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Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral
Current Oncology ( IF 2.6 ) Pub Date : 2021-01-11 , DOI: 10.3390/curroncol28010040
Satya Rashi Khare , Sreenath Arekunnath Madathil , Gerald Batist , Isabelle Vedel ,

BACKGROUND Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral. METHODS In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling (n = 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities. RESULTS 68% of the patients followed a pathway where family physician (FP) visits were dominant ("FP-centric") and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant ("ED-centric"). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12-111) vs. 22 (IQR: 5-69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit. CONCLUSIONS Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.

中文翻译:

从首次就诊到专科转诊的肺癌预诊断途径

背景肺癌通常在晚期被诊断出,并且具有高相关死亡率。及时诊断取决于及时转诊至呼吸科专家;然而,在加拿大,人们对患者如何通过初级保健获得呼吸专科医生知之甚少。因此,我们旨在识别和描述初级保健中从首次就诊到转诊的肺癌预诊断途径。方法 在这项回顾性队列研究中,从魁北克蒙特利尔的肺癌中心通过连续抽样(n = 50)招募了原发性肺癌患者。从图表审查和结构化患者访谈中收集初级保健中医疗保健服务利用的数据,并使用潜在类别分析进行分析,以确定具有相似预诊断路径的患者组。每组都根据患者和肿瘤相关特征以及利用活动的顺序进行描述。结果 68% 的患者遵循以家庭医生 (FP) 就诊为主(“以 FP 为中心”)的途径,32% 遵循以步入式诊所和急诊科 (ED) 就诊为主的途径(“以 ED 为中心” ”)。FP 组的转诊时间是 ED 组的两倍(45 天(IQR:12-111)与 22 天(IQR:5-69)),疾病更晚期(65% 对 50%)。在 FP 组中,29% 的患者在被转诊前看过他们的 FP 3 次或更多次,41% 的患者曾就诊过 ED。结论我们的研究结果可能反映了在初级保健中诊断肺癌的挑战,错过了早期诊断的机会,以及初级保健和专科保健之间缺乏整合。
更新日期:2021-01-11
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