Time-to-diagnosis and symptoms of myeloma, lymphomas and leukaemias: a report from the Haematological Malignancy Research Network.
Time-to-diagnosis and symptoms of myeloma, lymphomas and leukaemias: a report from the Haematological Malignancy Research Network.
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DOI：
10.1186/2052-1839-13-9
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发表时间：
2013-10-31
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影响因子：
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通讯作者：
Roman, Eve
中科院分区：
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作者：
Howell, Debra A;Smith, Alexandra G;Roman, Eve
背景：在诊断之前，血液系统癌症患者经常进行多次初级保健咨询，导致诊断延迟。他们不太可能被紧急转诊到医院，往往是作为紧急情况出现。我们研究了病人的角度的时间来寻求帮助和诊断，以及相关的症状和experiences.METHODS：英国的血液病研究网络（http：//www.example.com）定期收集数据，所有新诊断的骨髓瘤，淋巴瘤和白血病（> 2000年，人口360万）。在临床同意的情况下，还邀请患者参加一项关于导致其诊断的情况的持续调查（有/无症状;症状类型和发作日期;首次寻求医疗建议的日期（求助）;诊断前重要经历的总结）。从2004年至2011年，8858名患者进行了接触，5038人同意他们可以联系研究目的; 3329人要求并返回了完整的问卷。根据患者特征和诊断检查总间期（症状发作至诊断）、患者间期（症状发作至求助）和诊断间期（求助至诊断）的持续时间。症状的类型和频率进行了检查集体，诊断和比较英国转诊guidelines. RESULTS：约三分之一的患者在诊断时无症状。在那些有症状的患者中，大多数疾病的中位患者间隔往往短于诊断间隔。不同诊断的间隔时间有显著差异：急性髓性白血病为41天（四分位距（IQR）17 - 85），弥漫性大B细胞淋巴瘤为98天（IQR 53 - 192），骨髓瘤为163天（IQR 84 - 306）。许多症状与英国转诊指南中引用的症状一致，但有些症状很少报告（例如饮酒疼痛）。相比之下，其他人，没有指导，更频繁（如胃和肠道问题）。症状，如疲劳和疼痛是常见的所有疾病，虽然一些特异性是明显的亚型，如淋巴结肿大淋巴瘤和出血和瘀伤在急性leukemia.CONCLUSIONS：诊断途径是多种多样的，可以是不可接受的延长，特别是骨髓瘤和一些淋巴瘤。需要更多的证据，沿着干预措施，以减少诊断时间，如公众教育活动和全科医生决策援助，以及完善现有的转诊指南。
BACKGROUND: Prior to diagnosis, patients with haematological cancers often have multiple primary care consultations, resulting in diagnostic delay. They are less likely to be referred urgently to hospital and often present as emergencies. We examined patient perspectives of time to help-seeking and diagnosis, as well as associated symptoms and experiences.METHODS: The UK's Haematological Malignancy Research Network (http://www.hmrn.org) routinely collects data on all patients newly diagnosed with myeloma, lymphoma and leukaemia (>2000 annually; population 3.6 million). With clinical agreement, patients are also invited to participate in an on-going survey about the circumstances leading to their diagnosis (presence/absence of symptoms; type of symptom(s) and date(s) of onset; date medical advice first sought (help-seeking); summary of important experiences in the time before diagnosis). From 2004-2011, 8858 patients were approached and 5038 agreed they could be contacted for research purposes; 3329 requested and returned a completed questionnaire. The duration of the total interval (symptom onset to diagnosis), patient interval (symptom onset to help-seeking) and diagnostic interval (help-seeking to diagnosis) was examined by patient characteristics and diagnosis. Type and frequency of symptoms were examined collectively, by diagnosis and compared to UK Referral Guidelines.RESULTS: Around one-third of patients were asymptomatic at diagnosis. In those with symptoms, the median patient interval tended to be shorter than the diagnostic interval across most diseases. Intervals varied markedly by diagnosis: acute myeloid leukaemia being 41days (Interquartile range (IQR) 17-85), diffuse large B-cell lymphoma 98days (IQR 53-192) and myeloma 163days (IQR 84-306). Many symptoms corresponded to those cited in UK Referral Guidelines, but some were rarely reported (e.g. pain on drinking alcohol). By contrast others, absent from the guidance, were more frequent (e.g. stomach and bowel problems). Symptoms such as tiredness and pain were common across all diseases, although some specificity was evident by sub-type, such as lymphadenopathy in lymphoma and bleeding and bruising in acute leukaemia.CONCLUSIONS: Pathways to diagnosis are varied and can be unacceptably prolonged, particularly for myeloma and some lymphomas. More evidence is needed, along with interventions to reduce time-to-diagnosis, such as public education campaigns and GP decision-making aids, as well as refinement of existing Referral Guidelines.