The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia.
Cancer Council NSW, Sydney, NSW, Australia.
Cancer Causes Control. 2023 Jan;34(1):47-58. doi: 10.1007/s10552-022-01634-2. Epub 2022 Oct 9.
To determine pathways to endometrial or ovarian cancer diagnosis by comparing health service utilization between cancer cases and matched cancer-free controls, using linked health records.
From cancer registry records, we identified 238 incident endometrial and 167 ovarian cancer cases diagnosed during 2006-2013 in the Australian 45 and Up Study cohort (142,973 female participants). Each case was matched to four cancer-free controls on birthdate, sex, place of residence, smoking status, and body mass index. The use of relevant health services during the 13-18-, 7-12-, 0-6-, and 0-1-months pre-diagnosis for cases and the corresponding dates for their matched controls was determined through linkage with subsidized medical services and hospital records.
Healthcare utilization diverged between women with cancer and controls in the 0-6-months, particularly 0-1 months, pre-diagnosis. In the 0-1 months, 74.8% of endometrial and 50.3% of ovarian cases visited a gynecologist/gynecological oncologist, 11.3% and 59.3% had a CA125 test, 5.5% and 48.5% an abdominal pelvic CT scan, and 34.5% and 30.5% a transvaginal pelvic ultrasound, respectively (versus ≤ 1% of matched controls). Moreover, 25.1% of ovarian cancer cases visited an emergency department in the 0-1-months pre-diagnosis (versus 1.3% of matched controls), and GP visits were significantly more common for cases than controls in this period.
Most women with endometrial or ovarian cancer accessed recommended specialists and tests in the 0-1-months pre-diagnosis, but a high proportion of women with ovarian cancer visited an emergency department. This reinforces the importance of timely specialist referral.
通过比较癌症病例和匹配的无癌症对照者的卫生服务利用情况，利用关联健康记录确定子宫内膜癌或卵巢癌诊断的途径。
从癌症登记记录中，我们在澳大利亚 45 岁及以上研究队列（142973 名女性参与者）中确定了 2006-2013 年间诊断的 238 例子宫内膜癌和 167 例卵巢癌病例。每个病例都按出生日期、性别、居住地、吸烟状况和体重指数与 4 名无癌症对照者相匹配。通过与补贴医疗服务和医院记录的链接，确定了病例和相应对照者在诊断前 13-18 个月、7-12 个月、0-6 个月和 0-1 个月期间的相关卫生服务使用情况。
在诊断前 0-6 个月，尤其是 0-1 个月期间，癌症女性和对照组之间的医疗保健使用情况出现差异。在 0-1 个月期间，74.8%的子宫内膜癌病例和 50.3%的卵巢癌病例看了妇科医生/妇科肿瘤医生，11.3%和 59.3%做了 CA125 测试，5.5%和 48.5%做了腹部盆腔 CT 扫描，34.5%和 30.5%做了阴道超声检查（而匹配对照组的比例均≤1%）。此外，25.1%的卵巢癌病例在诊断前 0-1 个月期间看了急诊（而匹配对照组的比例为 1.3%），而且在这段时间内，看全科医生的病例明显多于对照组。
大多数子宫内膜癌或卵巢癌患者在诊断前 0-1 个月内接受了推荐的专家和检查，但相当一部分卵巢癌患者去了急诊。这再次强调了及时转介专家的重要性。
