Cancer diagnostic delay in the COVID-19 era: what happens next?
Cancer diagnostic delay in the COVID-19 era: what happens next?
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DOI：
10.1016/s1470-2045(20)30391-0
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发表时间：
2020-08
期刊：
影响因子：
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通讯作者：
Hamilton W
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作者：
Hamilton W
毫无疑问，癌症应该得到及时诊断和治疗。及时的诊断可能会使癌症在可治疗的阶段被发现，并防止并发症。几十年来，这种想法一直支撑着英国医疗保健服务的设计，在患者癌症旅程的许多阶段都有举措。英格兰的愿望是到2028年，75%的癌症在I期或II期被诊断出来（因此可能是可治愈的），高于2018年的约53%。在英国，国家筛查可用于乳腺癌，结直肠癌和宫颈癌;然而，筛查仅识别10%的成人癌症，其余癌症患者表现出症状。大多数这些患者向他们的初级保健提供者提出，然后使用2周等待制度提供紧急调查，这保证了专家在这一时间范围内的投入。2周等待途径的选择遵循国家健康与护理卓越研究所（NICE）的指导，该研究所使用3%的癌症风险作为紧急调查的阈值风险。2具有非典型或低风险症状的患者通常会定期去看专家（不能保证很快被看到）。一些患者接受初级保健调查，如成像或血液检测，那些检测阳性，然后提供了2周的等待转诊。第三种主要的诊断途径是急诊入院，通常伴有癌症并发症，结果预后更差，生存率降低。3由于COVID-19大流行，这个混合系统现在处于混乱状态。由于英国的封锁，出现了两个主要变化。首先，患者感到害怕，特别是老年患者和现有健康状况的患者。许多人通过尽量减少自己和他人之间的互动来屏蔽，并尽可能呆在家里，并鼓励这样做。与此同时，英国国家医疗服务体系（NHS）迅速将其全面的医疗保健转变为几乎完全专注于护理COVID-19患者的医疗保健。癌症筛查于2020年3月下旬暂停（约8500名患者的结直肠筛查试验呈阳性，
Unquestionably, cancer should be diagnosed and treated without delay. Timely diagnosis might allow the cancer to be identified at a treatable stage and prevent complications. This thinking has underpinned the design of UK health-care delivery for decades, with initiatives at many stages of the patient’s cancer journey. The aspiration in England, is for 75% of cancers to be diagnosed at stage I or II (thus potentially curable) by 2028, up from approximately 53% in 2018. 1 National screening is available for breast, colorectal, and cervical cancers in the UK; however, screening identifies only 10% of adult cancers, leaving the remainder of patients with cancer to present with symptoms. Most of these patients present to their primary care provider and are then offered urgent investigation using the 2-week-wait system, which guarantees specialist input within that timeframe. Selection for the 2-week-wait pathway follows guidance from the National Institute for Health and Care Excellence (NICE), which used a cancer risk of 3% as a threshold risk warranting urgent investigation. 2 Patients with atypical or low-risk symptoms will generally see a specialist routinely (with no guarantee of being seen rapidly). Some patients undergo primary care investigations, such as imaging or blood testing, with those testing positive then offered a 2-weekwait referral. The third main route to diagnosis is by an emergency admission, generally with a complication of the cancer, and resultant worse prognosis and reduced survival. 3This hybrid system is now in disarray due to the COVID-19 pandemic. Two main changes have arisen as a consequence of the lockdown in the UK. First, patients are frightened, especially older patients and those with existing health conditions. Many are shielding by minimising interactions between themselves and others and staying home as much as possible, and are encouraged to do so. At the same time, the UK National Health Service (NHS) rapidly switched its comprehensive health care to one almost entirely focused on care for patients with COVID-19. Cancer screening was suspended in late March, 2020 (leaving around 8500 patients with a positive colorectal screening test,