Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

Abstract

ObjectivesTo summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals.DesignA scoping review following the Joanna Briggs Institute’s methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sourcesMEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021.Eligibility and criteriaStudy participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis.Data extraction and synthesisWe summarised findings graphically and descriptively.ResultsFrom 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator.ConclusionsMultidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

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“…The rising incidence of cancer coupled with the high mortality rates highlights the need for new and more effective treatments in oncology. However, the outcome of anticancer treatments significantly depends on the extent of tumor disease at treatment initiation, which further highlights the relevance of preventive strategies as well as diagnostic procedures or other clinical interventions to allow early diagnosis of cancer and timely treatment initiation ( Kwong et al, 2021 ; Okoli et al, 2021 ). With respect to the development of novel anticancer drugs, there is a continuous effort to define the most accurate methods as well as the relevant endpoints to assess the clinical benefit of new compounds in the context of different tumors ( Daniele et al, 2020 ).…”

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“…However, few of them can be used as a screening for people at high risk of developing a type of cancer-based on strong family history or specific risk factors for a particular type of cancer [ 66 ]. Diagnosis: for the patients who have cancer-specific symptoms, they can help with other specific diagnostic methods to detect cancer and help differentiate from other conditions with similar symptoms [ 67 ] Monitoring the response to specific treatment: for certain cancers (eg breast, testicular, colon and rectal cancers, ovary, pancreas) serial and repeated monitoring of the appropriate markers allows the assessment of the effectiveness of the treatment, especially in the advanced stages of the disease (if the serum marker decreases, the treatment is effective; the serum marker remains high, it is necessary to adjust or change the treatment). However, the information provided by the marker values should be used with caution because there are situations that may increase or decrease the level of the marker regardless of the evolution or involution of the tumor [ 68 ].…”

“…Diagnosis: for the patients who have cancer-specific symptoms, they can help with other specific diagnostic methods to detect cancer and help differentiate from other conditions with similar symptoms [ 67 ]…”

“…Identifying biomarkers is only a first step in the battle against cancer. Tumor biomarkers can be measured before starting treatment to determine the appropriate therapy and certain biomarkers in tumor tissue are the target of specific targeted therapies [ 67 , 154 ]. If the biomarker is common enough in a specific location of cancer and is associated with a targeted therapy approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMEA), the choice of a therapeutic option appropriate to the characteristics of the tumor, in other words, therapy personalized, is the natural consequence [ 94 ].…”

“…ii. Diagnosis: for the patients who have cancer-specific symptoms, they can help with other specific diagnostic methods to detect cancer and help differentiate from other conditions with similar symptoms [67] iii. Monitoring the response to specific treatment: for certain cancers (eg breast, testicular, colon and rectal cancers, ovary, pancreas) serial and repeated monitoring of the appropriate markers allows the assessment of the effectiveness of the treatment, especially in the advanced stages of the disease (if the serum marker decreases, the treatment is effective; the serum marker remains high, it is necessary to adjust or change the treatment).…”