scholarly journals Timeliness of Presentation and Referral Among Cancer Patients Who Presented With Abdominal Symptoms: Evidence to Inform Symptom Awareness Campaigns

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 35s-35s
Author(s):  
M.M. Koo ◽  
C. von Wagner ◽  
G.A. Abel ◽  
S. McPhail ◽  
W. Hamilton ◽  
...  
Keyword(s):  
Primary Care ◽  
Abdominal Pain ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Symptom Onset ◽  
Abdominal Symptom ◽  
Awareness Campaigns ◽  
Abdominal Symptoms ◽  
Raising Awareness ◽  
Symptom Awareness

Background: Abdominal symptoms at presentation are common among patients subsequently diagnosed with cancer. While public health education campaigns in England and other countries have traditionally focused on 'red flag' symptoms associated with a single common cancer (e.g., 'blood in poo' and colorectal cancer), there is increasing interest in raising awareness of symptoms grouped by body area or system (eg 'abdominal symptoms'). Evidence regarding the frequency and nature of abdominal symptoms at presentation among a representative cancer patient cohort could inform the design and evaluation of community based cancer symptom awareness campaigns. Aim: To describe the frequency of abdominal symptoms at presentation among an incident cohort of cancer patients, examine variation in diagnostic timeliness and subsequently diagnosed cancer sites by abdominal symptom. Methods: The presenting symptom(s) of 15,956 cancer patients from a national audit of primary care records in England was coded into symptom categories. Eight abdominal symptoms with a range of predictive values and specificity for cancer were studied: abdominal pain, change in bowel habit, bloating/distension, dyspepsia, rectal bleeding, dysphagia, reflux, and nausea/vomiting. We investigated the prevalence of abdominal symptoms among the cancer patient population, examined variation in the length of the patient interval (time from symptom onset to presentation to primary care) and primary care interval (time from presentation to specialist referral) by symptom, and described the associated spectrum of diagnosed cancer sites for each individual symptom. Results: Almost a quarter (23%) of the incident cancer patient population had abdominal symptom(s) at presentation (n=3,661/15,956). The relative lengths of the patient and primary care intervals varied greatly by abdominal symptom. One in two cancer patients who had dysphagia before diagnosis presented 30 days after symptom onset (median (IQR) patient interval: 30 (10-61) days), but were referred immediately (median (IQR) primary care interval: 0 (0-14) days). In comparison, cancer patients who presented with abdominal pain had longer intervals postpresentation (median (IQR) patient interval: 7 (0-28) days, median (IQR) primary care interval: 16 (2-43) days). The majority (88.6%) of cancer patients who presented with an abdominal symptom were diagnosed with an abdominal or adjacent cancer, including colorectal, esophageal, ovarian, and pancreatic cancers. However, the remainder of patients were diagnosed with solid tumors of nonabdominal organ origin (7.6%) or a hematologic cancer (3.8%). Conclusion: Cancer symptom awareness campaigns focusing on abdominal symptoms could contribute to the earlier diagnosis of numerous common and rarer cancers. Evidence regarding the relative lengths of the patient and primary care intervals could be used as a measure of relative need for raising awareness.

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.

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 Strengthening the Evidence Base of Cancer Symptom Awareness Campaigns: A Conceptual Framework

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 36s-36s
Author(s):  
M.M. Koo ◽  
G.P. Rubin ◽  
G. Lyratzopoulos
Keyword(s):  
Early Diagnosis ◽  
Early Stage ◽  
Logic Model ◽  
Cancer Site ◽  
Theoretical Understanding ◽  
Cancer Symptoms ◽  
Awareness Campaigns ◽  
Raising Awareness ◽  
Symptom Awareness ◽  
Diagnosis Of Cancer

Background: Cancer control strategies in different countries increasingly encompass public health education campaigns that aim to promote earlier presentation and diagnosis of cancer by raising awareness of possible cancer symptoms. However, the theoretical understanding that underpins these complex early diagnosis interventions remains underdeveloped. Aim: To propose a theoretical framework to guide the design, implementation, and evaluation of cancer symptom awareness campaigns and motivate further relevant research. Methods: Informed by Wilson and Junger's principles of early disease detection for screening (1968) and existing conceptual frameworks for early diagnosis of cancer, we considered the logic model underlying cancer symptom awareness campaigns and relevant emerging evidence from disciplines including health psychology, cancer epidemiology, and health services research. Real-world examples across high-/low-income settings were used where possible to illustrate discussions of implications for practice. Results: We identified four major factors that contribute to the logic model of cancer symptom awareness campaigns beyond contextual and practical factors. Disease burden statistics (cancer site-specific incidence, survival, mortality) could be used to gauge relative need for raising awareness. This should be triangulated with symptom epidemiology (including existing levels of awareness, symptom prevalence, the associated predictive value for cancer, symptom-specific diagnostic timeliness, and whether the symptom is a sign of early stage disease) to motivate selection of individual symptoms in a campaign. Psychosocial factors (such as cancer fatalism or fear and health literacy) and their interaction with symptom awareness should also be considered as they affect symptom appraisal. Further, an understanding and awareness of system factors (availability and access to healthcare, investigation processes, and clinical capacity) will be important for assessing campaign feasibility and knock-on effects in the health system. Based on the above, campaigns should ideally target symptoms that are strongly predictive of early stage (treatable) cancer for which there is low awareness in the target population, and are associated with long intervals to help-seeking. Campaign impact should be amplified by targeting psychosocial barriers to prompt presentation. Additionally, campaigns should be accompanied by downstream capacity planning for potential cancer investigation and subsequent treatment. Conclusion: The proposed framework considers the logic model of cancer symptom awareness campaigns, acknowledging key factors that should be taken into account beyond contextual factors. This could help identify evidential gaps in early diagnosis research, and improve campaign design and evaluation.

scholarly journals A237 IMPROVEMENT IN ABDOMINAL SYMPTOMS WITH LINACLOTIDE IN PATIENTS WITH IRRITABLE BOWEL SYNDROME WITH CONSTIPATION: RESULTS FROM A PHASE 3B TRIAL

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 287-288
Author(s):  
S Sidani ◽  
K Boutros ◽  
G S Sayuk ◽  
H Gonzalez ◽  
D M Brenner
Keyword(s):  
Irritable Bowel Syndrome ◽  
Abdominal Pain ◽  
Primary Endpoint ◽  
Repeated Measures ◽  
Mixed Model ◽  
Abdominal Symptom ◽  
Double Blind ◽  
Abdominal Bloating ◽  
Abdominal Symptoms ◽  
Irritable Bowel

Abstract Background Linaclotide (LIN) is a guanylate cyclase-C agonist approved to treat irritable bowel syndrome with constipation (IBS-C) in adults. Abdominal symptoms are important to patients with IBS-C. In a recent Phase 3b study, LIN significantly improved a composite score of abdominal bloating, pain, and discomfort (Abdominal Score), which was used as the primary endpoint in the study. Aims To evaluate the efficacy of LIN for improving additional efficacy abdominal symptom endpoints in a randomized, double-blind, placebo (PBO)-controlled Phase 3 study of LIN in patients with IBS-C. Methods Adults with IBS-C were randomized to PBO (N=308) or LIN 290 μg (N=306) once daily for 12 weeks. Patients recorded their daily abdominal symptoms, including the individual items of bloating, pain, and discomfort, using an 11-point scale (0–10; 0=none, 10=worst possible). The primary endpoint was the Abdominal Score. Additional efficacy endpoints included 6/12-week abdominal pain and constipation (APC)+1 responder, 6/12-week abdominal bloating responder, 6/12-week abdominal pain responder, and 6/12-week abdominal discomfort responder. For individual symptoms, a responder was a patient who had an improvement from baseline of ≥2 points in the respective endpoint for ≥6 of the 12 weeks. Changes from baseline (CFB) over 12 weeks in abdominal bloating, pain, and discomfort were evaluated using a mixed model with repeated measures framework. Proportions of responders were compared between groups for each responder endpoint using a Cochran-Mantel-Haenszel test. Results 614 patients (mean age, 46.7 years; 81% female; similar baseline abdominal symptoms) were randomized. LIN-treated patients had greater least-squares mean (LSM) CFB in abdominal bloating (LSM difference [95% CI]: –0.889 [–1.249, –0.530], p&lt;0.001), pain (–0.881 [–1.238, –0.524], p&lt;0.001), and discomfort (–0.837 [–1.196, –0.478], p&lt;0.001) compared to PBO-treated patients. There was a greater proportion of LIN-treated vs. PBO-treated patients who were 6/12-week APC+1 (29% vs. 17%; p=0.0003), bloating (40% vs. 24%; p&lt;0.001), pain (42% vs. 25%; p&lt;0.001), and discomfort (42% vs. 26%; p&lt;0.001) responders (Figure). Diarrhea was the most common treatment-emergent adverse event (LIN: 4.6%; PBO: 1.6%). Conclusions LIN significantly improved multiple abdominal symptom and secondary responder endpoints in patients with IBS-C. These results support the effectiveness of LIN for improving a spectrum of abdominal symptoms in IBS-C. Funding Agencies This study was sponsored by Allergan plc, Dublin, Ireland (prior to acquisition by AbbVie Inc.). Writing and editorial assistance were provided to the authors by Brittany Y. Jarrett, PhD, Jane Beck, MA, and Rebecca Fletcher, BA(Hons) of Complete HealthVizion, Inc., Chicago, IL, USA and funded by Allergan plc (prior to acquisition by AbbVie Inc.).

scholarly journals Palpitations in the Cancer Patient

2021 ◽  
Vol 16 ◽  
Author(s):  
Hani Essa ◽  
Gregory YH Lip
Keyword(s):  
Primary Care ◽  
Cardiovascular Diseases ◽  
General Population ◽  
Cancer Patient ◽  
Cancer Patients ◽  
Causes Of Death ◽  
Evidence Based ◽  
Evidence Based Guidelines ◽  
Development And Management ◽  
Growing Population

Cancer and cardiovascular diseases (CVD) are among the leading causes of death worldwide. In response to the growing population of cancer patients and survivors with CVD, the sub-specialty of cardio-oncology has been developed to better optimise their care. Palpitations are one of the most common presenting complaints seen in the emergency room or by the primary care provider or cardiologist. Palpitations are defined as a rapid pulsation or abnormally rapid or irregular beating of the heart and present a complex diagnostic entity with no evidence-based guidelines currently available. Palpitations are a frequent occurrence in people with cancer, and investigations and treatment are comparable to that in the general population although there are some nuances. Cancer patients are at a higher risk of arrhythmogenic causes of palpitations and non-arrhythmogenic causes of palpitations. This review will appraise the literature with regards to the development and management of palpitations in the cancer patient.

scholarly journals Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. e1003708
Author(s):  
Annie Herbert ◽  
Meena Rafiq ◽  
Tra My Pham ◽  
Cristina Renzi ◽  
Gary A. Abel ◽  
...  
Keyword(s):  
Primary Care ◽  
Abdominal Pain ◽  
Rectal Bleeding ◽  
Bowel Habit ◽  
Composite Outcome ◽  
Predictive Values ◽  
Abdominal Bloating ◽  
Abdominal Symptoms ◽  
Specialist Referral ◽  
Inflammatory Bowel

Background The diagnostic assessment of abdominal symptoms in primary care presents a challenge. Evidence is needed about the positive predictive values (PPVs) of abdominal symptoms for different cancers and inflammatory bowel disease (IBD). Methods and findings Using data from The Health Improvement Network (THIN) in the United Kingdom (2000–2017), we estimated the PPVs for diagnosis of (i) cancer (overall and for different cancer sites); (ii) IBD; and (iii) either cancer or IBD in the year post-consultation with each of 6 abdominal symptoms: dysphagia (n = 86,193 patients), abdominal bloating/distension (n = 100,856), change in bowel habit (n = 106,715), rectal bleeding (n = 235,094), dyspepsia (n = 517,326), and abdominal pain (n = 890,490). The median age ranged from 54 (abdominal pain) to 63 years (dysphagia and change in bowel habit); the ratio of women/men ranged from 50%/50% (rectal bleeding) to 73%/27% (abdominal bloating/distension). Across all studied symptoms, the risk of diagnosis of cancer and the risk of diagnosis of IBD were of similar order of magnitude, particularly in women, and younger men. Estimated PPVs were greatest for change in bowel habit in men (4.64% cancer and 2.82% IBD) and for rectal bleeding in women (2.39% cancer and 2.57% IBD) and lowest for dyspepsia (for cancer: 1.41% men and 1.03% women; for IBD: 0.89% men and 1.00% women). Considering PPVs for specific cancers, change in bowel habit and rectal bleeding had the highest PPVs for colon and rectal cancer; dysphagia for esophageal cancer; and abdominal bloating/distension (in women) for ovarian cancer. The highest PPVs for abdominal pain (either sex) and abdominal bloating/distension (men only) related to non-abdominal cancer sites. For the composite outcome of diagnosis of either cancer or IBD, PPVs of rectal bleeding exceeded the National Institute of Health and Care Excellence (NICE)-recommended specialist referral threshold of 3% in all age–sex strata, as did PPVs of abdominal pain, change in bowel habit, and dyspepsia, in those aged 60 years and over. Study limitations include reliance on accuracy and completeness of coding of symptoms and disease outcomes. Conclusions Based on evidence from more than 1.9 million patients presenting in primary care, the findings provide estimated PPVs that could be used to guide specialist referral decisions, considering the PPVs of common abdominal symptoms for cancer alongside that for IBD and their composite outcome (cancer or IBD), taking into account the variable PPVs of different abdominal symptoms for different cancers sites. Jointly assessing the risk of cancer or IBD can better support decision-making and prompt diagnosis of both conditions, optimising specialist referrals or investigations, particularly in women.

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 AB1304-HPR KNOWLEDGE OF HIGH SCHOOL STUDENTS ABOUT RHEUMATIC DISEASES: EFFECT OF AN EDUCATIONAL SESSION JOINTLY PROVIDED BY PORTUGUESE EULAR ASSOCIATIONS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1942.2-1943
Author(s):  
G. Pimentel ◽  
A. Marques ◽  
R. Ferreira ◽  
E. Mateus ◽  
A. Pais
Keyword(s):  
High School ◽  
Primary Care ◽  
Health Care ◽  
High School Students ◽  
Primary Schools ◽  
Wilcoxon Test ◽  
School Students ◽  
Educational Session ◽  
Awareness Campaigns ◽  
Word Clouds

Background:International studies have shown that the awareness and knowledge of the general population about rheumatic and musculoskeletal diseases (RMDs) is poor. This is even lower in the young population, which are also affected by these disease but do not have as much awareness campaigns as adult community. Their professors and primary health care professionals may also play here also a key role, promoting early detection of signs and interpretations of symptoms, thus avoiding late health care referrals and diagnosis. (Vlieland, 2016).Objectives:To assess the knowledge of high school Portuguese students about the RMDs and raise awareness for RMDs in young people, their professors, vigilants, and primary care nurses, within the school environment.Methods:A 1-hour educational session about RMDs was planned (with the inputs from members of the Portuguese EULAR Associations) and performed during school activities. The educational session started with a knowledge questionnaire about RMDs in a paper sheet (9 questions; Graph 1), repeated in the end. An interactive session, using slides, interactive questions (Sli.do®), and practical demonstrations to simulate RMD symptoms (e.g. stiffness and functional limitations) was then lead by a rheumatology nurse, with the testimony from a young patient representative. A primary care nurse assisted in order to be engaged and promote future sessions (“autonomously”). Change in knowledge was assessed with Wilcoxon-test and awareness was documented with “word clouds” (using Sli.do®).Results:A total of 75 students participated in four sessions (mode=16 years). Half of students (52%) had never heard about RMDs. Knowledge increased significantly in all questions (p<0.001; Graph 1). Figures 1 and 2 document the most common words representing what defines a RMD and what are the main symptoms, respectively.Conclusion:Our results confirm that awareness and knowledge about RMDs are very low high school students. The single and educational session was very well received by all students, and the the knowledge increased. Post-educational feedback was that students especially liked the testimony of a peer. Other sessions are taking place in primary schools.References:[1]Vlieland, T. P., et al. RMD Open, 2016;2:e000337. doi:10.1136/rmdopen- 2016-000337Acknowledgments:To European League Against Rheumatism for the founding provided through the campaign “Don’t Delay, Connect Today”.Disclosure of Interests:None declared

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

2020 ◽  
pp. 1-5
Author(s):  
João Machado Nogueira ◽  
Inês Fonseca ◽  
Marco Duarte
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Symptoms ◽  
Definitive Diagnosis ◽  
Hot Water ◽  
Illustrative Case ◽  
Raising Awareness ◽  
Detailed Medical History ◽  
Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

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