Sundquist Jan, Palmér Karolina, Rydén Stefan, Sävblom Charlotta, Ji Jianguang, Stenman Emelie
Center for Primary Health Care Research, Skåne Regional Council, Lund University, Malmö, Sweden.
Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Front Oncol. 2020 Nov 30;10:561379. doi: 10.3389/fonc.2020.561379. eCollection 2020.
Fast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries. Our objective was to analyze time intervals in the diagnostic routes of patients diagnosed with cancer at Sweden's first Diagnostic Center (DC) for nonspecific symptoms and compare with time intervals of matched control patients.
Adult patients with nonspecific symptoms that could not be explained by an initial investigation in primary care were eligible for referral to the DC. Patients diagnosed with cancer were matched with patients at another hospital within the same healthcare organization. We aimed for two control patients per DC-patient and matched on tumor type, age and sex. Five time intervals were compared: 1) patient interval (first symptom-primary care contact), 2) primary care interval (first visit-referral to the DC/secondary care), 3) diagnostic interval (first visit-cancer diagnosis), 4) information interval (cancer diagnosis-patient informed) and 5) treatment interval (cancer diagnosis-treatment start). Comparisons between groups and matched cohort analyses were made.
Sixty-four patients (22.1%) were diagnosed with cancer at the DC, of which eight were not matchable. Forty-two patients were matched with two controls and 14 were matched with one control. There were no significant differences in patient-, primary care-, or diagnostic intervals between the groups. The information interval was shorter at the DC compared to the control group (difference between matched pairs 7 days, p = 0.001) and the treatment interval was also shorter at the DC with significant differences in the matched analysis (difference between matched pairs 13 days, p = 0.049). The findings remained the same in four sensitivity analyses, made to compensate for differences between the groups.
Up to diagnosis, we could not detect significant differences in time intervals between the DC and the control group. However, the shorter information and treatment intervals at the DC should be advantageous for these patients who will get timely access to treatment or palliative care. Due to limitations regarding comparability between the groups, the results must be interpreted with caution and further research is warranted.
ClinicalTrials.gov-ID: NCT01709539. Registration-date: October 18, 2012.
几个国家已经为有非特异性严重症状的患者实施了快速转诊途径。我们的目的是分析瑞典首个针对非特异性症状的诊断中心（DC）诊断为癌症的患者诊断路径中的时间间隔，并与匹配的对照患者的时间间隔进行比较。
在初级保健中经过初步检查无法解释非特异性症状的成年患者有资格被转诊至DC。诊断为癌症的患者与同一医疗保健机构内另一家医院的患者进行匹配。我们的目标是为每位DC患者匹配两名对照患者，并按肿瘤类型、年龄和性别进行匹配。比较了五个时间间隔：1）患者间隔（首次症状-初级保健接触），2）初级保健间隔（首次就诊-转诊至DC/二级保健），3）诊断间隔（首次就诊-癌症诊断），4）信息间隔（癌症诊断-患者被告知）和5）治疗间隔（癌症诊断-治疗开始）。进行了组间比较和匹配队列分析。
64名患者（22.1%）在DC被诊断为癌症，其中8名无法匹配。42名患者与两名对照匹配，14名患者与一名对照匹配。两组之间在患者、初级保健或诊断间隔方面没有显著差异。与对照组相比，DC的信息间隔更短（匹配对之间的差异为7天，p = 0.001），并且DC的治疗间隔也更短，在匹配分析中有显著差异（匹配对之间的差异为13天，p = 0.049）。在进行的四项敏感性分析中，为弥补组间差异，结果保持不变。
直至诊断时，我们未发现DC与对照组在时间间隔上有显著差异。然而，DC较短的信息和治疗间隔对于这些将及时获得治疗或姑息治疗的患者应该是有利的。由于组间可比性存在局限性，结果必须谨慎解释，并且有必要进行进一步研究。
ClinicalTrials.gov标识符：NCT01709539。注册日期：2012年10月18日。
