Diagnosing cancer in patients with 'non-alarm' symptoms: Learning from diagnostic care innovations in Denmark.

Published on Apr 24, 2018in Cancer Epidemiology2.179
· DOI :10.1016/J.CANEP.2018.03.011
Alice S Forster1
Estimated H-index: 1
Cristina Renzi13
Estimated H-index: 13
Georgios Lyratzopoulos51
Estimated H-index: 51
Cited By9
#1Andrew G. Murchison (John Radcliffe Hospital)H-Index: 6
#2Julie-Ann Moreland (John Radcliffe Hospital)
Last. Fergus Gleeson (John Radcliffe Hospital)H-Index: 6
view all 3 authors...
Abstract Rationale and objectives To determine the prevalence of incidental findings and define the rate and outcomes of further investigations in a referral pathway for patients with non-specific cancer symptoms. Material and methods Incidental findings in each category of a structured report were documented and details of subsequent investigations were obtained from the local PACS and Electronic Patient Record system. Results 1034 patients were included. Of these, 11% were diagnosed with cance...
#1M. Martinez (University of Valencia)H-Index: 2
#2J. Montón-Bueno (University of Valencia)H-Index: 1
Last. I. Chirivella Gonzalez (University of Valencia)H-Index: 4
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Background Cancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation. Patients and methods Descriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Mal...
#1Brian D Nicholson (University of Oxford)H-Index: 15
#1Brian Nicholson (University of Oxford)H-Index: 18
Last. Willie Hamilton (University of Exeter)H-Index: 17
view all 6 authors...
Abstract Objective To quantify the predictive value of unexpected weight loss (WL) for cancer according to patient’s age, sex, smoking status, and concurrent clinical features (symptoms, signs, and abnormal blood test results). Design Diagnostic accuracy study. Setting Clinical Practice Research Datalink electronic health records data linked to the National Cancer Registration and Analysis Service in primary care, England. Participants 63 973 adults (≥18 years) with a code for unexpected WL from...
2 CitationsSource
#1Georgios Lyratzopoulos (UCL: University College London)H-Index: 51
#2Gary A. Abel (University of Exeter)H-Index: 37
Evidence arising from primary care electronic health records can help to assess the risk of symptomatic-but-as-yet-undiagnosed cancer. Existing evidence and methodological innovations in this field of study hold further promise for improving the diagnostic process and achieving earlier diagnosis in cancer patients.
1 CitationsSource
#1Brian D Nicholson (University of Oxford)H-Index: 15
#2Willie Hamilton (University of Exeter)H-Index: 17
Last. Paul Aveyard (University of Oxford)H-Index: 65
view all 6 authors...
BACKGROUND: We aimed to understand the time period of cancer diagnosis and the cancer types detected in primary care patients with unexpected weight loss (UWL) to inform cancer guidelines. METHODS: This retrospective matched cohort study used cancer registry linked electronic health records from the UK's Clinical Practice Research Datalink from between 2000 and 2014. Univariable and multivariable time-to-event analyses examined the association between UWL, and all cancers combined, cancer site a...
5 CitationsSource
#1A. Creak (Royal Sussex County Hospital)
Abstract Aims The UK National Health Service has well-developed site-specific referral pathways for patients with suspected cancer, but historically there has been inequality of access for patients with suspected Metastatic malignant disease of Unknown primary Origin (MUO). The Brighton cancer of unknown primary (CUP) clinic covers a population of about 650 000. As well as ‘in-house’ referrals, direct general practitioner referrals are also accepted (since 2015), aiming to shorten the diagnostic...
#1Brian D Nicholson (University of Oxford)H-Index: 15
#2Paul Aveyard (University of Oxford)H-Index: 65
Last. FD Richard Hobbs (University of Oxford)H-Index: 57
view all 4 authors...
### What you need to know Unexpected weight loss presents a diagnostic challenge in primary care. It is associated with a wide range of benign and serious conditions (box 1).1 Box 1 ### Differential diagnosis for patients with unexpected weight loss1RETURN TO TEXT Weight loss may be missed or misattributed because of several factors (see box 2). Once it is detected, the uncertainty for clinicians is not about whether unexpected weight loss is a symptom of concern, it is about who should be inves...
4 CitationsSource
#1Cristina Renzi (UCL: University College London)H-Index: 13
#2Aradhna Kaushal (UCL: University College London)H-Index: 4
Last. Georgios Lyratzopoulos (University of Cambridge)H-Index: 51
view all 11 authors...
An earlier diagnosis is a key strategy for improving the outcomes of patients with cancer. However, achieving this goal can be challenging, particularly for the growing number of people with one or more chronic conditions (comorbidity/multimorbidity) at the time of diagnosis. Pre-existing chronic diseases might affect patient participation in cancer screening, help-seeking for new and/or changing symptoms and clinicians’ decision-making on the use of diagnostic investigations. Evidence suggests,...
31 CitationsSource
#1Brian D Nicholson (University of Oxford)H-Index: 15
#2Rafael Perera (University of Oxford)H-Index: 68
Last. Matthew Thompson (UW: University of Washington)H-Index: 64
view all 3 authors...
In this issue of the BJGP , Just and colleagues question PSA testing in men with lower urinary tract symptoms (LUTS).1 Like others, they propose that the majority of cancers detected will be indolent and unrelated to the LUTS, basing their judgement on PSA screening trial data and general population LUTS surveys.2 Danish primary care data, not included by Just and colleagues, indicates that indolent prostate cancer detection increases as PSA testing increases without a corresponding change in ad...
3 CitationsSource