The success of the Rapid Diagnostic Clinic (RDC) detecting new cancers in patients with non-localizing symptoms.

303 Background: Rapid Diagnostic Clinics (RDC) are being set up across the UK allow primary care physicians to refer patients with symptoms concerning for cancer that do not fulfil tumour-specific two week wait urgent referral criteria. Guy’s RDC was established to address the high cancer related mortality in our network. There is little data assessing the effectiveness of RDC models is available in a British population. Methods: We evaluated all patients referred to Guy’s RDC pilot scheme between December 2016-June 2019 (n=1,341) to assess the rate and type of cancer diagnosed and clinical outcomes. Results: Of 1341 patients, 96 cancers were diagnoses (7.2%). Most common were lung (16%), haematological (13%) and colorectal (12%). A third were at early stage (I-II) and 40% received radical treatment. Median time to cancer diagnosis 28 days (IQR 15-47) and treatment 56 days (IQR 32-84). 75% of patients were suitable for anti-cancer treatment: surgery (26%), systemic (24%) and radiotherapy (14%). We plan to present updated data on > 2000 patients referred until June 2020. Overall 6% of patients were diagnosed with pre-malignant conditions. Conclusions: RDCs provide a streamlined pathway for complex vague symptoms patients which are challenging for primary care. The 7% rate of cancer diagnosis exceeds many tumour specific urgent pathways which supports the need for rapid tailored diagnostics. The detection of pre-malignant conditions in 6% allows surveillance and intervention to potentially improve long-term outcomes. RDCs are likely to be pivotal in the cancer recovery phase of the COVID-19 pandemic.

Download Full-text

Primary care physicians’ educational needs and learning preferences in end of life care: A focus group study in the UK

BMC Palliative Care ◽

10.1186/s12904-017-0191-2 ◽

2017 ◽

Vol 16 (1) ◽

Cited By ~ 15

Author(s):

Lucy Ellen Selman ◽

Lisa Jane Brighton ◽

Vicky Robinson ◽

Rob George ◽

Shaheen A. Khan ◽

...

Keyword(s):

Primary Care ◽

Focus Group ◽

End Of Life ◽

End Of Life Care ◽

Primary Care Physicians ◽

Educational Needs ◽

Learning Preferences ◽

Life Care ◽

Focus Group Study ◽

The Uk

Download Full-text

Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study

BMC Geriatrics ◽

10.1186/s12877-021-02457-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Abe ◽

S. Tsunawaki ◽

M. Dejonckheere ◽

C. T. Cigolle ◽

K. Phillips ◽

...

Keyword(s):

Primary Care ◽

Early Intervention ◽

Advance Directives ◽

Primary Care Physicians ◽

Long Term Care ◽

Term Care ◽

Care Services ◽

The Us ◽

Diagnosis Of Dementia

Abstract Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.

Download Full-text

Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

Clinical & Investigative Medicine ◽

10.25011/cim.v43i2.33566 ◽

2020 ◽

Vol 43 (2) ◽

pp. E14-23

Author(s):

Sophie Marcoux, MD, PhD Marcoux ◽

Caroline Laverdière

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Primary Care Physicians ◽

Adult Survivors ◽

Likert Scale ◽

Care Transition ◽

Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

Download Full-text

Significant decline in cancer diagnostic testing in U.S. CMS population during the COVID-19 pandemic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6536 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6536-6536

Author(s):

Dave Smart ◽

Peter Riccelli ◽

Keith Kerr ◽

Jordan Clark ◽

Susanne Munksted Fosvig ◽

...

Keyword(s):

Primary Care ◽

Cancer Diagnosis ◽

Primary Care Physicians ◽

Diagnostic Testing ◽

Delayed Diagnosis ◽

Cancer Control ◽

Unintended Consequences ◽

Initial Diagnosis ◽

Test Volume ◽

The Us

6536 Background: The COVID-19 pandemic has caused >400,000 infection related deaths in the US to January 2021. Actions taken to limit COVID-19 infection and mortality could potentially lead to unintended consequences, precipitating excess mortality due to other causes. One such cause is delayed cancer diagnosis. Significant decreases in presentation for cancer diagnosis at the primary care level have been noted in the UK. This study aimed to look for evidence of a similar effect in the US. Methods: CMS claims data from JAN18-JUN20 associated with primary diagnosis across 11 cancers (bladder, breast, cervical, colorectal, endometrial, lung, ovarian, pancreatic, prostate, sarcoma and thyroid) were analyzed for use of surgical pathology (SP), a procedure associated with initial diagnosis, and immunohistochemistry (IHC). Test volumes varied widely by test and cancer so were normalized to enable comparison across indications. This was done by dividing the month-on-month difference for the period JAN19-JUN19 vs JAN20-JUN20 by the median monthly test volume for the period JAN18-DEC19 (“pre-COVID period”). Extent and duration of declines in test rates and number of missing patients as the sum of these declines were then determined. The ratio of IHC to SP testing was taken to determine any decline in likely post-initial diagnosis testing. Results: There were significant (>10%) declines in test volumes for SP for all 11 cancers at some time in Q1-Q2 2020. Table. Extent, duration and return to pre-COVID levels for SP testing across 11 cancers Median extent and duration of the decline was 56% (range 41.1%-80.4%) and 2 months (range 1- >4). This equates to 32,192 missing diagnoses across all cancers. SP test volumes for all cancers except lung and breast had returned to around pre-COVID levels by JUN20. There was no significant (>10%) increase in normalized SP test volume after the COVID dip for any cancer. While SP showed decreased test volumes across all cancers at some point during the first half of 2020, test volume ratios of IHC to SP showed increases for most cancers in the same time period. Conclusions: These data highlight that the decline in patients presenting to their primary care physicians with suspicion of cancer for diagnostic investigation was linked to COVID-19 prevention strategies. No evidence for increased, “catch up” testing to address presentational/diagnostic backlog was observed. Thus, it is predicted that these patients may subsequently present with a more advanced cancer. Potential excess morbidity, mortality and cost associated with absent or delayed diagnosis should be factored into cancer control programs going forward.[Table: see text]

Download Full-text

The context of healthcare

Oxford Handbook of Primary Care and Community Nursing ◽

10.1093/med/9780198831822.003.0001 ◽

2020 ◽

pp. 1-34

Keyword(s):

Public Health ◽

Primary Care ◽

Northern Ireland ◽

Healthcare Services ◽

Health Profile ◽

Long Term Conditions ◽

Key Concepts ◽

The Uk

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

Download Full-text

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

BMJ Open ◽

10.1136/bmjopen-2019-033008 ◽

2020 ◽

Vol 10 (1) ◽

pp. e033008 ◽

Cited By ~ 3

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.

Download Full-text

The pathway to diagnosis and treatment for surgically managed lung cancer patients

Family Practice ◽

10.1093/fampra/cmz064 ◽

2019 ◽

Author(s):

Victoria White ◽

Rebecca J Bergin ◽

Robert J Thomas ◽

Kathryn Whitfield ◽

David Weller

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Cancer Patients ◽

Secondary Care ◽

Primary Care Physicians ◽

Treatment Time ◽

Early Stage ◽

Diagnosis And Treatment ◽

Early Stage Disease ◽

Lung Cancer Patients

Abstract Background Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis. Methods Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or ‘investigation’ of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age. Results One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than ‘investigation’ patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant. Conclusion Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.

Download Full-text

A Review of COVID-19 and the Implications for Orthodontic Provision in England

Orthodontic Update ◽

10.12968/ortu.2020.13.3.117 ◽

2020 ◽

Vol 13 (3) ◽

pp. 117-124

Author(s):

Sally Zahran ◽

Natasha Wright

Keyword(s):

Infection Control ◽

Recovery Phase ◽

High Risk Group ◽

Dental Procedures ◽

Close Proximity ◽

Control Procedures ◽

Dental Profession ◽

The Uk ◽

Guidelines And Recommendations

COVID-19 is an unprecedented virus that is destroying the lives of many people worldwide. Dentistry as a profession falls into a high-risk group due to our close proximity to patients and the aerosols generated in routine dental procedures. The UK dental community has frantically searched for answers to questions about the new virus and guidance on provision of dental care. This article will review the most up-to-date recommendations for infection control procedures and use of personal protective equipment (PPE) in England. PubMed, Embase and Google Scholar databases were searched up until 9 June. This is a review of the current information, guidelines and recommendations about the COVID-19 virus and use of PPE for dentists and orthodontists. As of 9 June, the dental profession has received mixed guidance on how best to manage our patients whilst national lockdown is eased and we enter a recovery phase, but uncertainty remains for the long-term provision of Orthodontics. CPD/Clinical Relevance: This article gives an overview of guidance and recommendations for dentists and orthodontists in the UK during the COVID-19 pandemic, especially with regards to infection control and use of PPE.

Download Full-text