Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

Neal, Richard D; Tharmanathan, Puvan; Din, Nafees Ud; Cotton, S; Fallon-Ferguson, Julia; Hamilton, William; Hendry, Annie; Hendry, Maggie; Lewis, Ruth; Macleod, Una; Mitchell, Elizabeth; Pickett, Mary; Rai, Tekendra; Shaw, Katie; Stuart, N. S. A.; Tørring, Marie Louise; Wilkinson, Clare; Williams, Blair; Williams, Nefyn; Emery, Jon

doi:10.1038/bjc.2015.48

Cited by 722 publications

(671 citation statements)

References 186 publications

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“…38 Survival also decreases as the diagnostic interval increases beyond 28 days owing to the growth of the tumour over time. 39 Patients with cancers located in other sites might well also have a J-shaped curve for the association between time to diagnosis and survival, but the number and methodological strength of reports available for any other form of cancer is substantially lower than that available on patients with colorectal cancer. 39,40 [H2] Morbidity and time to diagnosis…”

Section: [H2] Survival and Time To Diagnosismentioning

confidence: 99%

Improving early diagnosis of symptomatic cancer

Hamilton

Walter

Rubin³

et al. 2016

Nat Rev Clin Oncol

105

121

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| Much time, effort and investment goes into the diagnosis of symptomatic cancer, with the expectation that this approach brings clinical benefits. This investment of resources has been particularly noticeable in the UK, which has, for several years, appeared near the bottom of international league tables for cancer survival in economically developed countries. This Review examines expedited diagnosis of cancer from four perspectives. The first examines the potential for benefits from expedited diagnosis of symptomatic cancer. Limited evidence from clinical trials is available, but the considerable observational evidence suggests benefits can be obtained from this approach. The second perspective considers how expedited diagnosis can be achieved. We concentrate on data from the UK, where extensive awareness campaigns have been conducted, and initiatives in primary care, including clinical decision support, have all occurred during a period of considerable national policy change. The third section considers the most appropriate patients for cancer investigations, and the possible community settings for this. UK national guidance for selection of patients for investigation is discussed. Finally, the health economics of the subject are reviewed, although few studies provide definitive evidence on this topic.In all developed countries, much time, effort and finance is spent on the diagnosis of cancer.

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Section: [H2] Survival and Time To Diagnosismentioning

confidence: 99%

Improving early diagnosis of symptomatic cancer

Hamilton

Walter

Rubin³

et al. 2016

Nat Rev Clin Oncol

105

121

View full text Add to dashboard Cite

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“…There have been numerous reports on cancer survival revealing improvements through various therapies, derived from hospital-based datasets (1)(2)(3)(4). However, there are few reports on the general efficiency of cancer health services derived from long-term population-based cancer registration systems (5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Cancer survival in Qidong between 1972 and 2011: A population-based analysis

Chen

Zhu

Zhang

et al. 2017

Molecular and Clinical Oncology

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Abstract. Population-based cancer survival is an improved index for evaluating the overall efficiency of cancer health services in a given region. The current study analysed the observed survival and relative survival of leading cancer sites from a population-based cancer registry between 1972 and 2011 in Qidong, China. A total of 92,780 incident cases with cancer were registered and followed-up for survival status. The main sites of the cancer types, based on the rank order of incidence, were the liver, stomach, lung, colon and rectum, oesophagus, breast, pancreas, leukaemia, brain and central nervous system (B and CNS), bladder, blood [non-Hodgkin's lymphoma (NHL)] and cervix. For all malignancies combined, the 5-year observed survival was 13.18% and the relative survival was 15.80%. Females had higher observed survival and relative survival (19.32 and 22.71%, respectively) compared with males (9.63 and 11.68%, respectively). The cancer sites with the highest five-year relative survival rates were the female breast, bladder, cervix and colon and rectum; followed by NHL, stomach, B and CNS cancer and leukaemia. The poorest survival rates were cancers of oesophagus, lung, pancreas and liver. Higher survival rates were observed in younger patients compared with older patients. Cancers of the oesophagus, female breast and bladder were associated with higher survival in middle-aged groups. Improved survival rates in the most recent two 5-year calendar periods were identified for stomach, lung, colon and rectum, oesophagus, female breast and bladder cancer, as well as leukaemia and NHL. The observations of the current study provide the opportunity for evaluation of the survival outcomes of frequent cancer sites that reflects the changes and improvement in a rural area in China.

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“…Systematic reviews have suggested that a benefit accrues from shortening wait times, and their conclusions recommend minimizing delays to diagnosis and treatment. The reviews are not able to define the time at which a delay becomes clinically relevant 4,5 , but a recent study by Bleicher et al 1 showed decreased survival with a time of more than 60 days from diagnosis to surgery.…”

Section: Introductionmentioning

confidence: 99%