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Diagnostic Window Prior to a Haematological Cancer Diagnosis and the Association With Patient Pathways: A Nationwide
Line Flytkjær Virgilsen1, Peter Vedsted1,2, Henry Jensen3
1Research Unit for General Practice, Aarhus, Denmark.
Insights
Healthcare use increased in the two years before a haematological cancer diagnosis, particularly for women, suggesting a potential diagnostic window for earlier detection of these blood cancers.
Area of Science:
- Oncology
- Epidemiology
- Health Services Research
Background:
- Hematological cancers, including leukemia, multiple myeloma, and lymphoma, pose significant health challenges.
- Early detection of hematological malignancies is crucial for improving patient outcomes.
- Understanding pre-diagnostic healthcare utilization patterns can inform early diagnostic strategies.
Purpose of the Study:
- To investigate healthcare utilization in general practice and hospitals in the two years preceding a hematological cancer diagnosis.
- To analyze the association between pre-diagnostic healthcare use and patient pathways (unplanned vs. elective routes).
Main Methods:
- A nationwide register-based cohort study included 12,994 patients diagnosed with leukemia, multiple myeloma, or lymphoma between 2014-2018.
- Matched references were used for comparison.
- Patient pathways were categorized into unplanned (acute admission) and elective routes.
Main Results:
- Female patients showed increased general practice contacts and healthcare utilization (point-of-care tests, hospital visits, radiological investigations) up to 24 months before diagnosis.
- Male patients exhibited similar patterns, albeit with a later onset.
- No significant differences in healthcare use were observed between unplanned and elective diagnostic pathways.
Conclusions:
- A notable increase in healthcare utilization in primary and secondary care was observed up to two years before a hematological cancer diagnosis.
- These findings suggest a potential 'diagnostic window' that could be leveraged for earlier detection of hematological cancers.
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.
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