Grunfeld E, Watters J M, Urquhart R, O'Rourke K, Jaffey J, Maziak D E, Morash C, Patel D, Evans W K
Cancer Outcomes Research Program, Cancer Care Nova Scotia and Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Br J Cancer. 2009 Jan 13;100(1):56-62. doi: 10.1038/sj.bjc.6604819. Epub 2008 Dec 16.
The objective of this study was to prospectively measure peri-diagnostic and surgical time intervals for patients with suspected colorectal, lung, or prostate cancer. Prospective eligible patients were referred to a regional hospital in Ottawa, Canada between February 2004 and February 2005 for diagnostic assessment of presumptive colorectal, lung, or prostate cancer. Chart abstractions were used to measure nine time intervals; the primary interval was the date of referral for diagnostic assessment to the date the patient was informed of the diagnosis. Health-related quality-of-life (HRQL) was assessed 5 days following the patient being informed of their diagnosis. The median (IQR) time for the primary interval was 71 (30-110), 37 (29-49), and 81 (56-100) days for colorectal, lung, and prostate patients, respectively (Kruskal-Wallis P=0.0001). This interval was significantly less for colorectal patients diagnosed with cancer than for those without cancer (median difference=59.0 days; Wilcoxon P=0.003). No differences in HRQL existed for patients with cancer and those without. Colorectal and prostate patients wait longer between referral for suspected cancer and being informed of their diagnosis than current recommendations. The shorter diagnostic intervals for colorectal patients with cancer suggest clinicians have an effective process for triaging patients referred for diagnostic assessment.
本研究的目的是前瞻性地测量疑似结直肠癌、肺癌或前列腺癌患者的诊断前后及手术时间间隔。2004年2月至2005年2月期间,符合条件的前瞻性患者被转诊至加拿大渥太华的一家地区医院,以对疑似结直肠癌、肺癌或前列腺癌进行诊断评估。通过病历摘要来测量九个时间间隔;主要间隔是从转诊进行诊断评估之日到患者被告知诊断结果之日。在患者被告知诊断结果5天后评估其健康相关生活质量(HRQL)。结直肠癌、肺癌和前列腺癌患者主要间隔的中位(四分位间距)时间分别为71(30 - 110)天、37(29 - 49)天和81(56 - 100)天(Kruskal - Wallis检验P = 0.0001)。被诊断患有癌症的结直肠癌患者的这一间隔明显短于未患癌症的患者(中位差异 = 59.0天;Wilcoxon检验P = 0.003)。患癌患者和未患癌患者的HRQL没有差异。结直肠癌和前列腺癌患者从疑似癌症转诊到被告知诊断结果的等待时间比当前建议的时间更长。患有癌症的结直肠癌患者诊断间隔较短,这表明临床医生在对转诊进行诊断评估的患者进行分诊方面有一个有效的流程。