丹麦西部实施国家肝癌快速通道临床路径的效果。

Effects of implementation of a national fast track clinical pathway for hepatocellular carcinoma in Western Denmark.

机构信息

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus,

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.

出版信息

J Gastrointestin Liver Dis. 2019 Mar;28(1):83-88. doi: 10.15403/jgld.2014.1121.281.dnk.

DOI:10.15403/jgld.2014.1121.281.dnk

PMID:30851176

Abstract

BACKGROUND AND AIMS

In 2009, the Danish Government instituted "Fast Track Clinical Pathways" (FTCP) to accelerate diagnosis and treatment of cancers including hepatocellular carcinoma (HCC). We examined how the implementation of FTCP affected the time from referral to diagnosis and treatment as well as the patient survival.

METHODS

309 consecutive patients with suspected HCC were included, 79 referred during the period 2007-2008 (before FTCP) and 230 during 2009-2011. Of those, 271 (88%) were diagnosed with HCC and 161 (60%) had cirrhosis, in most cases caused by alcohol.

RESULTS

The time from referral to the first visit was reduced from a mean 16.4 (11.5) to 5.4 (6) days (p<0.001) and the time from the first visit to the Multidisciplinary Tumour Conference (MDT) treatment decision from 34.9 (27.9) to 16.1 (14.4) days (p<0.001). The total time from referral to treatment was reduced from 53.2 (37.9) to 35.9 (23.1) days (p<0.001). There was a weak trend of improved survival after FTCP: 231 (147-368) vs. 293 (227-396) days (p=0.11).

CONCLUSIONS

The implementation of FTCP reduced the total time from referral to treatment by three weeks; however, without significant effects on overall mortality. While shortened waiting time is a comfort for the patient, it remains to be elucidated whether it will change the prognosis.

摘要

背景与目的

2009 年，丹麦政府实施了“快速通道临床路径”（FTCP），以加速包括肝细胞癌（HCC）在内的癌症的诊断和治疗。我们研究了 FTCP 的实施如何影响从转诊到诊断和治疗的时间以及患者的生存情况。

方法

共纳入 309 例疑似 HCC 患者，79 例于 2007-2008 年（FTCP 实施前）转诊，230 例于 2009-2011 年转诊。其中，271 例（88%）被诊断为 HCC，161 例（60%）患有肝硬化，大多数由酒精引起。

结果

从转诊到首次就诊的时间从平均 16.4（11.5）天缩短至 5.4（6）天（p<0.001），从首次就诊到多学科肿瘤会议（MDT）治疗决策的时间从 34.9（27.9）天缩短至 16.1（14.4）天（p<0.001）。从转诊到治疗的总时间从 53.2（37.9）天缩短至 35.9（23.1）天（p<0.001）。FTCP 实施后，生存时间有改善的趋势：231（147-368）天 vs. 293（227-396）天（p=0.11）。