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[Cancer treatment in Skane and in Sjaelland. Do differences concerning examination and treatment explain reduced survival among Danish cancer patients?]

https://arctichealth.org/en/permalink/ahliterature19989
Source
Ugeskr Laeger. 2001 Jan 22;163(4):439-42
Publication Type
Article
Date
Jan-22-2001
Author
L K Specht
T. Landberg
Author Affiliation
Onkologisk klinik, Finsencentret, H:S Rigshospitalet, DK-2100 København ø.
Source
Ugeskr Laeger. 2001 Jan 22;163(4):439-42
Date
Jan-22-2001
Language
Danish
Publication Type
Article
Keywords
Bladder Neoplasms - diagnosis - therapy
Breast Neoplasms - diagnosis - therapy
Clinical Competence
Colonic Neoplasms - diagnosis - therapy
Comparative Study
Denmark - epidemiology
English Abstract
Female
Humans
Lung Neoplasms - diagnosis - therapy
Male
Neoplasms - diagnosis - mortality - therapy
Oncologic Nursing - standards - statistics & numerical data
Oncology Service, Hospital - standards - statistics & numerical data
Physician's Practice Patterns
Survival Rate
Sweden - epidemiology
Abstract
INTRODUCTION: Danish cancer patients generally have a poorer survival than Swedish cancer patients. The difference is most pronounced for certain tumour types, e.g. common types such as lung, breast, colorectal, and prostate cancer. The reasons are not clear. The present article examines if differences in the diagnostic workup and treatment can explain some of this variation. MATERIAL AND METHODS: Aspects of the diagnostic workup and treatment of the above mentioned four cancer types are examined using data from cancer registry analyses and official reports. These data are seen in the context of counts of trained personnel and equipment in cancer diagnostics and treatment in the two countries. RESULTS: With regard to lung and breast cancer, the data seem to indicate that Danish patients are diagnosed later, and that Denmark lags behind in treatment capacity. With regard to rectal cancer, the data seem to indicate that concentrating operations in fewer hospitals, and improvements in operation technique have been introduced earlier in Sweden than in Denmark. With regard to prostate cancer, however, the data seem to indicate that many more indolent cases that do not need treatment are diagnosed in Sweden than in Denmark. The total capacity for oncologic treatment, both in terms of trained personnel and equipment, seen in relation to the size of the population, is considerably larger in Southern Sweden than in Eastern Denmark. DISCUSSION: The data for some of the common cancer types seem to indicate that problems in the areas of sufficient capacity for diagnostic workup and treatment may explain some of the difference in survival between Danish and Swedish cancer patients.
PubMed ID
11218779 View in PubMed
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Lung cancer practice guidelines: lessons learned and issues addressed by the Ontario Lung Cancer Disease Site Group.

https://arctichealth.org/en/permalink/ahliterature207614
Source
J Clin Oncol. 1997 Sep;15(9):3049-59
Publication Type
Article
Date
Sep-1997
Author
W K Evans
T. Newman
I. Graham
J J Rusthoven
D. Logan
F A Shepherd
D. Chamberlain
Author Affiliation
Ontario Cancer Treatment and Research Foundation, Ottawa Regional Cancer Centre, Canada. bevans@cancercare.on.ca
Source
J Clin Oncol. 1997 Sep;15(9):3049-59
Date
Sep-1997
Language
English
Publication Type
Article
Keywords
Canada
Clinical Trials as Topic
Conflict of Interest
Humans
Lung Neoplasms - diagnosis - therapy
Ontario
Physician's Practice Patterns - standards
Practice Guidelines as Topic - standards
Randomized Controlled Trials as Topic
Abstract
The primary objective was to identify the lessons learned and issues addressed by the Disease Site Group (DSG) developing guidelines on lung cancer for practitioners in the province of Ontario.
The minutes of the Ontario Lung Cancer Disease Site Group (LCDSG) and the meeting notes of a medical sociologist who attended all LCDSG meetings were reviewed to identify the disease-specific and generic issues addressed by the LCDSG during guideline development.
The Ontario LCDSG has completed three practice guidelines and has five evidence-based recommendations (EBRs) in production. Topics for guideline development were selected on the basis of known practice variability (eg, advanced-stage non-small-cell lung cancer [NSCLC]); the size of the patient population that could potentially be affected by the guideline; results of phase II trials of new and potentially expensive agents (vinorelbine, paclitaxel, and docetaxel); and randomized controlled clinical trials that support new practice standards (combined modality therapy for unresectable stage III NSCLC). The wording of each EBR reflects the strength and quality of the evidence in support of the treatment option, the primary outcome(s), and the individual physician and discipline values concerning treatment outcomes in the absence of known patient values.
Notes
Comment In: J Clin Oncol. 1997 Sep;15(9):3027-99294464
PubMed ID
9294467 View in PubMed
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Medical complexity and time to lung cancer treatment - a three-year retrospective chart review.

https://arctichealth.org/en/permalink/ahliterature285859
Source
BMC Health Serv Res. 2017 Jan 17;17(1):45
Publication Type
Article
Date
Jan-17-2017
Author
Trine Stokstad
Sveinung Sørhaug
Tore Amundsen
Bjørn H Grønberg
Source
BMC Health Serv Res. 2017 Jan 17;17(1):45
Date
Jan-17-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Humans
Lung Neoplasms - diagnosis - therapy
Male
Medical Audit
Middle Aged
Norway
Quality Indicators, Health Care
Referral and Consultation
Retrospective Studies
Time Factors
Abstract
The time from a referral for suspected lung cancer is received at a hospital until treatment start has been defined as a quality indicator. Current Norwegian recommendation is that =70% should start surgery or radiotherapy within 42 calendar days and systemic therapy within 35 days. However, delays can occur due to medical complexity. The aim of this study was to quantify the proportion of patients who started treatment within the recommended timeframes; and to assess the proportion of non-complex patients for which there were no good reasons for delays.
We performed a retrospective chart review of all patients diagnosed with lung cancer at a university hospital during 2011-2013. We defined "non-complex" patients as those who underwent =1 tissue diagnostic procedure and had no delays due to comorbidity, intercurrent disease or complications to diagnostic procedures ("Medical delays") of more than three days.
Four hundred forty-nine cases were analyzed; 142 (32%) had >1 tissue diagnostic procedures; 67 (15%) had medical delays >3 days; 262 (58%) were non-complex and 363 (81%) received treatment for lung cancer. Median number of days until surgery or radiotherapy was 48 (overall) and 41 (non-complex patients). The proportions who started surgery or radiotherapy within 42 days were 41% (overall) and 56% (non-complex). Corresponding numbers for systemic therapy were 29 days (overall) and 25 days (non-complex), and 64% (overall) and 80% (non-complex).
Fewer lung cancer patients than desired started treatment within the recommended timeframes. Even among the least complex patients, too few patients received timely treatment. The reasons need to be identified and understood, and changes in the organization appear to be necessary in order to offer timely treatment to more patients.
Notes
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PubMed ID
28095840 View in PubMed
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National quality measurement using clinical indicators: the Danish National Indicator Project.

https://arctichealth.org/en/permalink/ahliterature88939
Source
J Surg Oncol. 2009 Jun 15;99(8):500-4
Publication Type
Article
Date
Jun-15-2009
Author
Mainz Jan
Hansen Anne-Marie
Palshof Torben
Bartels Paul D
Author Affiliation
National Indicator Project, University of Southern Denmark, Aalborg Psychiatric Hospital, Aalborg, Denmark. jan.mainz@rn.dk
Source
J Surg Oncol. 2009 Jun 15;99(8):500-4
Date
Jun-15-2009
Language
English
Publication Type
Article
Keywords
Clinical Audit
Denmark
Health Plan Implementation
Humans
Lung Neoplasms - diagnosis - therapy
National Health Programs - standards - statistics & numerical data
Quality Indicators, Health Care - organization & administration - statistics & numerical data
Registries
Survival Analysis
Total Quality Management - organization & administration - statistics & numerical data
Abstract
This article describes the Danish National Indicator Project that aims to document and improve the quality of care at national level. Specific clinical indicators, standards, and prognostic factors have been developed for eight diseases (e.g. lung cancer). It has been implemented in all clinical departments in Denmark. Participation is mandatory. Results related to lung cancer are presented and discussed. The experiences from 2000 to 2008 indicate that the quality of care related to the eight diseases improve over time and that that performance and outcome measurement will get paid in terms of quality improvement.
PubMed ID
19466740 View in PubMed
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The prognostic value of pre-treatment thrombocytosis in two cohorts of patients with non-small cell lung cancer treated with curatively intended chemoradiotherapy.

https://arctichealth.org/en/permalink/ahliterature299769
Source
Neoplasma. 2017; 64(6):909-915
Publication Type
Journal Article
Author
G Holgersson
S Bergstrom
A Hallqvist
P Liv
J Nilsson
L Willen
J Nyman
S Ekman
R Henriksson
M Bergqvist
Source
Neoplasma. 2017; 64(6):909-915
Language
English
Publication Type
Journal Article
Keywords
Anemia
Carcinoma, Non-Small-Cell Lung - diagnosis - therapy
Chemoradiotherapy
Clinical Trials, Phase II as Topic
Humans
Leukocytosis
Lung Neoplasms - diagnosis - therapy
Neoplasm Staging
Prognosis
Retrospective Studies
Survival Analysis
Sweden
Thrombocytosis - pathology
Abstract
Chemoradiotherapy is the standard of care for inoperable stage III non-small cell lung cancer (NSCLC). This treatment, however, offers only a small chance of cure and is associated with many side effects. Little research has been made concerning which patients benefit most/least from the treatment. The present study evaluates the prognostic value of anemia, leukocytosis and thrombocytosis at diagnosis in this treatment setting. In the present study, data were collected retrospectively for 222 patients from two different phase II studies conducted between 2002-2007 in Sweden with patients treated with chemoradiotherapy for stage IIIA-IIIB NSCLC. Clinical data and the serum values of hemoglobin (Hgb), White blood cells (WBC) and Platelets (Plt) at enrollment were collected for all patients and studied in relation to overall survival using Kaplan-Meier product-limit estimates and a multivariate Cox proportional hazards regression model. The results showed that patients with thrombocytosis (Plt > 350 x 109/L) had a shorter median overall survival (14.5 months) than patients with normal Plt at baseline (23.7 months). Patients with leukocytosis (WBC > 9 x 109/L) had a shorter median survival (14.9 months) than patients with a normal WBC at baseline (22.5 months). However, in a multivariate model including all lab parameters and clinical factors, only thrombocytosis and performance status displayed a prognostic significance. In Conclusion, thrombocytosis showed to be an independent prognostic marker associated with shorter overall survival in stage III NSCLC treated with curatively intended chemoradiotherapy. This knowledge can potentially be used together with established prognostic factors, such as performance status when choosing the optimal therapy for the individual patient in this clinical setting.
PubMed ID
28895417 View in PubMed
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Reasons for prolonged time for diagnostic workup for stage I-II lung cancer and estimated effect of applying an optimized pathway for diagnostic procedures.

https://arctichealth.org/en/permalink/ahliterature308958
Source
BMC Health Serv Res. 2019 Sep 18; 19(1):679
Publication Type
Journal Article
Date
Sep-18-2019
Author
Trine Stokstad
Sveinung Sørhaug
Tore Amundsen
Bjørn H Grønberg
Author Affiliation
Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, PO Box 8905, MTFS, NO-7491, Trondheim, Norway. trine.stokstad@ntnu.no.
Source
BMC Health Serv Res. 2019 Sep 18; 19(1):679
Date
Sep-18-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Critical Pathways
Decision Making
Early Detection of Cancer - standards
Female
Humans
Lung Neoplasms - diagnosis - therapy
Male
Medical Records
Middle Aged
Norway
Positron Emission Tomography Computed Tomography
Referral and Consultation
Retrospective Studies
Time Factors
Time-to-Treatment
Tomography, X-Ray Computed
Abstract
Minimizing the time until start of cancer treatment is a political goal. In Norway, the target time for lung cancer is 42?days. The aim of this study was to identify reasons for delays and estimate the effect on the timelines when applying an optimal diagnostic pathway.
Retrospective review of medical records of lung cancer patients, with stage I-II at baseline CT, receiving curative treatment (n?=?100) at a regional cancer center in Norway.
Only 40% started treatment within 42?days. The most important delays were late referral to PET CT (n?=?27) and exercise test (n?=?16); repeated diagnostic procedures because bronchoscopy failed (n?=?15); and need for further investigations after PET CT (n?=?11). The time from referral to PET CT until the final report was 20.5?days in median. Applying current waiting time for PET CT (=7?days), 48% would have started treatment within 42?days (p?=?0.254). "Optimal pathway" was defined as 1) referral to PET CT and exercise test immediately after the CT scan and hospital visit, 2) tumor board discussion to decide diagnostic strategy and treatment, 3) referral to surgery or curative radiotherapy, 4) tissue sampling while waiting to start treatment. Applying the optimal pathway, current waiting time for PET CT and observed waiting times for the other procedures, 80% of patients could have started treatment within 42?days (p?
PubMed ID
31533705 View in PubMed
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A systematic review and Canadian consensus recommendations on the use of biomarkers in the treatment of non-small cell lung cancer.

https://arctichealth.org/en/permalink/ahliterature133382
Source
J Thorac Oncol. 2011 Aug;6(8):1379-91
Publication Type
Article
Date
Aug-2011
Author
Peter M Ellis
Normand Blais
Dennis Soulieres
Diana N Ionescu
Meenakshi Kashyap
Geoff Liu
Barb Melosky
Tony Reiman
Phillippe Romeo
Frances A Shepherd
Ming-Sound Tsao
Natasha B Leighl
Author Affiliation
Juravinski Cancer Centre, Hamilton, Ontario, Canada. peter.ellis@jcc.hhsc.ca
Source
J Thorac Oncol. 2011 Aug;6(8):1379-91
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Canada
Carcinoma, Non-Small-Cell Lung - diagnosis - therapy
Clinical Trials as Topic
Consensus
Humans
Lung Neoplasms - diagnosis - therapy
Practice Guidelines as Topic
Tumor Markers, Biological - analysis
Abstract
Greater understanding of molecular pathways important in cell growth and proliferation of thoracic malignancies, particularly non-small cell lung cancer (NSCLC), has resulted in intense clinical and translational research. There is now considerable interest in personalizing treatment based on an understanding of tumor histology and molecular abnormalities. However, there is a multiplicity of data, often with discordant results resulting in confusion and uncertainty among clinicians.
We conducted a systematic review and a consensus meeting of Canadian lung cancer oncologists and pathologists to make recommendations on the use of biomarkers in NSCLC. PubMed covering 2005 to March 2010 was searched using MESH terms for NSCLC and randomized trials, plus text words for the biomarkers of interest. Conference proceedings from 2005 to 2009 ASCO, ESMO, IASLC, and USCAP were also searched. The articles were reviewed by pairs of oncologists and pathologists to determine eligibility for inclusion.
Ten oncologists and pathologists reviewed and summarized the literature at a meeting attended by 37 individuals. Draft recommendations were formulated and agreed upon by consensus process. There is some evidence that histology is prognostic for survival. There is evidence from multiple randomized clinical trials to recommend the following: histologic subtype is predictive of treatment efficacy and for some agents toxicity. Immunohistochemistry testing should be performed on NSCLC specimens that cannot be classified accurately with conventional H&E staining. As EGFR mutations are predictive of benefit from tyrosine kinase inhibitors, diagnostic NSCLC samples should be routinely tested for EGFR-activating mutations. Clinical data on K-RAS mutations are inconsistent, therefore testing is not recommended. There is insufficient evidence to recommend other biomarker testing. No biomarkers to date reliably predict improved efficacy for anti-VEGF therapy. Routine assessment for EML4/ALK mutations is not recommended at present, although emerging data suggest that it may become valuable in the near future.
Assessment of NSCLC biomarkers is becoming increasingly important. Therefore, adequate diagnostic material must be obtained for accurate histologic subtyping and relevant molecular biology assays.
Notes
Comment In: J Thorac Oncol. 2012 Apr;7(4):773-4; author reply 77422425934
PubMed ID
21709590 View in PubMed
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Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer - a register based cohort-study.

https://arctichealth.org/en/permalink/ahliterature283165
Source
BMC Health Serv Res. 2017 Apr 12;17(1):267
Publication Type
Article
Date
Apr-12-2017
Author
Maria Iachina
Erik Jakobsen
Anne Kudsk Fallesen
Anders Green
Source
BMC Health Serv Res. 2017 Apr 12;17(1):267
Date
Apr-12-2017
Language
English
Publication Type
Article
Keywords
Aged
Carcinoma, Non-Small-Cell Lung - diagnosis - therapy
Denmark
Female
Hospitals
Humans
Lung Neoplasms - diagnosis - therapy
Male
Middle Aged
Patient transfer
Prospective Studies
Referral and Consultation
Registries
Survival Rate
Time-to-Treatment
Abstract
Lung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested as a potential cause of the poor prognosis and as consequence, fast track cancer care pathways were implemented describing maximum acceptable time thresholds from referral to treatment. In Denmark, patients with lung cancer are often transferred between hospitals with diagnostic facilities to hospitals with treatment facilities during the care pathway. We wanted to investigate whether this organizational set-up influenced the time that patients wait for the diagnosis and treatment. Therefore, the objective of this study was to uncover the impact of transfer between hospitals on the delay in the diagnosis and treatment of Non-Small Cell Lung Cancer (NSCLC).
We performed a historical prospective cohort study using data from the Danish Lung Cancer Registry (DLCR). All patients diagnosed with primary NSCLC from January 1st 2008 to December 31st 2012 were included. Patients with unresolved pathology and incomplete data on the dates of referral, diagnosis and treatment were excluded.
A total of 11 273 patients were included for further analyses. Transfer patients waited longer for treatment after the diagnosis, (Hazard ratio (HR) 0.81 (0.68-0.96)) and in total time from referral to treatment (HR 0.84 (0.77-0.92)), than no-transfer patients. Transfer patients had lower odds of being diagnosed (Odds Ratio (OR) 0.82 (0.74-0.94) and treated (OR 0.66 (0.61-0.72) within the acceptable time thresholds described in the care pathway.
Fast track cancer care pathways were implemented to unify and accelerate the diagnosis and treatment of cancer. We found that the transfer between hospitals during the care pathway might cause delay from diagnosis to treatment as well as in the total time from referral to treatment in patients with Non Small-Cell Lung Cancer. The difference between no-transfer and transfer patients persists after adjusting for known predictors of delay.
Notes
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PubMed ID
28403839 View in PubMed
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8 records – page 1 of 1.