Preventing delayed diagnosis of cancer: clinicians’ views on main problems and solutions

Car, Lorainne Tudor; Papachristou, Nikolaos; Urch, Catherine; Majeed, Azeem; El-Khatib, Mona; Aylin, Paul; Atun, Rifat; Car, Josip; Vincent, Charles

doi:10.7189/jogh.06.020901

Cited by 22 publications

(20 citation statements)

References 39 publications

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“…GPs’ views on the importance of closer links between primary and secondary care were identified in that and other studies 29 30. Our PCPs’ call for improved patient education and better access to diagnostic testing specialist care were also prioritised by GPs in a UK study 40. Our findings map across to the findings from qualitative research on patient-perceived barriers to early presentation and diagnosis of cancer, which have identified the need for better access to services for patients41 42 and better patient awareness of cancer symptoms42 as key issues.…”

Section: Discussionmentioning

confidence: 70%

How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis

et al. 2019

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BackgroundNational European cancer survival rates vary widely. Prolonged diagnostic intervals are thought to be a key factor in explaining these variations. Primary care practitioners (PCPs) frequently play a crucial role during initial cancer diagnosis; their knowledge could be used to improve the planning of more effective approaches to earlier cancer diagnosis.ObjectivesThis study sought the views of PCPs from across Europe on how they thought the timeliness of cancer diagnosis could be improved.DesignIn an online survey, a final open-ended question asked PCPs how they thought the speed of diagnosis of cancer in primary care could be improved. Thematic analysis was used to analyse the data.SettingA primary care study, with participating centres in 20 European countries.ParticipantsA total of 1352 PCPs answered the final survey question, with a median of 48 per country.ResultsThe main themes identified were: patient-related factors, including health education; care provider-related factors, including continuing medical education; improving communication and interprofessional partnership, particularly between primary and secondary care; factors relating to health system organisation and policies, including improving access to healthcare; easier primary care access to diagnostic tests; and use of information technology. Re-allocation of funding to support timely diagnosis was seen as an issue affecting all of these.ConclusionsTo achieve more timely cancer diagnosis, health systems need to facilitate earlier patient presentation through education and better access to care, have well-educated clinicians with good access to investigations and better information technology, and adequate primary care cancer diagnostic pathway funding.

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Section: Discussionmentioning

confidence: 70%

How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis

et al. 2019

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“…Symptom awareness and appraisal by patients and doctors is an important determinant of timely presentation and investigation [31][32][33][34] but the optimal design of early diagnosis interventions aimed at earlier recognition of possible cancer symptoms by members of the public and health-care professionals remains unclear. Alongside considerations such as cancer site incidence, psychosocial barriers to presentation, and the predictive value of symptoms, evidence about the associations between presenting symptoms and stage at diagnosis can help to guide the design of early diagnosis interventions.…”

Section: Discussionmentioning

confidence: 99%

Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study

Koo

Swann

McPhail

et al. 2020

The Lancet Oncology

155

106

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Background Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis. Methods In this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I-III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms. Findings We analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1-3; eight of 584 patients) for abnormal mole to 80% (71-87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the "any other symptom" category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV. Interpretation Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease.

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“…During the first World Hepatitis Summit in 2015, Glasgow Declaration on Hepatitis committed all governments to eliminate viral hepatitis [17]. Successful policies and programs in prevention and treatment require the public’s awareness, attention, and action [31]. This study revealed several disconnections in the recognition and behavior steps necessary for hepatitis eradication and liver disease prevention, some of which are critical yet often overlooked in extant literature and policy discussion.…”

Section: Discussionmentioning

confidence: 99%

The disconnect in hepatitis screening: participation rates, awareness of infection status, and treatment-seeking behavior

Lin

Clark

et al. 2019

Journal of Global Health

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Background Over 325 million people in the world are infected with hepatitis B or C virus. Chronic hepatitis is responsible for 78% of cases of hepatocellular carcinoma and an estimated 1.3 million preventable deaths a year. As “silent killers”, liver diseases are often asymptomatic and go undiagnosed until their terminal stage. Knowledge of infection status via screening is thus a vital part of preventing spread and seeking early treatment. Recently there has been a worldwide push to eliminate hepatitis. The objective of this study is to assess hepatitis B and C self-reported awareness of infection status vs correct awareness (compared to blood test results) and follow-up rates in Taiwan to inform global health promotion efforts that utilize screening interventions to prevent chronic liver diseases. Methods De-identified data from a Liver Foundation’s nationwide community-outreach free blood screening programs was utilized, including 50 909 participants’ data from 74 sites with a questionnaire (demographics, screening history, hepatitis awareness, monitoring behavior) and blood test results. Chi square tests were applied using R programing to examine the impacts of demographic variables on infection prevalence, awareness, and behavior relating to hepatitis. Results Among all participants, 41.1% indicated having had a hepatitis screening, of which only 60.8% knew their results. Around 69.7% and 66.5% self-reported awareness of their hepatitis B and C status respectively; 12.8% and 26.4% of individuals who tested positive for HBsAg and Anti-HCV respectively incorrectly thought they were not infected. Of those who self-reported awareness of their positive infection, 43.4% and 26.6% did not follow up with a health care professional for monitoring or treatment; the top reasons were “no symptoms”, “too busy”, and “don’t know where to follow up”. Rural populations showed higher infection prevalence but lower screening rates and self-reported awareness. Conclusions Intervention programs must address the substantial number of people that do not recall if they were screened or do not know the results of a screening. Discrepancies between self-reported awareness, correct awareness, and follow-up and disparities across demographic groups deserve further scrutiny. Global hepatitis eradication initiatives should reconsider how screening, test results, and education are presented in order to improve awareness and prevent chronic infection that could develop into life-threatening liver diseases.

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Preventing delayed diagnosis of cancer: clinicians’ views on main problems and solutions

Cited by 22 publications

References 39 publications

How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis

How European primary care practitioners think the timeliness of cancer diagnosis can be improved: a thematic analysis

Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study

The disconnect in hepatitis screening: participation rates, awareness of infection status, and treatment-seeking behavior

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