Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Bartholins Allé 2, DK-8000 Aarhus C, Denmark.
Cancer Epidemiol. 2020 Apr;65:101690. doi: 10.1016/j.canep.2020.101690. Epub 2020 Feb 27.
The routes to diagnosis and the time intervals along the diagnostic pathway affect cancer outcomes. Some data on routes to diagnosis and milestone dates can be extracted from registries or databases. When this data is incomplete, inaccurate or non-existing, other data sources are needed. This study investigates the agreement between multiple data sources on routes to diagnosis and milestone dates of cancer pathway.
Information on routes to diagnosis and milestone dates were compared across four data sources (cancer patients, general practitioners, cancer specialists and registries) for breast, colorectal, lung and ovarian cancers across the UK, Scandinavia, Canada and Australia. Agreement on routes to diagnosis and milestone dates was assessed by Kappa and AC1 coefficients and Lin's concordance correlation coefficient (CCC).
4502 patients were included in the analysis of routes to diagnosis. The agreement was almost perfect (kappa = 0.15-0.88, AC1 = 0.86-0.91) for breast cancer, substantial to almost perfect (kappa = 0.07-0.86, AC1 = 0.74-0.93) for colorectal and ovarian cancers, and substantial (kappa = 0.09-0.11, AC1 = 0.65-0.74) for lung cancer. 2287 patients were included in the analysis of milestone dates. The agreement was adequate for all cancer types (CCC = 0.88-0.99); highest agreement was seen for date of diagnosis (CCC = 0.94-0.99).
We found a reasonable agreement between patient/physician questionnaires and registry data for routes to diagnosis and milestone dates. The agreement on routes to diagnosis was generally higher for breast cancer than for colorectal, ovarian and lung cancers. Lower agreement was seen on date of first presentation to primary care and date of treatment initiation compared to date of diagnosis.
诊断途径和诊断途径上的时间间隔会影响癌症的结局。一些关于诊断途径和里程碑日期的数据可以从登记处或数据库中提取。当这些数据不完整、不准确或不存在时，就需要其他数据源。本研究调查了多个数据源在癌症途径的诊断途径和里程碑日期上的一致性。
在英国、斯堪的纳维亚、加拿大和澳大利亚，对乳腺癌、结直肠癌、肺癌和卵巢癌患者的四个数据源（癌症患者、全科医生、癌症专家和登记处）的诊断途径和里程碑日期信息进行了比较。通过 Kappa 和 AC1 系数以及 Lin 的一致性相关系数（CCC）评估了诊断途径和里程碑日期的一致性。
共纳入 4502 例患者进行诊断途径分析。对于乳腺癌，一致性几乎为完美（kappa=0.15-0.88，AC1=0.86-0.91），对于结直肠癌和卵巢癌，一致性为高度到几乎完美（kappa=0.07-0.86，AC1=0.74-0.93），对于肺癌，一致性为高度（kappa=0.09-0.11，AC1=0.65-0.74）。共纳入 2287 例患者进行里程碑日期分析。所有癌症类型的一致性均为适度（CCC=0.88-0.99），诊断日期的一致性最高（CCC=0.94-0.99）。
我们发现患者/医生问卷和登记数据在诊断途径和里程碑日期方面具有合理的一致性。对于乳腺癌，诊断途径的一致性一般高于结直肠癌、卵巢癌和肺癌。与诊断日期相比，首次就诊初级保健和开始治疗的日期的一致性较低。
