Howell D A, Smith A G, Roman E
Epidemiology & Genetics Unit, Department of Heath Sciences, Seebohm Rowntree Building, University of York, York, UK.
Eur J Cancer Care (Engl). 2006 Jul;15(3):272-8. doi: 10.1111/j.1365-2354.2006.00651.x.
This study examines illness trajectories of patients with lymphoma and assesses whether UK government targets to reduce waiting time for diagnosis and treatment are achievable and appropriate. One hundred and ninety-four patients, residents in West Yorkshire, aged more than 25 years and newly diagnosed with lymphoma during 2000 were included. Data collected from interviews, primary care and hospital records were used to examine time between critical events on the illness trajectory and characteristics of patients not meeting proposed targets. Forty-two per cent of patients did not receive a hospital appointment within 2 weeks of general practitioner referral, 26% were not treated within 1 month of diagnosis and 64% were not treated within 2 months of referral. Target achievement differed by diagnostic group, and trends were seen by age and deprivation. The interval from onset of symptoms to treatment averaged more than 1 year and approximately half of this occurred before first medical contact. Results suggest that significant improvements are needed to achieve targets. Although existing targets particularly address referral and treatment intervals, these were the shortest intervals on the trajectory. Generalized targets may be inappropriate and unachievable for lymphoma as they do not consider individual disease characteristics or allow for variations in the urgency with which treatment is needed.
本研究调查了淋巴瘤患者的疾病轨迹，并评估了英国政府减少诊断和治疗等待时间的目标是否可实现及是否恰当。研究纳入了194名居住在西约克郡、年龄超过25岁且于2000年新诊断为淋巴瘤的患者。从访谈、初级保健和医院记录中收集的数据，用于研究疾病轨迹上关键事件之间的时间间隔以及未达到既定目标的患者特征。42%的患者在全科医生转诊后2周内未获得医院预约，26%的患者在诊断后1个月内未接受治疗，64%的患者在转诊后2个月内未接受治疗。目标达成情况因诊断组而异，且在年龄和贫困程度方面呈现出一定趋势。从症状出现到治疗的间隔平均超过1年，其中约一半时间发生在首次就医之前。结果表明，要实现目标需要大幅改进。尽管现有目标特别关注转诊和治疗间隔，但这些是疾病轨迹上最短的间隔。针对淋巴瘤的通用目标可能不合适且无法实现，因为它们没有考虑个体疾病特征，也没有考虑到治疗所需紧迫性的差异。
