The faster the better? — A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways

Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Psycho-Oncology (Impact Factor: 2.44). 08/2012; 21(1):1-10. DOI: 10.1002/pon.1929
Source: PubMed


To perform a systematic review of articles published in the last 25 years on prevalence and course of distress and quality of life surrounding the diagnostic process of suspected cancer, and the influence of rapid diagnostic programs.
Twenty-three articles were identified via Pubmed, PsycINFO, and reference lists of articles. Except for three randomized clinical trials and one case control study all studies were uncontrolled cohort studies.
Most studies involved patients with suspected breast cancer and therefore had a sex selection bias. Four studies on the effect of rapid outpatient diagnostic programs were found.Studies showed very high prevalence of anxiety, decreasing in case of a benign diagnosis but increasing or sustaining in patients waiting for results or after cancer diagnosis though not significantly more in rapid programs. Quality of life was low and showed varying patterns.
Distress in the diagnostic phase of cancer is a major problem and the rapid decrease of anxiety in patients eventually not diagnosed with cancer suggests a benefit of rapid diagnostic programs. The available evidence however is limited and shows some inconsistencies. Studies differ in subjects, objective and are limited by quality and quantity. Conflicting results prohibit a conclusion on patients ultimately diagnosed with cancer.

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    ABSTRACT: Delays in the diagnosis of lung cancer are under debate and may affect outcome. The objectives of this study were to compare various delays in a rapid outpatient diagnostic program (RODP) for suspected lung cancer patients with those described in literature and with guideline recommendations, to investigate the effects of referral route and symptoms on delays, and to establish whether delays were related to disease stage and outcome. A retrospective chart study was conducted of all patients with suspected lung cancer, referred to the RODP of our tertiary care university clinic between 1999 and 2009. Patient characteristics, tumor stage and different delays were analyzed. Medical charts of 565 patients were retrieved. 290 patients (51.3%) were diagnosed with lung cancer, 48 (8.5%) with another type of malignancy, and in 111 patients (19.6%) the radiological anomaly was diagnosed as non-malignant. In 112 (19.8%) no immediate definite diagnosis was obtained, however in 82 of these cases (73.2%) the proposed follow-up strategy confirmed a benign outcome. The median first line delay was 54 days, IQR (interquartile range) 20-104 days, median patient delay 19 days (IQR 4-52 days), median referral delay was 7 days (IQR 5-9 days), median diagnostic delay 2 days (IQR 1-19 days). In 87% a diagnosis was obtained within 3 weeks after visiting a chest physician and 52.5% started curative therapy within 2 weeks after diagnosis. Patients presenting with hemoptysis had shorter first line delays. The RODP care was generally far more timely compared to literature and published guidelines, except for both referral and palliative therapeutic delay. No specific delay was significantly related to disease stage or survival. An RODP results in a timely diagnosis well within guideline recommendations. Patient and first line delay account for most of total patient delay. Within the limitations of this retrospective study, we found no association with disease stage or survival.
    No preview · Article · Sep 2011 · Lung cancer (Amsterdam, Netherlands)

  • No preview · Article · Mar 2013 · Chest
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    ABSTRACT: Introduction: Despite the progress which has been made in the diagnosis and treatment of lung cancer, it is still one of the main causes of death in both men and women. The introduction of new therapeutic modalities did not improve the 5-year survival results of lung cancer patients. The Lublin Voivodeship is a sparsely-inhabited area with little urbanization and a population of about 2.2 million people. Only 46.8% of its citizens live in the towns, while the national average is 61.9%. Objectives: The aim of the study was to compare the differences in the periods of time and reasons for delay in diagnosis and initiation of treatment of lung cancer among patients who are inhabitants of the rural and urban regions of Lublin Voivodeship, and who were consulted in Thoracic Surgery Department. Materials and methods: 300 lung cancer patients who were consulted in the Thoracic Surgery Outpatient Clinic or who were hospitalized in the Department of Thoracic Surgery in the period between 2 January 2010 - 7 January 2011 were included in the study. Delays were calculated for two periods of time: 1) time from the first signs of the disease to the first medical examination; 2) the time from the first visit to a doctor to the start of treatment, or disqualification from the causative treatment. The time of the first delay for the urban and rural populations was similar and ranged from 2-37 weeks and 2-23 weeks, respectively. Lack of time and disregard of signs of disease were the most commonly reasons given for the first delay among rural residents. The urban population indicated fear and lack of time as the main reasons of delay. Assessment of the second reason for delay was possible thanks to a specially designed research protocol which gathered the main reasons of delay in several subgroups that enabled their statistical evaluation. The length of second period was similar for both populations. Results: There were no significant differences in the length of the time of delay between the two assessed groups. In both groups, delays dependent on poor healthcare access were similar. Among rural inhabitants, the most often reasons of delay were waiting for hospital admission and re-bronchoscopy. In the urban population, the most common reasons for delay were waiting for hospitalization and CT procedure. Conclusions: The results of the presented research allowed the following conclusions to be drawn: between the two assessed groups there were no differences in the length of the time of delay; 2) delays in diagnosis and treatment were too long for the patients and could affect the severity of the disease and final prognosis; 3) there is a need for intensification of information campaigns on lung cancer in order to reduce the delays dependent on patients, and to improve the cooperation of family doctors, pulmonologists, thoracic surgeons and oncologists.
    No preview · Article · Mar 2013 · Annals of agricultural and environmental medicine: AAEM
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