Delay in Cancer Diagnosis and Factors Affecting Outcomes

Editorial

12 July 2024

Editorial: Delay in cancer diagnosis and factors affecting outcomes

Sara Haddadi

Mehdi Dehghani

and

Gina D'Amato

1,251 views

1 citations

Editors

Sara Haddadi

Sylvester Comprehensive Cancer Center, University of Miami Health System

Mehdi Dehghani

Shiraz University of Medical Sciences

Gina D'Amato

Sylvester Comprehensive Cancer Center, University of Miami Health System

Impact

Original Research

03 November 2023

Avoidance of medical care among American Indians with a history of cancer during the coronavirus pandemic

Sixia Chen

, 5 more and

Mark P. Doescher

Objectives: Assess the percentage of cancer-related appointment delays, cancelations, and the unavailability of medications experienced by American Indian participants during the COVID-19 pandemic.

Methods: This cross-sectional survey study was completed between October 2020 and July 2021 by 360 individuals with cancer who lived in California and Oklahoma. Binary and multivariate logistic regression analysis was completed in SAS 9.4.

Results: During the initial Covid-19 pandemic, almost one-third (30%) of respondents delayed cancer-related appointments, 42% canceled cancer-related appointments, and one-quarter (24%) were unable to access prescription medications or over-the-counter medications (27%) due to COVID-19. People who underwent testing for COVID-19 were five times more likely to delay a medical appointment [adjusted odds ratio (aOR) = 5.3, 95% CI:2.4, 11.7] and people who followed three or more social distancing measures were more than six times more likely to cancel medical appointments (aOR:6.3, 95% CI:2.9, 13.9).

Conclusion: This study identifies delays, cancelations, and medication inaccessibility people identifying as American Indian faced during the coronavirus pandemic. Disparities in healthcare delivery could contribute to increased morbidity and mortality rates of cancer.

1,999 views

2 citations

Brief Research Report

18 October 2023

Nonbiological factors affecting outcomes in adolescents and young adults with lymphoma

Aditi Dhir

, 2 more and

Ana C. Xavier

1,305 views

1 citations

Forest plot representing the pooled median duration and 95% confidence intervals for the patient (A), diagnostic (B), and treatment (C) intervals in oral cancer. The asterisk (*) represents a median obtained from only one study, which prevented an estimation of the confidence interval. CI, confidence interval; IQR, interquartile range. k: number of studies or, alternatively, number of groups of patients in whom an interval duration was measured (e.g., a study may have reported the duration of the treatment interval for women and men separately). N: number of patients with available information on each interval’s duration.

Systematic Review

08 August 2023

The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis

Nicolás Francisco Fernández-Martínez

, 7 more and

María José Sánchez

Introduction: Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival.

Materials and methods: We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist.

Results: Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31–73), k = 18, of the diagnosis interval 35 days (95% CI = 21–38), k = 11, and of the treatment interval 30 days (95% CI = 23–53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates.

Conclusion: Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.

2,947 views

4 citations

Original Research

14 February 2023

Impact of COVID-19 pandemic on outpatient visit volume in cancer patients: Results of COMETA multicenter retrospective observational study

Vincenza Frisardi

, 16 more and

Nicola Silvestris

Objective: To evaluate the impact of the COVID-19 pandemic on first and follow-up visits for cancer outpatients.

Methods: This is a multicenter retrospective observational study involving three Comprehensive Cancer Care Centers (CCCCs): IFO, including IRE and ISG in Rome, AUSL-IRCCS of Reggio Emilia, and IRCCS Giovanni Paolo II in Bari) and one oncology department in a Community Hospital (Saint'Andrea Hospital, Rome). From 1 January 2020 and 31 December 2021, we evaluated the volume of outpatient consultations (first visits and follow-up), comparing them with the pre-pandemic year (2019). Results were analyzed by quarter according to the Rt (real-time indicator used to assess the evolution of the pandemic). IFO and IRCCS Giovanni Paolo II were “COVID-free” while AUSL-IRCCS RE was a “COVID-mixed” Institute. Depending on the Rt, Sain't Andrea Hospital experienced a “swinging” organizational pathway (COVID-free/ COVID-mixed).

Results: Regarding the “first appointments”, in 2020 the healthcare facilities operating in the North and Center of Italy showed a downward trend. In 2021, only AUSL-IRCCS RE showed an upward trend. Regarding the “follow-up”, only AUSL IRCCS RE showed a slight up-trend in 2020. In 2021, IFO showed an increasing trend, while S. Andrea Hospital showed a negative plateau. Surprisingly, IRCCS Giovanni Paolo II in Bari showed an uptrend for both first appointment and follow-ups during pandemic and late pandemic except for the fourth quarter of 2021.

Conclusions: During the first pandemic wave, no significant difference was observed amongst COVID-free and COVID-mixed Institutes and between CCCCs and a Community Hospital. In 2021 (“late pandemic year”), it has been more convenient to organize COVID-mixed pathway in the CCCCs rather than to keep the Institutions COVID-free. A swinging modality in the Community Hospital did not offer positive results in term of visit volumes. Our study about the impact of COVID-19 pandemic on visit volume in cancer outpatients may help health systems to optimize the post-pandemic use of resources and improve healthcare policies.

1,657 views

3 citations

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