scholarly journals CPP or Not, That Is the Question: Physicians’ Work With Activating CPPs

2021 ◽  
pp. 104973232110207
Author(s):  
Siri Christine K. Næss
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Secondary Care ◽  
Institutional Ethnography ◽  
Qualitative Interviews ◽  
Diagnostic Investigation ◽  
Clear Cut ◽  
Patient Pathways ◽  
Starting Point ◽  
Potential Cancer

The Norwegian government has launched a policy titled cancer patient pathways (CPPs), which assigns maximum deadlines to the various phases of the diagnostic investigation. In this article, I examine the starting point of CPPs through the lens of institutional ethnography—that is, how physicians work with the referral of patients in the context of CPPs. Based on qualitative interviews with physicians in both primary and secondary care across Norway ( N = 37), the findings reveal that the distinction between CPP or not is by no means clear-cut for either primary or specialist physicians. The starting point of CPPs is mediated by the interaction between physicians and patients and how the referral is composed, as well as how and by whom the referral is interpreted, in conjunction with overarching discourses, policies, and guidelines for practice. The findings challenge the notion that all potential cancer patients can and should be equally prioritized.

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.

scholarly journals Equitable access to cancer patient pathways in Norway – a national registry-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frank Olsen ◽  
Bjarne K. Jacobsen ◽  
Ivar Heuch ◽  
Kjell M. Tveit ◽  
Lise Balteskard
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
National Registry ◽  
Diagnostic Process ◽  
Equitable Access ◽  
Place Of Residence ◽  
Income Groups ◽  
Patient Pathways ◽  
Hospital Referral ◽  
Risk Of Cancer

Abstract Background In 2015, cancer patient pathways (CPP) were implemented in Norway to reduce unnecessary non-medical delay in the diagnostic process and start of treatment. The main aim of this study was to investigate the equality in access to CPPs for patients with either lung, colorectal, breast or prostate cancer in Norway. Methods National population-based data on individual level from 2015 to 2017 were used to study two proportions; i) patients in CPPs without the cancer diagnosis, and ii) cancer patients included in CPPs. Logistic regression was applied to examine the associations between these proportions and place of residence (hospital referral area), age, education, income, comorbidity and travel time to hospital. Results Age and place of residence were the two most important factors for describing the variation in proportions. For the CPP patients, inconsistent differences were found for income and education, while for the cancer patients the probability of being included in a CPP increased with income. Conclusions The age effect can be related to both the increasing risk of cancer and increasing number of GP and hospital contacts with age. The non-systematic results for CPP patients according to income and education can be interpreted as equitable access, as opposed to the systematic differences found among cancer patients in different income groups. The inequalities between income groups among cancer patients and the inequalities based on the patients’ place of residence, for both CPP and cancer patients, are unwarranted and need to be addressed.

Cancer patients’ experiences with urgent referrals to cancer patient pathways

2018 ◽  
Vol 28 (1) ◽  
pp. e12927 ◽  
Author(s):  
Mette Sandager ◽  
Henry Jensen ◽  
Henriette Lipczak ◽  
Cecilie Dyg Sperling ◽  
Peter Vedsted
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Patient Pathways

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 Diagnostic intervals before and after implementation of cancer patient pathways – a GP survey and registry based comparison of three cohorts of cancer patients

BMC Cancer ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Henry Jensen ◽  
Marie Louise Tørring ◽  
Frede Olesen ◽  
Jens Overgaard ◽  
Morten Fenger-Grøn ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Patient Pathways ◽  
Before And After ◽  
Diagnostic Intervals

PSYCHOLOGICAL REHABILITATION AND SCREENING OF EMOTIONAL STRESS IN CANCER PATIENTS

2017 ◽  
Vol 63 (2) ◽  
pp. 316-319 ◽  
Author(s):  
Valentina Chulkova ◽  
Tatyana Semiglazova ◽  
Margarita Vagaytseva ◽  
Andrey Karitskiy ◽  
Yevgeniy Demin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Emotional Stress ◽  
Self Esteem ◽  
Breast Cancer Patients ◽  
Psychological Study ◽  
Psychological Assistance

Psychological rehabilitation is an integral part of rehabilitation of a cancer patient. Psychological rehabilitation is aimed at a patient adaptation in the situation of the disease and improvement his quality of life. Understanding of an oncological disease is extreme and (or) crisis situation and monitoring dynamics of the psychological statement of a patient allows using differentiated approach in the provision of professional psychological assistance. The modified scale of self-esteem level of distress (IPOS) was used for screening of mental and emotional stress of cancer patients. There were selected groups of cancer patients who were most in need of professional psychological assistance. Results of a psychological study of one of these groups - breast cancer patients - are presented.

scholarly journals Interhospital referral of colorectal cancer patients: a Dutch population-based study

2021 ◽  
Author(s):  
A. K. Warps ◽  
◽  
M. P. M. de Neree tot Babberich ◽  
E. Dekker ◽  
M. W. J. M. Wouters ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Waiting Time ◽  
Secondary Care ◽  
Advanced Disease ◽  
Waiting Times ◽  
Tertiary Care ◽  
Disease Stage ◽  
Colorectal Cancer Patients ◽  
Tertiary Care Hospitals

Abstract Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

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