Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study
Objective To assess the impact of prehospital factors (diagnostic pathways, first presentation to healthcare services, intervals, participation in primary care) on 1-year and 5-year survival in people with epithelial ovarian cancer (EOC).Design Retrospective quasi-population-based cohort study.Setti...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e060499.full |
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| author | Mercè Marzo-Castillejo Josep M Borras Carmen Vela-Vallespín Paula Manchon‐Walsh Luisa Aliste |
| author_facet | Mercè Marzo-Castillejo Josep M Borras Carmen Vela-Vallespín Paula Manchon‐Walsh Luisa Aliste |
| author_sort | Mercè Marzo-Castillejo |
| collection | DOAJ |
| description | Objective To assess the impact of prehospital factors (diagnostic pathways, first presentation to healthcare services, intervals, participation in primary care) on 1-year and 5-year survival in people with epithelial ovarian cancer (EOC).Design Retrospective quasi-population-based cohort study.Setting Catalan Integrated Public Healthcare System.Participants People with EOC who underwent surgery with a curative intent in public Catalan hospitals between 1 January 2013 and 31 December 2014.Outcome measures Data from primary and secondary care clinical histories and care processes in the 18 months leading up to confirmation (signs and symptoms at presentation, diagnosis pathways, referrals, diagnosis interval) of the EOC diagnosis (stage, histology type, treatment). Diagnostic process intervals were based on the Aarhus statement. 1-year and 5-year survival analysis was undertaken.Results Of the 513 patients included in the cohort, 67.2% initially consulted their family physician, while 36.4% were diagnosed through emergency services. In the Cox models, survival was influenced by advanced stage at 1 year (HR 3.84, 95% CI 1.23 to 12.02) and 5 years (HR 5.36, 95% CI 3.07 to 9.36), as was the type of treatment received, although this association was attenuated over follow-up. Age became significant at 5 years of follow-up. After adjusting for age, adjusted morbidity groups, stage at diagnosis and treatment, 5-year survival was better in patients presenting with gynaecological bleeding (HR 0.35, 95% CI 0.16 to 0.79). Survival was not associated with a starting point involving primary care (HR 1.39, 95% CI 0.93 to 2.09), diagnostic pathways involving referral to elective gynaecological care from non-general practitioners (HR 0.80, 95% CI 0.51 to 1.26), or self-presentation to emergency services (HR 0.82, 95% CI 0.52 to 1.31).Conclusions Survival in EOC is not associated with diagnostic pathways or prehospital healthcare, but it is influenced by stage at diagnosis, administration of primary cytoreduction plus chemotherapy and patient age. |
| format | Article |
| id | doaj-art-0efee40181134eacac87604226a2eeb7 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-0efee40181134eacac87604226a2eeb72025-01-31T00:00:14ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-060499Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort studyMercè Marzo-Castillejo0Josep M Borras1Carmen Vela-Vallespín2Paula Manchon‐Walsh3Luisa Aliste4Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research (IDIAP) Jordi Gol, Catalan Health Institut, Cornellà de Llobregat, SpainCatalonian Cancer Strategy, Department of Health, L`Hospitalet de Llobregat, SpainPrimary Health Care Center Riu Nord i Riu Sud, Catalan Institute of Health, Santa Coloma de Gramenet, SpainCatalonian Cancer Strategy, Department of Health, L`Hospitalet de Llobregat, SpainCatalonian Cancer Strategy, Department of Health, L`Hospitalet de Llobregat, SpainObjective To assess the impact of prehospital factors (diagnostic pathways, first presentation to healthcare services, intervals, participation in primary care) on 1-year and 5-year survival in people with epithelial ovarian cancer (EOC).Design Retrospective quasi-population-based cohort study.Setting Catalan Integrated Public Healthcare System.Participants People with EOC who underwent surgery with a curative intent in public Catalan hospitals between 1 January 2013 and 31 December 2014.Outcome measures Data from primary and secondary care clinical histories and care processes in the 18 months leading up to confirmation (signs and symptoms at presentation, diagnosis pathways, referrals, diagnosis interval) of the EOC diagnosis (stage, histology type, treatment). Diagnostic process intervals were based on the Aarhus statement. 1-year and 5-year survival analysis was undertaken.Results Of the 513 patients included in the cohort, 67.2% initially consulted their family physician, while 36.4% were diagnosed through emergency services. In the Cox models, survival was influenced by advanced stage at 1 year (HR 3.84, 95% CI 1.23 to 12.02) and 5 years (HR 5.36, 95% CI 3.07 to 9.36), as was the type of treatment received, although this association was attenuated over follow-up. Age became significant at 5 years of follow-up. After adjusting for age, adjusted morbidity groups, stage at diagnosis and treatment, 5-year survival was better in patients presenting with gynaecological bleeding (HR 0.35, 95% CI 0.16 to 0.79). Survival was not associated with a starting point involving primary care (HR 1.39, 95% CI 0.93 to 2.09), diagnostic pathways involving referral to elective gynaecological care from non-general practitioners (HR 0.80, 95% CI 0.51 to 1.26), or self-presentation to emergency services (HR 0.82, 95% CI 0.52 to 1.31).Conclusions Survival in EOC is not associated with diagnostic pathways or prehospital healthcare, but it is influenced by stage at diagnosis, administration of primary cytoreduction plus chemotherapy and patient age.https://bmjopen.bmj.com/content/12/7/e060499.full |
| spellingShingle | Mercè Marzo-Castillejo Josep M Borras Carmen Vela-Vallespín Paula Manchon‐Walsh Luisa Aliste Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study BMJ Open |
| title | Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study |
| title_full | Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study |
| title_fullStr | Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study |
| title_full_unstemmed | Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study |
| title_short | Prehospital care for ovarian cancer in Catalonia: could we do better in primary care? Retrospective cohort study |
| title_sort | prehospital care for ovarian cancer in catalonia could we do better in primary care retrospective cohort study |
| url | https://bmjopen.bmj.com/content/12/7/e060499.full |
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