Time to diagnosis and treatment for cancer patients in the Netherlands: Room for improvement?
Time to diagnosis and treatment for cancer patients in the Netherlands: Room for improvement?
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DOI：
10.1016/j.ejca.2017.10.003
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发表时间：
2017-12-01
影响因子：
8.4
通讯作者：
de Wit, Niek N. J.
中科院分区：
文献类型：
--
作者：
Helsper, Charles C. W.;van Erp, Nicole N. F.;de Wit, Niek N. J.
背景与目的：减少诊断性癌症治疗途径的持续时间是人们迫切追求的目标。这项研究的目的是绘制出荷兰五种最常见癌症的诊断途径。方法：回顾性队列研究，使用与荷兰癌症登记处相关的癌症患者匿名初级保健数据（免费文本和编码）。我们确定了中位持续时间：1。初级保健间隔（IPCs）：第一次癌症相关的全科医生咨询转诊，2。转诊间隔（IRs）：转诊至诊断，3。治疗间隔（ITs）：从诊断到治疗和总体间隔，4。诊断间隔（id）： IPC和IR组合和5。卫生保健间隔（ihc）： IPC、IR和IT的组合。结果：诊断为乳腺癌、结直肠癌、肺癌、前列腺癌和黑色素瘤的患者分别为465例、309例、197例、237例和149例；乳腺癌和黑色素瘤的中位IPC、IR和ID持续时间最短（ID持续时间分别为7天和21天），肺癌和结肠癌的中位IPC、IR和ID持续时间中等（ID持续时间分别为49天和54天），前列腺癌的中位IPC、IR和ID持续时间最长（ID持续时间为137天）。对于所有的癌症，10-25%持续时间最长的间隔时间急剧增加。对于结直肠癌，增加的ID持续时间表明归因于初级保健（IPC）的时间比例增加。结论：大约10-25%的癌症患者表现出相当长的诊断间隔。减少初级保健延迟似乎与结直肠癌特别相关。(C) 2017 Elsevier Ltd.版权所有。
Background & aim: Reducing the duration of the diagnostic cancer care pathway is intensively pursued. The aim of this study was to chart the diagnostic pathway for the five most common cancers in the Netherlands.Methods: Aretrospective cohort study using cancer patients' anonymised primary care data (free text and coded) linked to the Netherlands Cancer Registry. We determined the median duration of the following: 1. Primary care intervals (IPCs): the first cancer-related general practitioner consultation to referral, 2. Referral intervals (IRs): referral to diagnosis, 3. Treatment intervals (ITs): diagnosis to treatment and the overarching intervals, 4. Diagnostic intervals (IDs): IPC and IR combined and 5. Health care intervals (IHCs): IPC, IR and IT combined.Results: For 465, 309, 197, 237 and 149 patients diagnosed with breast-, colorectal-, lung-, prostate cancer and melanoma, respectively; median IPC, IR and ID durations were shortest for breast cancer and melanoma (ID duration 7 and 21 days, respectively), intermediate for lung-and colon cancer (ID duration 49 and 54 days) and the longest for prostate cancer (ID duration 137 days). For all cancers, the duration of intervals increased steeply for the 10-25% with longest durations. For colorectal cancer, increasing ID durations showed increasing proportions of time attributable to primary care (IPC).Conclusion: Approximately 10-25% of cancer patients show substantially long duration of diagnostic intervals. Reducing primary care delay seems particularly relevant for colorectal cancer. (C) 2017 Elsevier Ltd. All rights reserved.