Medical Records and Mobile Device Data for Research Purposes

2020 ◽  
Vol 7 (6) ◽  
pp. 1115-1121
Author(s):  
Elizabeth F Franklin ◽  
Helen M Nichols ◽  
Linda House ◽  
Joanne Buzaglo ◽  
Kim Thiboldeaux
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Medical Records ◽  
Health Care Services ◽  
Survey Methodology ◽  
Cross Sectional Study ◽  
Patient Perspectives ◽  
Cross Sectional ◽  
Care Services ◽  
Application Data

Sharing data is critical to advancing science, improving health, and creating advances in the delivery of health care services. The value of sharing data for cancer research purposes is well established, and there are multiple initiatives under way that address this need. However, there has been less focus on cancer patient perspectives regarding the sharing of their health information for research purposes. This study examined cancer patient perspectives on the sharing of de-identified health data for research purposes including both data from medical records and mobile applications. This cross-sectional study used survey methodology to collect data from cancer patients/survivors (N = 677). Overall, we found that participants were largely willing (71%) to share de-identified medical data and were most motivated (88%) by a desire to help other cancer patients. Patients were less likely to be comfortable sharing mobile application data (34%). It is vital that we understand patient perspectives on data sharing and work with them as partners, valuing their unique contributions, and attending to their preferences.

The Importance of Family History in Breast Cancer Patients in Primary Care Setting: a Cross-sectional Study

2017 ◽  
Vol 33 (3) ◽  
pp. 602-609
Author(s):  
Mehtap Kartal ◽  
Nilgun Ozcakar ◽  
Sehnaz Hatipoglu ◽  
Makbule Neslisah Tan ◽  
Azize Dilek Guldal
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Family History ◽  
Cancer Patients ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cross Sectional Study ◽  
Breast Cancer Patients ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Awareness of Diagnosis and Decision-Making Preferences of Greek Cancer Patients

2020 ◽  
pp. 5-12
Author(s):  
Despoina G Alamanou ◽  
Konstantinos Giakoumidakis ◽  
Dimosthenis G Theodosiadis ◽  
Nikolaos V Fotos ◽  
Elissavet Patiraki ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Active Role ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical Encounter ◽  
The Mean ◽  
The Impact ◽  
The City

Objective: In Greece, the old phenomenon of hiding cancer diagnosis and depriving cancer patients of their right to participate in decisionmaking remains a reality. The aim of this study was to assess the decision-making preferences of Greek cancer patients and their awareness of diagnosis. Methods: It was a cross-sectional study. The sample consisted of 229 adult Greek patients diagnosed with cancer, attending the oncology outpatient department (outpatients) or being hospitalized (inpatients), in one general hospital in Athens. Patients who were aware of cancer diagnosis (n=209) were administered at the Control Preference Scale (CPS), a tool, designed to elicit decision-making preferences. The IBM SPSS program, version 21.0 was used for statistical analysis. Results: One hundred and one patients (52.8%) were males. The mean [±standard deviation (SD)] age was 64.8 (±11.2) years. The vast majority of patients knew they suffered from cancer (n=209, 91.3%). Older patients (p=0.003), those who lived in suburbs of the city (p=0.01), those who had lower educational level (p=0.001), those with lower personal income (p=0.001) and shorter disease duration (p=0.001) stated that were unaware of cancer diagnosis. Seventy five (36.2%) patients chose the shared-decision role in decision-making procedures. Lower age (OR 1.04, 95%, CI: 1.00-1.08, p= 0.05) and higher education level (OR 2, 63, 95%, CI: 1.11-6.29, p=0.03) were significantly associated with the preference of patients to actively participate in decision-making regarding treatment. Conclusions: Although Greek cancer patients are aware of cancer diagnosis and treatment, nowadays, they still seem to hesitate in playing a more active role in the decision-making procedures, which portrays the impact of the dominating paternalistic model of doctor-patient relationship in the Greek medical encounter

scholarly journals Breaking bad news of cancer diagnosis – Perception of the cancer patients in a rural community in Malaysia

2014 ◽  
Vol 03 (02) ◽  
pp. 116-121 ◽  
Author(s):  
Mathew Gabriel Bain ◽  
Cheah Whye Lian ◽  
Chang Ching Thon
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Current Method ◽  
Bad News ◽  
Breaking Bad News ◽  
Language Management ◽  
Cross Sectional ◽  
Breaking Bad ◽  
Information Giving ◽  
Significant Difference

Abstract Context: Breaking of bad news is an important component in the management of cancer patients. Aims: This study aimed to assess the perceptions of breaking bad news of cancer diagnosis. Settings and Design: It was a cross-sectional study using Breaking Bad News Assessment Schedule (BAS) questionnaire on cancer patients in Serian district. Materials and Methods: Using snowballing sampling method, a total of 134 patients were interviewed face-to-face after the consent was obtained from each of the respondents. Statistical Analysis Used: Data was entered and analyzed using SPSS version 19.0. Results: Majority were comfortable with the current method of breaking bad news. The main aspects found to be the areas of concern were the importance of the usage of body language, management of time and identifying patients′ key area of concerns. There were significant difference between sex and "information giving" (P = 0.028) and "general consideration" (P = 0.016) and also between "the age and setting the scene" (P = 0.042). Significant difference was also found between the types of cancer and "the setting of scene" (P = 0.018), "breaking bad news technique" (P = 0.010), "eliciting concerns" (P = 0.003) and "information giving" (P = 0.004). Conclusion: Good and effective communication skill of breaking bad news is vital in the management of cancer patients. As the incidence of new cases of cancer increase every year, breaking of bad news has become a pertinent to the medical professionals′ role. Specific aspects of communication skills based on local characteristics should be more emphasized in the formulation of training for doctors.

Survival in Adult Italian Cancer Patients, 1978–1989

1997 ◽  
Vol 83 (1) ◽  
pp. 39-425 ◽  
Author(s):  
Arduino Verdecchia ◽  
Arduino Verdecchia ◽  
Riccardo Capocaccia ◽  
Roberta De Angelis ◽  
Fulvia Valente ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Patient Survival ◽  
National Level ◽  
International Comparisons ◽  
Relative Survival ◽  
Cancer Registries ◽  
Population Based ◽  
Cancer Site ◽  
Malignant Neoplasms

Aims To present a systematic analysis of population-based cancer patient survival in Italy. Methods Population-based survival data have been made available from 10 Italian cancer registries within the ITACARE project. Data, collected and validated using a common protocol, included over 100,000 patients with cancer diagnosed between 1978 and 1989. Multivariate weighted analysis was used to provide relative survival estimates attributable to Italy at national level. Results Results are presented, according to a systematic frame, as the main object of the ITACARE study, involving crude and relative survival figures for adult Italian cancer patients, by age, sex, period of diagnosis and registry area. An estimate with reference to Italy as a whole is also presented by cancer site and for all malignant neoplasms combined. Age-standardized relative survival figures are presented to allow comparisons between Italian registries and also to give a basis for international comparisons with countries involved in the EUROCARE study. Conclusions For the fist time, population-based survival of cancer patients is made available in Italy on a large scale analysis of data from all the Italian cancer registries in a combined action. Estimates of cancer patient survival at a national level in Italy allow proper international comparisons with European countries and give elements of evaluation and discussion on the performance of the Italian health care system.

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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