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Cancer Epidemiol. 2021 Aug;73:101969. doi: 10.1016/j.canep.2021.101969. Epub 2021 Jun 19.
A standard measure of the cancer diagnostic pathway, diagnostic interval, is the time from "first presentation of cancer" to diagnosis. Cancer presentation may be unclear in patients with multimorbidity or non-specific symptoms, signs or test results ("features"). We propose an alternative, guideline interval, with a more certain start date; namely, when the patient first meets suspected-cancer criteria for investigation or referral.
This retrospective cohort study used Clinical Practice Research Datalink (CPRD) and English cancer registry data. Participants, aged ≥55 years, had diagnostic codes for oesophagogastric cancers in 1/1/12-31/12/17. Features of oesophagogastric cancer in the year before diagnosis were identified from CPRD codes for dysphagia, haematemesis, upper-abdominal mass or pain, low haemoglobin, reflux, dyspepsia, nausea, vomiting, weight loss or thrombocytosis. Diagnostic interval was the time from first feature to diagnosis; guidance interval, the time from first meeting criteria in NICE suspected-cancer guidance to diagnosis. Multimorbidity burden was quantified using Adjusted Clinical Groups®. Accelerated failure-time models explored associations between multimorbidity burden and length of both diagnostic and guideline interval.
There were 3,793 eligible participants (69.0 % male), mean age 74.1 years (SD 10.5). 3,097 (81.7 %) presented with ≥1 feature in the year before diagnosis, and 1,990 (52.5 %) met NICE suspected-cancer criteria. The median for both intervals was 11 days in healthy users, and rose with increasing morbidity burden. At very high multimorbidity burden, diagnostic interval was 5.47 (95%CI 3.25-9.20) times longer and guideline interval was 3.91 (2.63-5.80) times longer than for healthy users.
Guideline interval is proposed as a new measure of the cancer diagnostic pathway. It has a more certain start date than diagnostic interval, and is lengthened less than diagnostic interval in people with a very high multimorbidity burden. Guideline interval has potential for assessing the implementation of suspected-cancer policies.
癌症诊断途径的一个标准衡量指标是诊断间隔，即从“癌症首次出现”到诊断的时间。患有多种疾病或症状、体征或检查结果不明确的患者（“特征”）可能诊断不明确。我们提出了一种替代方案，即指南间隔，其开始日期更为确定；即当患者首次符合疑似癌症的检查或转诊标准时。
本回顾性队列研究使用了临床实践研究数据库（CPRD）和英国癌症登记数据。参与者年龄≥55 岁，在 2012 年 1 月 1 日至 2017 年 12 月 31 日期间有食管胃交界癌的诊断代码。在诊断前一年，从 CPRD 代码中识别出食管癌和胃癌的特征，包括吞咽困难、呕血、上腹部肿块或疼痛、低血红蛋白、反流、消化不良、恶心、呕吐、体重减轻或血小板增多。诊断间隔是从首次出现特征到诊断的时间；指南间隔是从符合 NICE 疑似癌症指南的标准到诊断的时间。使用调整后的临床组（Adjusted Clinical Groups®）量化多疾病负担。加速失效时间模型探索了多疾病负担与诊断和指南间隔长度之间的关联。
共纳入 3793 名符合条件的参与者（69.0%为男性），平均年龄为 74.1 岁（标准差为 10.5）。3097 名（81.7%）在诊断前一年有≥1 个特征，1990 名（52.5%）符合 NICE 疑似癌症标准。健康人群的两个间隔中位数均为 11 天，且随着发病率的增加而增加。在极高的多发病负担下，诊断间隔比健康人群长 5.47 倍（95%CI 3.25-9.20），指南间隔长 3.91 倍（2.63-5.80）。
本研究提出了一种新的癌症诊断途径的衡量指标，即指南间隔。它的开始日期比诊断间隔更为确定，并且在患有极高多发病负担的人群中，其延长程度小于诊断间隔。指南间隔有可能用于评估疑似癌症政策的实施情况。
