Diagnostic and health service pathways to diagnosis of cancer-registry notified cancer of unknown primary site (CUP)
Cancer of unknown primary (CUP) is a late-stage malignancy with poor prognosis, but we know little about what diagnostic tests and procedures people with CUP receive prior to diagnosis. The purpose of this study was to determine how health service utilisation prior to diagnosis for people with cance...
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| Veröffentlicht in: | PloS one 2020-01, Vol.15 (3), p.e0230373-e0230373 |
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| creator | Schaffer, Andrea L Pearson, Sallie-Anne Perez-Concha, Oscar Dobbins, Timothy Ward, Robyn L van Leeuwen, Marina T Rhee, Joel J Laaksonen, Maarit A Craigen, Glynis Vajdic, Claire M |
| description | Cancer of unknown primary (CUP) is a late-stage malignancy with poor prognosis, but we know little about what diagnostic tests and procedures people with CUP receive prior to diagnosis. The purpose of this study was to determine how health service utilisation prior to diagnosis for people with cancer-registry notified CUP differs from those notified with metastatic cancer of known primary.
We identified people with a cancer registry notification of CUP (n = 327) from the 45 and Up Study, a prospective cohort of 266,724 people ≥45 years in New South Wales, Australia, matched with up to three controls with a diagnosis of metastatic cancer of known primary (n = 977). Baseline questionnaire data were linked to population health data to identify all health service use, diagnostic tests, and procedures in the month of diagnosis and 3 months prior. We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
After adjusting for age and educational attainment, people with a cancer-registry notified CUP diagnosis were more likely to be an aged care resident (OR = 2.78, 95%CI 1.37-5.63), have an emergency department visit (OR = 1.65, 95%CI 1.23-2.21), serum tumor marker tests (OR = 1.51, 95%CI 1.12-2.04), or a cytology test without immunohistochemistry (OR = 2.01, 95%CI 1.47-2.76), and less likely to have a histopathology test without immunohistochemistry (OR = 0.43, 95%CI 0.31-0.59). Neither general practitioner, specialist, allied health practitioner or nurse consultations, hospitalisations, nor imaging procedures were associated with a CUP diagnosis.
The health service and diagnostic pathway to diagnosis differs markedly for people notified with CUP compared to those with metastatic cancer of known primary. While these differences may indicate missed opportunities for earlier detection and appropriate management, for some patients they may be clinically appropriate. |
| doi_str_mv | 10.1371/journal.pone.0230373 |
| format | Article |
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We identified people with a cancer registry notification of CUP (n = 327) from the 45 and Up Study, a prospective cohort of 266,724 people ≥45 years in New South Wales, Australia, matched with up to three controls with a diagnosis of metastatic cancer of known primary (n = 977). Baseline questionnaire data were linked to population health data to identify all health service use, diagnostic tests, and procedures in the month of diagnosis and 3 months prior. We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
After adjusting for age and educational attainment, people with a cancer-registry notified CUP diagnosis were more likely to be an aged care resident (OR = 2.78, 95%CI 1.37-5.63), have an emergency department visit (OR = 1.65, 95%CI 1.23-2.21), serum tumor marker tests (OR = 1.51, 95%CI 1.12-2.04), or a cytology test without immunohistochemistry (OR = 2.01, 95%CI 1.47-2.76), and less likely to have a histopathology test without immunohistochemistry (OR = 0.43, 95%CI 0.31-0.59). Neither general practitioner, specialist, allied health practitioner or nurse consultations, hospitalisations, nor imaging procedures were associated with a CUP diagnosis.
The health service and diagnostic pathway to diagnosis differs markedly for people notified with CUP compared to those with metastatic cancer of known primary. While these differences may indicate missed opportunities for earlier detection and appropriate management, for some patients they may be clinically appropriate.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0230373</identifier><identifier>PMID: 32191753</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Antigens ; Big Data ; Cancer ; Confidence intervals ; Cytology ; Data collection ; Diagnosis ; Diagnostic systems ; Emergency medical care ; Emergency medical services ; Endoscopy ; Health services ; Histopathology ; Immunohistochemistry ; Malignancy ; Medical diagnosis ; Medical prognosis ; Medicare ; Medicine and Health Sciences ; Metastases ; Metastasis ; Patients ; Population ; Questionnaires ; Statistical analysis ; Studies ; Tumor markers</subject><ispartof>PloS one, 2020-01, Vol.15 (3), p.e0230373-e0230373</ispartof><rights>2020 Schaffer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Schaffer et al 2020 Schaffer et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-3bca29dcb459f5ef27d818935fd7cf51b7ec02585c18f9ac93772b23a7753ee53</citedby><cites>FETCH-LOGICAL-c526t-3bca29dcb459f5ef27d818935fd7cf51b7ec02585c18f9ac93772b23a7753ee53</cites><orcidid>0000-0002-3701-4997</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082007/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082007/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32191753$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Bowles, Erin</contributor><creatorcontrib>Schaffer, Andrea L</creatorcontrib><creatorcontrib>Pearson, Sallie-Anne</creatorcontrib><creatorcontrib>Perez-Concha, Oscar</creatorcontrib><creatorcontrib>Dobbins, Timothy</creatorcontrib><creatorcontrib>Ward, Robyn L</creatorcontrib><creatorcontrib>van Leeuwen, Marina T</creatorcontrib><creatorcontrib>Rhee, Joel J</creatorcontrib><creatorcontrib>Laaksonen, Maarit A</creatorcontrib><creatorcontrib>Craigen, Glynis</creatorcontrib><creatorcontrib>Vajdic, Claire M</creatorcontrib><title>Diagnostic and health service pathways to diagnosis of cancer-registry notified cancer of unknown primary site (CUP)</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Cancer of unknown primary (CUP) is a late-stage malignancy with poor prognosis, but we know little about what diagnostic tests and procedures people with CUP receive prior to diagnosis. The purpose of this study was to determine how health service utilisation prior to diagnosis for people with cancer-registry notified CUP differs from those notified with metastatic cancer of known primary.
We identified people with a cancer registry notification of CUP (n = 327) from the 45 and Up Study, a prospective cohort of 266,724 people ≥45 years in New South Wales, Australia, matched with up to three controls with a diagnosis of metastatic cancer of known primary (n = 977). Baseline questionnaire data were linked to population health data to identify all health service use, diagnostic tests, and procedures in the month of diagnosis and 3 months prior. We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
After adjusting for age and educational attainment, people with a cancer-registry notified CUP diagnosis were more likely to be an aged care resident (OR = 2.78, 95%CI 1.37-5.63), have an emergency department visit (OR = 1.65, 95%CI 1.23-2.21), serum tumor marker tests (OR = 1.51, 95%CI 1.12-2.04), or a cytology test without immunohistochemistry (OR = 2.01, 95%CI 1.47-2.76), and less likely to have a histopathology test without immunohistochemistry (OR = 0.43, 95%CI 0.31-0.59). Neither general practitioner, specialist, allied health practitioner or nurse consultations, hospitalisations, nor imaging procedures were associated with a CUP diagnosis.
The health service and diagnostic pathway to diagnosis differs markedly for people notified with CUP compared to those with metastatic cancer of known primary. While these differences may indicate missed opportunities for earlier detection and appropriate management, for some patients they may be clinically appropriate.</description><subject>Antigens</subject><subject>Big Data</subject><subject>Cancer</subject><subject>Confidence intervals</subject><subject>Cytology</subject><subject>Data collection</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Endoscopy</subject><subject>Health services</subject><subject>Histopathology</subject><subject>Immunohistochemistry</subject><subject>Malignancy</subject><subject>Medical diagnosis</subject><subject>Medical prognosis</subject><subject>Medicare</subject><subject>Medicine and Health Sciences</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Patients</subject><subject>Population</subject><subject>Questionnaires</subject><subject>Statistical 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(CUP)</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>15</volume><issue>3</issue><spage>e0230373</spage><epage>e0230373</epage><pages>e0230373-e0230373</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Cancer of unknown primary (CUP) is a late-stage malignancy with poor prognosis, but we know little about what diagnostic tests and procedures people with CUP receive prior to diagnosis. The purpose of this study was to determine how health service utilisation prior to diagnosis for people with cancer-registry notified CUP differs from those notified with metastatic cancer of known primary.
We identified people with a cancer registry notification of CUP (n = 327) from the 45 and Up Study, a prospective cohort of 266,724 people ≥45 years in New South Wales, Australia, matched with up to three controls with a diagnosis of metastatic cancer of known primary (n = 977). Baseline questionnaire data were linked to population health data to identify all health service use, diagnostic tests, and procedures in the month of diagnosis and 3 months prior. We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).
After adjusting for age and educational attainment, people with a cancer-registry notified CUP diagnosis were more likely to be an aged care resident (OR = 2.78, 95%CI 1.37-5.63), have an emergency department visit (OR = 1.65, 95%CI 1.23-2.21), serum tumor marker tests (OR = 1.51, 95%CI 1.12-2.04), or a cytology test without immunohistochemistry (OR = 2.01, 95%CI 1.47-2.76), and less likely to have a histopathology test without immunohistochemistry (OR = 0.43, 95%CI 0.31-0.59). Neither general practitioner, specialist, allied health practitioner or nurse consultations, hospitalisations, nor imaging procedures were associated with a CUP diagnosis.
The health service and diagnostic pathway to diagnosis differs markedly for people notified with CUP compared to those with metastatic cancer of known primary. While these differences may indicate missed opportunities for earlier detection and appropriate management, for some patients they may be clinically appropriate.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32191753</pmid><doi>10.1371/journal.pone.0230373</doi><orcidid>https://orcid.org/0000-0002-3701-4997</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Antigens Big Data Cancer Confidence intervals Cytology Data collection Diagnosis Diagnostic systems Emergency medical care Emergency medical services Endoscopy Health services Histopathology Immunohistochemistry Malignancy Medical diagnosis Medical prognosis Medicare Medicine and Health Sciences Metastases Metastasis Patients Population Questionnaires Statistical analysis Studies Tumor markers |
| title | Diagnostic and health service pathways to diagnosis of cancer-registry notified cancer of unknown primary site (CUP) |
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