Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery

Neal, Richard D; Nafees, Sadia; Pasterfield, Diana; Hood, Kerenza; Hendry, Maggie; Gollins, Simon; Makin, Matthew; Stuart, N.; Turner, Jim; Carter, Ben; Wilkinson, Clare; Williams, Nefyn; Robling, Michael

doi:10.1186/1472-6963-14-3

Cited by 32 publications

(48 citation statements)

References 27 publications

(29 reference statements)

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“…The SYMPTOM lung questionnaire, drawing on the C-SIM questionnaire ( Neal et al , 2014b ), was modified for use among people before diagnosis. Due to the sensitive nature of the subject matter, we consulted widely among clinical and research colleagues and patient representatives to achieve appropriate wording.…”

Section: Methodsmentioning

confidence: 99%

Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study

et al. 2015

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Background:This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis.Methods:Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage.Results:Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003).Conclusions:Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.

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Section: Methodsmentioning

confidence: 99%

Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study

et al. 2015

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“…Where participants provided estimated dates, these were converted to exact dates by adapting an algorithm used in the C-SIM trial (Neal et al , 2014b; Walter et al , 2015). We used exact dates where available and estimated dates otherwise.…”

Section: Methodsmentioning

confidence: 99%

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study

et al. 2016

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Background:The objective of this study is to investigate symptoms, clinical factors and socio-demographic factors associated with colorectal cancer (CRC) diagnosis and time to diagnosis.Methods:Prospective cohort study of participants referred for suspicion of CRC in two English regions. Data were collected using a patient questionnaire, primary care and hospital records. Descriptive and regression analyses examined associations between symptoms and patient factors with total diagnostic interval (TDI), patient interval (PI), health system interval (HSI) and stage.Results:A total of 2677 (22%) participants responded; after exclusions, 2507 remained. Participants were diagnosed with CRC (6.1%, 56% late stage), other cancers (2.0%) or no cancer (91.9%). Half the cohort had a solitary first symptom (1332, 53.1%); multiple first symptoms were common. In this referred population, rectal bleeding was the only initial symptom more frequent among cancer than non-cancer cases (34.2% vs 23.9%, P=0.004). There was no evidence of differences in TDI, PI or HSI for those with cancer vs non-cancer diagnoses (median TDI CRC 124 vs non-cancer 138 days, P=0.142). First symptoms associated with shorter TDIs were rectal bleeding, change in bowel habit, ‘feeling different' and fatigue/tiredness. Anxiety, depression and gastro-intestinal co-morbidities were associated with longer HSIs and TDIs. Symptom duration-dependent effects were found for rectal bleeding and change in bowel habit.Conclusions:Doctors and patients respond less promptly to some symptoms of CRC than others. Healthcare professionals should be vigilant to the possibility of CRC in patients with relevant symptoms and mental health or gastro-intestinal comorbidities.

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“…Reliability analysis will not be carried out as the instrument intends to collect only factual, objective information. The Protocol for calculating 'pseudo-exact' dates from estimated dates will be used for calculating the time intervals (Neal et al, 2014).…”

Section: Face Validitymentioning

confidence: 99%

“…Data on the patient interval, diagnostic interval and factors contributing to these intervals will be collected in a direct patient interview using the newly developed and validated instruments. Neal et al guideline will be followed for calculating the pseudo exact date from the estimated date provided by the patient (Neal et al, 2014). Time points like date of biopsy, date of biopsy report, patient registration number, and disease stage information will be collected from the patient case files.…”

Section: Variables and Data Sourcesmentioning

confidence: 99%

“…Moreover, there are very few validated instruments to measure these intervals. The only validated tool (Neal et al, 2014) available for measuring the various intervals in the diagnostic journey of cancer did not have provision for measuring those time intervals in oral cancer patients. Knowing more about the magnitude of this late presentation as well as the contributing factors for longer intervals will help in managing this public health problem.…”

Section: Introductionmentioning

confidence: 99%

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Patient and Diagnostic Intervals in Oral Cancer

Philip

Kannan

2019

ssp

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Background: Oral cancer is an important public health problem in Southeast Asian countries. Generally, cases are reported in advanced stages, resulting in prolonged treatment, high financial burden, and poor prognosis. When diagnosed early, treatment is simple and inexpensive. Materials and Methods: A sequential explanatory study design, cross-sectional survey followed by in-depth interviews, will be used to assess various factors contributing to the patient and diagnostic intervals in oral cancer. At the outset, Data collection tools will be developed and validated. The study protocol is designed as per the "Aarhus statement" for early diagnosis research. In-depth interviews with selected stakeholders and review of documents related to cancer control will constitute the explanatory component of the study design. Discussion: Primary prevention helps in reducing cancer incidence whereas secondary prevention helps in reducing morbidity and mortality. Early diagnosis is a key secondary prevention strategy. Research on early diagnosis of cancer in general and oral cancer, in particular, is scarce. In this regard, a comprehensive and thorough evaluation of various factors facilitates or impede early oral cancer symptom presentation will help in designing policies and programs to promote early diagnosis of oral cancer.

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Patient-reported measurement of time to diagnosis in cancer: development of the Cancer Symptom Interval Measure (C-SIM) and randomised controlled trial of method of delivery

Cited by 32 publications

References 27 publications

Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study

Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study

Symptoms and patient factors associated with longer time to diagnosis for colorectal cancer: results from a prospective cohort study

Patient and Diagnostic Intervals in Oral Cancer

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