Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, 33014, Finland.
Cancer Society of Finland, Unioninkatu 22, 00130, Helsinki, Finland.
BMC Health Serv Res. 2023 Mar 23;23(1):279. doi: 10.1186/s12913-023-09298-7.
Colorectal cancer (CRC) patient pathways focus typically on periods after confirmed diagnosis and only limited data are available on pathways prior to cancer diagnosis. The aim of the study was to describe the use of health services (HS) one year before diagnosis among CRC patients in Finland. We also studied the role of sex, age, stage, and university hospital district in relation to the use of HS during the pre-diagnostic phase. This information is expected to bring light on the question why CRC is often not found in its early stages.
Incident CRC cases (N = 3115) concerning year 2015 were retrieved from the Finnish Cancer Registry and linked with data from the Finnish Institute for Health and Welfare on primary or specialised care outpatient visits or inpatient episodes over one year prior to CRC diagnosis. We modelled the average number of HS events per patient using Poisson regression model with log-link. Change points for monthly HS event rates and 95% CIs one year before diagnosis were evaluated using Poisson broken line regression models.
Around 10% of patients diagnosed in 2015 had no events prior to cancer leaving 2816 CRCs in the study. Of all pre-diagnostic events (N = 23268), 86% were outpatient events and 14% inpatient episodes. More than half of the inpatient episodes (65%) started as urgent admissions. The use of HS started to increase 3-4 months before diagnosis. The average number of pre-diagnostic HS events per patient varied by sex, age, stage and university hospital district. Overall, men had more events per patient than women and older patients had more events than younger patients.
The amount of inpatient episodes starting as urgent admissions indicate potential bottlenecks in the access to health services. An increase in service use only 3-4 months prior to diagnosis reflects a need for advice both for health care professionals and the general population in recognising symptoms of CRC.
结直肠癌（CRC）患者的治疗路径通常集中在确诊后，而关于诊断前的治疗路径仅有有限的数据。本研究旨在描述芬兰 CRC 患者在确诊前一年使用卫生服务（HS）的情况。我们还研究了性别、年龄、分期和大学医院区在诊断前阶段使用 HS 方面的作用。这些信息有望阐明为什么 CRC 常常不能在早期发现的问题。
从芬兰癌症登记处检索了 2015 年的 CRC 新发病例（N=3115），并与芬兰卫生福利研究所关于患者在确诊前一年的初级或专科门诊就诊或住院治疗的数据进行了链接。我们使用泊松回归模型（对数链接）来模拟每位患者的平均 HS 事件数。使用泊松折线回归模型评估诊断前一年每月 HS 事件率及其 95%CI 的变化点。
2015 年诊断的患者中约有 10%在癌症诊断前没有就诊记录，因此本研究共纳入 2816 例 CRC 患者。在所有的诊断前事件（N=23268）中，86%为门诊事件，14%为住院事件。超过一半的住院事件（65%）为紧急入院。HS 的使用在诊断前 3-4 个月开始增加。每位患者的诊断前 HS 事件数量因性别、年龄、分期和大学医院区而异。总体而言，男性患者的就诊次数多于女性患者，老年患者的就诊次数多于年轻患者。
以紧急入院形式开始的住院事件数量表明在获得卫生服务方面存在潜在瓶颈。仅在诊断前 3-4 个月增加服务使用反映了需要向医疗保健专业人员和一般人群提供有关识别 CRC 症状的建议。
