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 A Community-Powered, Asset-Based Approach to Intersectoral Urban Health System Planning in Chicago

2016 ◽  
Vol 106 (10) ◽  
pp. 1872-1878 ◽  
Author(s):  
Stacy Tessler Lindau ◽  
Katherine Diaz Vickery ◽  
HwaJung Choi ◽  
Jennifer Makelarski ◽  
Amber Matthews ◽  
...  
Keyword(s):  
Health System ◽  
Urban Health ◽  
System Planning ◽  
Health System Planning

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.

Public Engagement and the Changing Face of Health System Planning

2008 ◽  
Vol 21 (4) ◽  
pp. 22-26 ◽  
Author(s):  
John Grant ◽  
Nancy A. Sears ◽  
Karen Born
Keyword(s):  
Health System ◽  
Public Engagement ◽  
System Planning ◽  
Health System Planning

Cancer care in the time of COVID-19: A conceptual framework to improve cancer outcomes during a pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18628-e18628
Author(s):  
Vivienne Milch ◽  
Cleola Anderiesz ◽  
Debra Hector ◽  
Scott Turnbull ◽  
Melissa Austen ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Conceptual Framework ◽  
Cancer Patients ◽  
Cancer Care ◽  
Cancer Outcomes ◽  
System Planning ◽  
Screening Programs ◽  
Cancer Management ◽  
Health System Planning

e18628 Background: At the start of the COVID-19 pandemic, a plan for cancer management during a pandemic did not exist. It soon became clear that without proper planning, cancer outcomes would worsen. Cancer patients are at increased risk of COVID-19 infection, morbidity, and mortality. Health sectors internationally reduced or paused non-urgent cancer care to protect cancer patients from COVID-19. However, disproportionate delays in screening, diagnosis, and treatment can unduly impact cancer outcomes, and backlogs can further burden a strained health system. Tailored approaches to cancer management are required which balance health resource availability along with the risks of exposure and benefits of treatment. Australia’s relatively low COVID-19 case numbers afforded Cancer Australia an opportunity to proactively plan for optimal cancer management during this, and future, pandemics. Methods: Cancer Australia’s Cancer care in the time of COVID-19: A conceptual framework for the management of cancer during a pandemic (the framework) maps evidence-based cancer care considerations in relation to a health system’s capacity across acute and recovery pandemic phases, in relation to steps of the cancer care pathway. The framework promotes infection control and resource prioritisation in the context of innovative care models, triaging approaches and individualised treatment plans, underpinned by effective communication and shared decision-making. Results: The framework supports health system planning and risk-stratified approaches to guide decision-making and improve cancer outcomes. Many aspects of cancer care are recommended to continue (to varying degrees) in most pandemic phases, with modifications or pauses in some aspects of care as the pandemic curve approaches or exceeds health system capacity. Principles of the framework were employed during the second wave of COVID-19 in the Australian state of Victoria, with continuation of cancer screening programs, diagnostic investigations, and treatments wherever it was safe to do so. This resulted in reductions in cancer services and treatment being relatively smaller than in the first wave. Conclusions: Cancer management in a pandemic is not a one-size-fits-all. Countries and jurisdictions need to tailor cancer care according to the risk of the health system becoming overwhelmed. The framework guides optimal cancer care to improve outcomes for people with cancer, while minimising COVID-19 infection. As further evidence becomes available from this pandemic or in future pandemics, this framework can be refined to inform ongoing and future pandemic health system planning.

scholarly journals Using Standardized Electronic Pathology and Surgery Data to Inform Clinical Quality Improvement and Health System Planning

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 68s-68s
Author(s):  
S. Sone ◽  
J. Kitchen ◽  
S. Mukhi ◽  
M. Argent-Katwala ◽  
J. Srigley
Keyword(s):  
Colorectal Cancer ◽  
Endometrial Cancer ◽  
Quality Of Care ◽  
Lynch Syndrome ◽  
Patient Care ◽  
Practice Variation ◽  
System Planning ◽  
Health System Planning ◽  
Pathology Data

Background: Practice variation in diagnosis and treatment exists between clinicians and jurisdictions across Canada. This variation can impact the quality of care that patients receive and patient outcomes. Knowledge of the scale and type of variation is the first step to developing action plans to improve consistency and enhance patient care. Aim: We aimed to establish a method by which to examine the magnitude of practice variation between clinicians and interjurisdictionally within the cancer system. We leveraged and derived evidence from discrete pathology data collected by five Canadian jurisdictions at the point of care to identify areas to improve quality of cancer care services and to direct patient care. Methods: Fifty pathologists, surgeons, and medical oncologists from 10 jurisdictions conferred to leverage literature and data standards (developed by the College of American Pathologists (CAP)) to create 48 descriptive and outcome indicators related to five cancers: breast, lung, colorectal, endometrial, and prostate cancer. Five jurisdictions collected and used data to generate the indicators. This baseline data were reviewed by 65 clinicians. Results: Interjurisdictional comparative baseline data analyses on 48 indicators showed clinical validity and relevance for use to direct downstream patient care. Data characterizing cancer type, stage, and grade distribution were consistently reported across geography and aligned with the evidence noted in the literature. The data also noted practice and performance variation across multiple cancer sites. For example, although the recommended guideline is to examine at least 12 lymph nodes in 90% of colorectal cancer patients, only one province met this target. Another example is Lynch syndrome testing, which may be important for patients with a diagnosis of colorectal or endometrial cancer depending on the age at diagnosis and family history. The data showed that 0%–70% of patients diagnosed with colorectal cancer prior to age 70 received testing for Lynch syndrome, and only 10%–40% of endometrial cancer cases were tested for markers of Lynch syndrome across the country. The value of these indicators is enormous to inform potential training opportunities and set standards of care at the local or broader clinical governance level so that consistent, high-quality care is delivered in accordance with evidence-based guidelines. Conclusion: Practice variation exists between clinicians and jurisdictions, and comparative pathology data can be used to create a cancer learning system. Four jurisdictions are now embarking on leveraging indicator data analysis to generate physician-level feedback reports and convening communities of practice with the goal of facilitating peer-to-peer conversations, and establishing benchmarks and targets to improve the quality of care, refine or develop clinical guidelines, and inform health system planning in Canada. These lessons can be applied in other cancer systems.

Sign in / Sign up

Export Citation Format

Share Document