Department of Anthropology, School of Culture and Society, Aarhus University, Højbjerg, Denmark.
Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Aarhus C, Denmark.
Eur J Cancer Care (Engl). 2019 Sep;28(5):e13100. doi: 10.1111/ecc.13100. Epub 2019 May 22.
To investigate the relationship between tumour stage at diagnosis and selected components of primary and secondary care in the diagnostic interval for breast, colorectal, lung and ovarian cancers.
Observational study based on data from 6,162 newly diagnosed symptomatic cancer patients from Module 4 of the International Cancer Benchmarking Partnership. We analysed the odds of advanced stage of cancer as a flexible function of the length of primary care interval (days from first presentation to referral) and secondary care interval (days from referral to diagnosis), respectively, using logistic regression with restricted cubic splines.
The association between time intervals and stage was similar for each type of cancer. A statistically significant U-shaped association was seen between the secondary care interval and the diagnosis of advanced rather than localised cancer, odds decreasing from the first day onwards and increasing around three and a half months. A different pattern was seen for the primary care interval, flat trends for colorectal and lung cancers and a slightly curved association for ovarian cancer, although not statistically significant.
The results confirm previous findings that some cancers may progress even within the relatively short time frame of regulated diagnostic intervals. The study supports the current emphasis on expediting symptomatic diagnosis of cancer.
探讨诊断时肿瘤分期与乳腺癌、结直肠癌、肺癌和卵巢癌诊断间隔期内初级和二级保健选定组成部分之间的关系。
基于国际癌症基准合作组织第 4 模块中 6162 名新诊断的有症状癌症患者的数据进行观察性研究。我们使用逻辑回归和限制立方样条分别分析了初级保健间隔期（从首次就诊到转诊的天数）和二级保健间隔期（从转诊到诊断的天数）的长度对癌症晚期的几率的影响。
每种癌症的时间间隔与分期之间的关联相似。二级保健间隔期与晚期而非局部癌症的诊断呈显著的 U 型关联，从第一天开始，几率逐渐下降，大约三个月半后逐渐上升。初级保健间隔期的情况则不同，结直肠癌和肺癌的趋势较为平坦，而卵巢癌的关联则稍微弯曲，但无统计学意义。
研究结果证实了之前的发现，即某些癌症可能在监管诊断间隔期的相对较短时间内进展。本研究支持当前加快癌症症状诊断的重点。
