Cancer of Unknown Primary: a Cancer Registry Study of Factors Affecting Access to Diagnosis

Crawford, S. M.; Skinner, Jane; Coombes, Emma; Jones, AP

doi:10.1016/j.clon.2016.09.011

Cited by 12 publications

(12 citation statements)

References 23 publications

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“…Our survey of seasoned pastoral leaders revealed that they had a lower than average cancer knowledge. This finding is in line with previous studies, which found that overall public knowledge of cancer is poor [23,24]. Yet, an encouraging 73% of church leaders in the present study indicated that they would be interested in trainings to increase their knowledge.…”

Section: Discussionsupporting

confidence: 80%

Current trends in cancer support within the religious community

Spellman¹,

Tse²,

Wonders³

et al. 2017

Nurs Palliat Care

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Section: Discussionsupporting

confidence: 80%

Current trends in cancer support within the religious community

Spellman¹,

Tse²,

Wonders³

et al. 2017

Nurs Palliat Care

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“…During the observation time this study was conducted, Medicare did not cover genetic/molecular tests. Thus, financial access to molecular tests may have been unavailable to many patients [30]. Recently, commercial tests of gene profiling microarrays became available for the diagnosis of CUP.…”

Section: Discussionmentioning

confidence: 99%

Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

Smith-Gagen¹,

Drake²,

White³

et al. 2019

Cancer Rep Rev

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Purpose: Current cancer registry data cannot distinguish a justified cancer of unknown primary (CUP) diagnosis, where the patient received a complete diagnostic evaluation that was unable to identify the primary tumor, from potentially misclassified patients, documented as CUP but not based on a complete diagnostic evaluation. This misclassification may skew population-based cancer registry surveillance research used to frame and guide translational CUP research. We identified characteristics of patients who received justified vs. potentially misclassified CUP diagnoses in cancer registry data. Methods: We developed a conceptual definition of a complete diagnostic evaluation from professional society-recommended guidelines. We translated this definition into procedure codes in the Medicare encounter data. We assessed age, gender, comorbidities, urban or rural residence, income, race, and tumor pathology by receipt of a complete diagnostic evaluation and palliative therapy among 10,575 elderly CUP patients in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset. We calculated odds ratios and adjusted probabilities using marginal standardization. Results: Only 35% of elderly CUP patients identified in the cancer registry received a complete diagnostic evaluation. After adjustment for age and comorbidities, socioeconomic barriers to a complete diagnostic evaluation persisted: adjusted odds ratio and 95% confidence interval (AOR) for rural vs. urban 0.8(0.8,0.9) and for highest income vs. lowest income 1.2(1.1,1.4). Patients with vague or undocumented tumor pathology in SEER had 80% lower odds of receiving a complete diagnostic evaluation AOR(95%CI)=0.2(0.2,0.2). Although patients with a complete diagnostic evaluation were twice as likely to receive palliative therapy than those without a complete evaluation, AOR(95%CI)=2.0(1.7,2.3), they only had a 46.7% probability of receiving therapy, 95%CI=(44.4,49.1). Conclusion: Patients without a complete diagnostic evaluation are not limited to the frail and underserved. For accurate assessment of the CUP burden and disparities in utilization of diagnostic care, we recommend that the SEER definition of CUP include the extent of diagnostic inquiry.

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“…This allowed us to construct a comprehensive picture of people's health service use prior to cancer diagnosis. While our sample size is one of the largest population-based studies of people with CUP [8,9], it is modest. As a result, we may have had insufficient power to detect an association with some health services, and where we did, the confidence intervals are wide.…”

Section: Plos Onementioning

confidence: 99%

“…While a diagnosis of CUP ideally should be limited to people with a histological confirmation of metastatic cancer, in whom thorough testing has failed to identify the site of the primary tumor, people registered with a diagnosis of CUP in population-based cancer registries are heterogeneous, with many people receiving a diagnosis based on clinical examination only. [4,5,[8][9][10][11] Thus, it is difficult to compare population-based studies of registry-notified CUP to cases series of "true CUP" cases, who have received exhaustive investigations.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and health service pathways to diagnosis of cancer-registry notified cancer of unknown primary site (CUP)

et al. 2020

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Background Cancer of unknown primary (CUP) is a late-stage malignancy with poor prognosis, but we know little about what diagnostic tests and procedures people with CUP receive prior to diagnosis. The purpose of this study was to determine how health service utilisation prior to diagnosis for people with cancer-registry notified CUP differs from those notified with metastatic cancer of known primary. Methods We identified people with a cancer registry notification of CUP (n = 327) from the 45 and Up Study, a prospective cohort of 266,724 people �45 years in New South Wales, Australia, matched with up to three controls with a diagnosis of metastatic cancer of known primary (n = 977). Baseline questionnaire data were linked to population health data to identify all health service use, diagnostic tests, and procedures in the month of diagnosis and 3 months prior. We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results After adjusting for age and educational attainment, people with a cancer-registry notified CUP diagnosis were more likely to be an aged care resident (OR = 2.78, 95%CI 1.37-5.63), have an emergency department visit (OR = 1.65, 95%CI 1.23-2.21), serum tumor marker tests (OR = 1.51, 95%CI 1.12-2.04), or a cytology test without immunohistochemistry (OR = 2.01, 95%CI 1.47-2.76), and less likely to have a histopathology test without immunohistochemistry (OR = 0.43, 95%CI 0.31-0.59). Neither general practitioner, specialist, allied health practitioner or nurse consultations, hospitalisations, nor imaging procedures were associated with a CUP diagnosis.

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Cancer of Unknown Primary: a Cancer Registry Study of Factors Affecting Access to Diagnosis

Cited by 12 publications

References 23 publications

Current trends in cancer support within the religious community

Current trends in cancer support within the religious community

Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

Diagnostic and health service pathways to diagnosis of cancer-registry notified cancer of unknown primary site (CUP)

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