Cancer epidemiology · 2025
Acute leukaemia: Patient factors associated with unplanned diagnostic pathways and the impact on survival - A nationwide register-based cohort study in Denmark.
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Virgilsen Line Flytkjær, Vedsted Peter, Jensen Henry, Frederiksen Henrik, El-Galaly Tarec Christoffer, Roug Anne Stidsholt, Rasmussen Linda Aagaard
Аннотация
BACKGROUND: Acute leukaemia (AL) is an aggressive haematological cancer. This study investigated patient factors in unplanned diagnostic pathways and the association with the prognosis and mortality of patients.
METHODS: This nationwide register-based study included all patients diagnosed with AL in Denmark in 2014-2018. Diagnostic pathways were divided into elective pathways and unplanned pathways (acute admission within up to 30 days before diagnosis and no planned admissions).
RESULTS: We included 1495 patients with AL. Diagnostic pathway did not differ by sociodemographic characteristics. Patients with a WHO performance score of 2-4 had a 64 % probability of being diagnosed in an unplanned pathway (95 % confidence interval (CI) 59-69 %) versus 47 % (95 % CI 44-50 %) in patients with a WHO performance score of 0-1. High comorbidity level was associated with higher probability of unplanned pathways. Patients in unplanned pathways had lower one-year survival than patients in elective pathways (adjusted all-cause mortality hazard ratio: 1.44 (95 % CI 1.29-1.62). This survival difference disappeared in landmark analyses with three-month delayed entry.
CONCLUSIONS: Patients with impaired performance score and high comorbidity level more often experienced an unplanned diagnostic pathway. Unplanned pathway was associated with lower survival and death within 3 months after the diagnosis.
METHODS: This nationwide register-based study included all patients diagnosed with AL in Denmark in 2014-2018. Diagnostic pathways were divided into elective pathways and unplanned pathways (acute admission within up to 30 days before diagnosis and no planned admissions).
RESULTS: We included 1495 patients with AL. Diagnostic pathway did not differ by sociodemographic characteristics. Patients with a WHO performance score of 2-4 had a 64 % probability of being diagnosed in an unplanned pathway (95 % confidence interval (CI) 59-69 %) versus 47 % (95 % CI 44-50 %) in patients with a WHO performance score of 0-1. High comorbidity level was associated with higher probability of unplanned pathways. Patients in unplanned pathways had lower one-year survival than patients in elective pathways (adjusted all-cause mortality hazard ratio: 1.44 (95 % CI 1.29-1.62). This survival difference disappeared in landmark analyses with three-month delayed entry.
CONCLUSIONS: Patients with impaired performance score and high comorbidity level more often experienced an unplanned diagnostic pathway. Unplanned pathway was associated with lower survival and death within 3 months after the diagnosis.