Guideline interval: A new time interval in the diagnostic pathway for symptomatic cancer
•We describe a new metric to describe the cancer diagnostic pathway: guideline interval.•Guideline interval increases less with multimorbidity compared with diagnostic interval.•We illustrate guideline interval using UK NICE suspected-cancer referral guidance.•Guideline interval is readily modifiabl...
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| Veröffentlicht in: | Cancer epidemiology Jg. 73; S. 101969 |
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| Hauptverfasser: | , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
New York
Elsevier Ltd
01.08.2021
Elsevier Limited Elsevier |
| Schlagworte: | |
| ISSN: | 1877-7821, 1877-783X, 1877-783X |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | •We describe a new metric to describe the cancer diagnostic pathway: guideline interval.•Guideline interval increases less with multimorbidity compared with diagnostic interval.•We illustrate guideline interval using UK NICE suspected-cancer referral guidance.•Guideline interval is readily modifiable to local policies or updates.•Guideline interval is readily adaptable to local suspected-cancer policies.
A standard measure of the cancer diagnostic pathway, diagnostic interval, is the time from “first presentation of cancer” to diagnosis. Cancer presentation may be unclear in patients with multimorbidity or non-specific symptoms, signs or test results (“features”). We propose an alternative, guideline interval, with a more certain start date; namely, when the patient first meets suspected-cancer criteria for investigation or referral.
This retrospective cohort study used Clinical Practice Research Datalink (CPRD) and English cancer registry data. Participants, aged ≥55 years, had diagnostic codes for oesophagogastric cancers in 1/1/12–31/12/17. Features of oesophagogastric cancer in the year before diagnosis were identified from CPRD codes for dysphagia, haematemesis, upper-abdominal mass or pain, low haemoglobin, reflux, dyspepsia, nausea, vomiting, weight loss or thrombocytosis. Diagnostic interval was the time from first feature to diagnosis; guidance interval, the time from first meeting criteria in NICE suspected-cancer guidance to diagnosis. Multimorbidity burden was quantified using Adjusted Clinical Groups®. Accelerated failure-time models explored associations between multimorbidity burden and length of both diagnostic and guideline interval.
There were 3,793 eligible participants (69.0 % male), mean age 74.1 years (SD 10.5). 3,097 (81.7 %) presented with ≥1 feature in the year before diagnosis, and 1,990 (52.5 %) met NICE suspected-cancer criteria. The median for both intervals was 11 days in healthy users, and rose with increasing morbidity burden. At very high multimorbidity burden, diagnostic interval was 5.47 (95%CI 3.25–9.20) times longer and guideline interval was 3.91 (2.63–5.80) times longer than for healthy users.
Guideline interval is proposed as a new measure of the cancer diagnostic pathway. It has a more certain start date than diagnostic interval, and is lengthened less than diagnostic interval in people with a very high multimorbidity burden. Guideline interval has potential for assessing the implementation of suspected-cancer policies. |
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| Bibliographie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
| ISSN: | 1877-7821 1877-783X 1877-783X |
| DOI: | 10.1016/j.canep.2021.101969 |