Table_1_Time Intervals Under the Lens at Sweden’s First Diagnostic Center for Primary Care Patients With Nonspecific Symptoms of Cancer. A Comparison With Matched Control Patients.docx

IntroductionFast-track referral pathways for patients with nonspecific, serious symptoms have been implemented in several countries. Our objective was to analyze time intervals in the diagnostic routes of patients diagnosed with cancer at Sweden’s first Diagnostic Center (DC) for nonspecific symptoms and compare with time intervals of matched control patients.
MethodsAdult patients with nonspecific symptoms that could not be explained by an initial investigation in primary care were eligible for referral to the DC. Patients diagnosed with cancer were matched with patients at another hospital within the same healthcare organization. We aimed for two control patients per DC-patient and matched on tumor type, age and sex. Five time intervals were compared: 1) patient interval (first symptom—primary care contact), 2) primary care interval (first visit—referral to the DC/secondary care), 3) diagnostic interval (first visit—cancer diagnosis), 4) information interval (cancer diagnosis—patient informed) and 5) treatment interval (cancer diagnosis—treatment start). Comparisons between groups and matched cohort analyses were made.
ResultsSixty-four patients (22.1%) were diagnosed with cancer at the DC, of which eight were not matchable. Forty-two patients were matched with two controls and 14 were matched with one control. There were no significant differences in patient-, primary care-, or diagnostic intervals between the groups. The information interval was shorter at the DC compared to the control group (difference between matched pairs 7 days, p = 0.001) and the treatment interval was also shorter at the DC with significant differences in the matched analysis (difference between matched pairs 13 days, p = 0.049). The findings remained the same in four sensitivity analyses, made to compensate for differences between the groups.
ConclusionsUp to diagnosis, we could not detect significant differences in time intervals between the DC and the control group. However, the shorter information and treatment intervals at the DC should be advantageous for these patients who will get timely access to treatment or palliative care. Due to limitations regarding comparability between the groups, the results must be interpreted with caution and further research is warranted.
Trial registrationClinicalTrials.gov-ID: NCT01709539. Registration-date: October 18, 2012.

引言 针对非特异性重症症状患者的快速转诊路径已在多个国家推行。本研究旨在分析瑞典首家针对非特异性症状的诊断中心（Diagnostic Center, DC）确诊癌症患者的诊断流程时间间隔，并与匹配对照患者的时间间隔进行对比。

方法 初诊于基层医疗且无法通过初始检查明确病因的非特异性症状成年患者，符合转诊至该诊断中心的纳入标准。将确诊癌症的患者与同一医疗体系内其他医院的患者进行匹配。本研究为每例诊断中心患者匹配2名对照患者，匹配维度包括肿瘤类型、年龄与性别。本研究共对比5类时间间隔：1）患者间隔期（首次出现症状至首次基层医疗就诊）；2）基层医疗间隔期（首次就诊至转诊至诊断中心/二级医疗）；3）诊断间隔期（首次就诊至癌症确诊）；4）告知间隔期（癌症确诊至患者被告知病情）；5）治疗间隔期（癌症确诊至开始治疗）。本研究开展组间对比及匹配队列分析。

结果 共有64例（22.1%）患者在该诊断中心确诊癌症，其中8例无法完成匹配。42例患者匹配到2名对照，14例患者匹配到1名对照。组间在患者间隔期、基层医疗间隔期及诊断间隔期均无显著差异。与对照组相比，诊断中心组的告知间隔期更短（配对差值为7天，p=0.001）；治疗间隔期同样更短，配对分析显示差异具有统计学意义（配对差值为13天，p=0.049）。针对组间差异进行校正的4项敏感性分析结果与上述结论一致。

结论 直至确诊阶段，本研究未发现诊断中心组与对照组在各时间间隔上存在显著差异。但诊断中心组更短的告知间隔期与治疗间隔期，将使患者能够及时获得治疗或姑息治疗，对患者而言具有临床获益。鉴于两组间可比性存在局限性，本研究结果需谨慎解读，未来仍需开展进一步研究。

试验注册 ClinicalTrials.gov 注册号：NCT01709539。注册日期：2012年10月18日。