scholarly journals Rural-Urban Variation in Time to Diagnosis and Treatment of Colorectal or Breast Cancer in Victoria, Australia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 47s-47s
Author(s):  
R. Bergin ◽  
J. Emery ◽  
R. Bollard ◽  
A. Falborg ◽  
H. Jensen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Health System ◽  
Diagnosis And Treatment ◽  
Cancer Type ◽  
Symptom Screening ◽  
Rural And Urban ◽  
Time To Diagnosis ◽  
Rural Patients ◽  
Diagnostic Intervals

Background: Rural-urban disparities in cancer outcomes are found in many countries, though these vary by cancer type. In Victoria, Australia, survival is poorer for rural patients with colorectal cancer, but not breast cancer. Delayed diagnosis and treatment may contribute to disparities, but previous studies have not compared the timeliness of rural and urban pathways to treatment of these common cancers. Aim: We investigated whether time to diagnosis and treatment differed for rural and urban patients with colorectal or breast cancer in Victoria, Australia. Methods: Population-based, cross-sectional surveys examining events and dates on the pathway to treatment completed by patients aged ≥ 40 and approached within six months of diagnosis, their general practitioner (GP) and specialist. Data were collected from 2013 to 2014 as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were explored: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment) and total intervals (symptom/screening to treatment). Rural-urban differences were examined for each cancer using quantile regression (50th, 75th and 90th percentiles) models including age, gender, health insurance and socioeconomic status. Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 GPs and 370 specialists completed surveys. Compared with urban patients, symptomatic colorectal cancer patients from rural areas had a significantly longer total interval at all percentiles: 50th (18 days longer, 95% confidence interval (CI): 9-27), 75th (53, 95% CI: 47-59) 90th (44, 95% CI: 40-48). These patients also had longer health system intervals, ranging 7-85 days longer. This appeared mostly due to longer diagnostic intervals (range: 6-54 days longer). Results were similar when including screen-detected cases. In contrast, breast cancer intervals were similar for rural and urban patients, except the patient interval, which was shorter for rural patients. Conclusion: Consistent with variation in survival, we found longer total and diagnostic intervals for rural compared with urban patients with colorectal cancer, but not breast cancer. The lack of rural-urban differences observed for breast cancer suggest that inequities in the timeliness of colorectal cancer pathways can be ameliorated, and may improve clinical outcomes. Indeed, based on previous research, delays observed in this study could result in stage progression and hence reduced survival. From our results, interventions targeting the time from presentation to colorectal cancer diagnosis in rural populations should be pursued. Countries seeking to understand cancer disparities in their local context may also consider using a pathways approach to identify possible targets for policy intervention.

scholarly journals Diagnosis and treatment pattern among rural and urban breast cancer patients in Southwest China from 2005 to 2009

Oncotarget ◽  
2016 ◽  
Vol 7 (47) ◽  
pp. 78168-78179 ◽  
Author(s):  
Zuxiang Peng ◽  
Jia Wei ◽  
Xuesong Lu ◽  
Hong Zheng ◽  
Xiaorong Zhong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Southwest China ◽  
Treatment Pattern ◽  
Diagnosis And Treatment ◽  
Breast Cancer Patients ◽  
Rural And Urban

scholarly journals Breast cancer screening in Brazil. Barriers related to the health system

2017 ◽  
Vol 63 (5) ◽  
pp. 466-474 ◽  
Author(s):  
René Aloisio da Costa Vieira ◽  
Alessandro Formenton ◽  
Silvia Regina Bertolini
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Health System ◽  
Breast Cancer Screening ◽  
Diagnosis And Treatment ◽  
Stage At Diagnosis ◽  
The Public ◽  
Effective Order ◽  
Study Results

Summary Objective: Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. Method: We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. Results: The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. Conclusion: There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

scholarly journals Delayed Colorectal Cancer Diagnosis during the COVID-19 Pandemic in Alberta: A Framework for Analyzing Barriers to Diagnosis and Generating Evidence to Support Health System Changes Aimed at Reducing Time to Diagnosis

2021 ◽  
Vol 18 (17) ◽  
pp. 9098
Author(s):  
Emily Walker ◽  
Yunting Fu ◽  
Daniel C. Sadowski ◽  
Douglas Stewart ◽  
Patricia Tang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health System ◽  
Severe Disease ◽  
Adjusted Relative Risk ◽  
System Planning ◽  
Health System Planning ◽  
System Changes ◽  
Diagnostic Pathways ◽  
Diagnostic Intervals ◽  
Alberta Cancer Registry

The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016–4 March 2020) and intra-pandemic (5 March 2020–1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.

scholarly journals Trends in Cancer Prevalence in Punjab, Pakistan: A Systematic Study from 2010 to 2016

2020 ◽  
Vol 7 (2) ◽  
pp. 68-78
Author(s):  
Sana Hafeez ◽  
Asmat Mahmood ◽  
Rizwan Ullah Khan ◽  
Naila Malkani
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Head And Neck ◽  
Cancer Registry ◽  
Local Population ◽  
Linear Increase ◽  
Current Status ◽  
Specific Rate ◽  
Cancer Type ◽  
Registry System

Cancer is the second leading cause of death globally. However, in Pakistan, in the absence of a national cancer registry, it is difficult to predict the current status of cancer incidence. Therefore, a need was felt to design a study that can give a depiction of the prevalence of common cancer types and their relevance to the local population in the absence of a proper cancer registry system. In view of this, data was collected from 2010 to 2016 for breast, prostate, head and neck, cervical and colorectal cancer from the cancer hospitals and centres located all over Punjab, Pakistan. All the data were analysed to calculate prevalence percentage, gender-based incidence rate, crude rate, and Age-specific rate (ASR) for each cancer type. The results showed that breast cancer was the most common type and its prevalence showed a linear increase through the study period (P < 0.001). Breast cancer (6561) was followed by prostate (1183), head and neck (833), cervical (697) and colorectal cancer (531) in terms of prevalence. Gender-specific cancers like breast, prostate, and cervical were found to be more common as compared to others. In the case of head and neck and colorectal cancers, males were more susceptible as compared to females. There is a radical increase in cancer cases in the study area and the same could be extrapolated to the whole country. Therefore, for the appropriate and focused efforts to combat this increasing trend of prevalence, it should be constantly monitored, which leads to the recommendation of an effective cancer registry system in the country.

scholarly journals Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer

2018 ◽  
Vol 27 (9) ◽  
pp. 1036-1046 ◽  
Author(s):  
Rebecca J. Bergin ◽  
Jon Emery ◽  
Ruth C. Bollard ◽  
Alina Zalounina Falborg ◽  
Henry Jensen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnosis And Treatment ◽  
Time To Diagnosis

Influence of health insurance status on breast cancer diagnosis and treatment delay: A safety net hospital's experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6592-6592
Author(s):  
B. K. Vakkalanka ◽  
K. Ruda ◽  
T. O'Brien
Keyword(s):  
Breast Cancer ◽  
Safety Net ◽  
Diagnosis And Treatment ◽  
Insurance Status ◽  
Pathologic Diagnosis ◽  
Abnormal Mammogram ◽  
Breast Cancer Outcome ◽  
Safety Net Hospital ◽  
Time To Diagnosis ◽  
Group A

6592 Background: Given barriers to access, uninsured women with breast cancer might experience delays in diagnosis and treatment when compared to insured women. The influence of insurance status on breast cancer outcome was addressed at a single institution whose mission statement requires that all pts be treated the same, regardless of their ability to pay Methods: Records of all pts with breast cancer seen from 1/00- 12/04 at a safety net hospital were reviewed. Insurance status was defined at the time of the first abnormal mammogram. Cases were divided into Group A (private insurance), B (medicaid or medicare) or C (uninsured). Time to diagnosis (TDx) was defined as the interval from abnormal mammogram to pathologic diagnosis of breast cancer. Time to treatment (TRx) was defined as time from pathologic diagnosis to definitive surgical therapy. Results: 560 cases were reviewed. Group A: 48%, B: 33%, C: 19%. Median age= 57 (GrpA=53, B= 67, C= 55). Race Caucasian 59%; AA 34%; other 7%. Stage (0, I, II, III and IV, in %, respectively): Grp A= 14.6, 42.9, 31.5, 7.1 and 3.9; Grp B= 13.1, 46, 22.7, 12.5 and 5.7; Grp C = 13.9, 33.7, 32.7, 11.9 and 7.9. No significant diff between groups, although there was a trend towards later (III/IV) pts in grps B and C than A (18.2% and 19.8% vs 10.9%, respectively). Mean TDx: Grp A= 50.6 days, B= 68.1d and C=52.8d; p= 0.006 when Group B was compared to the other two groups but there was no difference between uninsured and private groups. Mean TRx: 43.8d, 48.6d and 47.8 days, respectively, for groups A, B and C, without any statistical difference between any of the groups. Conclusions: A 5-year review of breast cancer cases at a large safety net hospital did not reveal any difference in the time to diagnosis or initiation of treatment for insured vs. uninsured pts. Uninsured and medicaid/medicare pts tended to present with later stage disease, perhaps due to access problems. A statistically significant delay in diagnosis was noted in the medicaid/medicare group but it is unlikely that this difference (18 days) was clinically important. Because uninsured pts are provided care at greatly discounted rates at our institution, these results may differ from those at other institutions. Further studies addressing this issue are warranted. No significant financial relationships to disclose.

Model of quality care indicators for patients with colorectal, lung, and breast cancer.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 241-241
Author(s):  
Eduardo Diaz-Rubio
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Quality Care ◽  
Care Quality ◽  
Histological Diagnosis ◽  
Diagnosis And Treatment ◽  
Concomitant Chemoradiotherapy ◽  
Elapsed Time ◽  
Initial Staging

241 Background: The care of an oncology patient is a complex process with important clinical, social and financial repercussions. The purpose of this work is to develop quality care indicators for the medical care of patients with cancer. It is fundamental that health organisations adopt such models based on quality standards with the intention to promote excellence in the care of cancer patients. Methods: Research for scientific evidence, revision and selection of standards using the Delphi method was employed and definition of indicators was established. Results: 50 quality indicators were created directed to: Organisation: Multidisciplinary committees; informed consent; patient security; elapsed time between diagnosis and treatment; tumour registry; treatment protocols. Colorectal cancer: Histopathology report and markers; chemotherapy for advanced/metastatic cancer; evaluation of staging of colorectal cancer; liver metastases; adjuvant chemotherapy; evaluation of history family; biological therapy and RAS gene mutation; radiotherapy; quality of surgical notes. Breast cancer: Histopathology report and markers; initial staging; hormonotherapy; other treatments; elapsed time between histological diagnosis and treatment and between surgery and adjuvant treatment; pre-operative assessment and conservative surgery focused on the armpit; access availability to initial radiological studies.Lung cancer: Histopathology report and markers; initial staging; elapsed time between histological diagnosis and treatment; concomitant chemoradiotherapy; evaluation of chemotherapy response; adjuvant chemotherapy; elapsed time till the completion of staging; surgery; chemotherapy with good functional status; adjuvant radiotherapy; concomitant chemoradiotherapy for small cell lung cancer. End of life: Organisation of palliative care; outpatient attention; identify patients; access to care; pain management; information availability; psycosociological support; constipation management; counselling of family after death. Conclusions: The indicators constitute a reference model based on standards in order to measure care quality and to compare achieved results among health institutions.

Differences in rural versus urban cancer patients’ perception of care coordination.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 114-114
Author(s):  
Izumi Okado ◽  
Michelle Hashimoto ◽  
Randall F. Holcombe
Keyword(s):  
Cancer Patients ◽  
Care Coordination ◽  
Rural Areas ◽  
Cancer Care ◽  
Care Delivery ◽  
Self Report ◽  
Cancer Type ◽  
Rural And Urban ◽  
Perception Of Care ◽  
Rural Patients

114 Background: Although advances in anticancer treatment have improved survival of patients with cancer overall, cancer mortality rates remain disproportionately high in rural areas. Disparities in rural cancer health outcomes are partially attributed to challenges with care coordination in rural areas. However, little is known about rural-urban differences in patients’ perception of cancer care coordination. In this exploratory study, we compared rural and urban cancer patients’ perception of care coordination (CC) using a Care Coordination Instrument (CCI), a validated self-report measure. Methods: We conducted a secondary analysis of cross-sectional survey data from two community-based cancer care delivery studies from 2018 and 2019 focused on cancer patients’ perception of CC. Patients receiving active therapy for any cancer completed a 29-item CCI. The CCI assesses overall perceptions of CC (Total) and across 3 domains: Communication, Navigation, and Operational. The rural patient cohort was derived from the American Cancer Society Hope Lodge Hawaii, which provides lodging for patients from neighbor islands (rural) receiving cancer care on Oahu (urban). The urban comparison group included patients residing on Oahu. Multivariate regression analyses were conducted to compare rural and urban patients’ perception of CC with adjustment for age, gender, and cancer type. Results: Data from 243 patients were analyzed; 23 (9.5%) were rural and 220 (90.5%) were urban. The rural and urban groups were similar with respect to patient demographics (age, gender) and clinical status. Rural patients reported significantly lower overall mean CCI scores than urban patients (54.7 vs 61.6; p = .02). Rural-urban differences in patients’ perception of CC were found for Communication (29.5 vs 35.1; p = .004) and Operational (19.7 vs 22.0; p = .02) domains. There were no rural-urban differences for Navigation. Conclusions: Our results demonstrate that rural patients had significantly poorer perception of care coordination overall than urban patients. Specifically, the observed rural vs urban differences in patients’ perception of care coordination were related to communication and operational challenges. Required coordination with a patient navigator to facilitate access to Hope Lodge may have confounded analysis in the Navigation domain. These findings highlight the need for interventions to address communication and operational CC challenges for rural patients in order to improve the quality of cancer care and reduce health disparities for rural cancer patients.

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