European journal of haematology · 2024
Diagnostic Window Prior to a Haematological Cancer Diagnosis and the Association With Patient Pathways: A Nationwide Register-Based Cohort Study on Healthcare Utilization in Denmark.
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Virgilsen Line Flytkjær, Vedsted Peter, Jensen Henry, Frederiksen Henrik, El-Galaly Tarec Christoffer, Rasmussen Linda Aagaard
Аннотация
OBJECTIVES: This study investigated healthcare utilisation in general practice and hospitals in the 2 years preceding a diagnosis of haematological cancer and the association with patient pathways.
METHODS: The nationwide register-based cohort study included 12 994 patients diagnosed with leukaemia, multiple myeloma and lymphoma in 2014-2018 and 10 matched references. Patient pathways were analysed in unplanned routes (acute admission up to 1 month's prior diagnosis) and elective routes (other routes, e.g., cancer patient pathways).
RESULTS: Female patients in unplanned diagnostic pathways had more contacts to general practice from 19 months before the diagnosis compared to their matched references; with IRR increasing from 1.14 (95% confidence interval (CI) 1.05-1.24) to 2.27 (95% CI 2.13-2.41) at 30-60 days before the diagnosis. Female patients had more point-of-care tests, hospital contacts and radiological investigations at 17, 24 and 17 months, respectively, before diagnosis compared to their references. Similar patterns were seen for male patients, although with a later onset of increase. No healthcare use variations were seen between patients diagnosed in unplanned versus elective pathways.
CONCLUSIONS: Increased healthcare utilisation was seen in general practice and hospitals up to 24 months preceding a diagnosis, which may indicate a diagnostic window for detecting haematological cancer earlier.
METHODS: The nationwide register-based cohort study included 12 994 patients diagnosed with leukaemia, multiple myeloma and lymphoma in 2014-2018 and 10 matched references. Patient pathways were analysed in unplanned routes (acute admission up to 1 month's prior diagnosis) and elective routes (other routes, e.g., cancer patient pathways).
RESULTS: Female patients in unplanned diagnostic pathways had more contacts to general practice from 19 months before the diagnosis compared to their matched references; with IRR increasing from 1.14 (95% confidence interval (CI) 1.05-1.24) to 2.27 (95% CI 2.13-2.41) at 30-60 days before the diagnosis. Female patients had more point-of-care tests, hospital contacts and radiological investigations at 17, 24 and 17 months, respectively, before diagnosis compared to their references. Similar patterns were seen for male patients, although with a later onset of increase. No healthcare use variations were seen between patients diagnosed in unplanned versus elective pathways.
CONCLUSIONS: Increased healthcare utilisation was seen in general practice and hospitals up to 24 months preceding a diagnosis, which may indicate a diagnostic window for detecting haematological cancer earlier.