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Missed opportunities for earlier cancer diagnosis within specific pathways to emergency presentation
Xavier Bosch1, Marc Montoya1, Tiago Mota Gomes2
1Department of Internal Medicine, Hospital Clínic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) and Clínic Foundation for Biomedical Research (FCRB), Barcelona, Spain.
Aims:
Research on missed opportunities for cancer diagnosis through emergency presentation is limited. We investigated missed opportunities and associated key intervals in cancer patients at a single high-volume academic hospital in Barcelona.
Methods:
Two pathways were defined: emergency referral from primary care (PC) and self-referral as emergencies following PC consultations. We used reliable data gathering methods and a rigorous validation procedure through independent reviews.
Results:
Missed opportunities were identified in 43% of PC-referred patients and 79% of those who self-referred. Patients with missed opportunities were more likely than those without to belong to underserved and ethnic communities. Intervals were invariably longer in patients with missed opportunities and self-referred patients. For pancreatic cancer in emergency referral patients with missed opportunities, the interval between diagnostic clue documentation and workup initiation was 28 (95% CI 24-32) days longer than in those without. For all cancers, the diagnostic interval in emergency referral patients with missed opportunities was 79 (95% CI 75-83) days longer than in those without and, among emergency self-referral patients, it was 119 (95% CI 112-128) days longer.
Conclusions:
These findings may guide PC physicians in decision-making, decreasing delays, and suggest opportunities to promote timely help-seeking for underrepresented populations.
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