Delays in referral and diagnosis for chronic hematologic malignancies: A literature review

Abel, Gregory A.; Friese, Christopher R.; Magazu, Lysa S.; Richardson, Lisa C.; Fernández, María E.; Zengotita, Juan Jaime De; Earle, Craig C.

doi:10.1080/10428190802124281

Cited by 23 publications

(27 citation statements)

References 50 publications

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“…In a review of diagnostic delays reported in multiple countries, we identified no variables consistently associated with delays [26]. Further, we found no empirical studies that examined diagnostic delays in multiple myeloma.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic delay and complications for older adults with multiple myeloma

Friese

Abel

Magazu

et al. 2009

Leukemia & Lymphoma

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Increased attention to timely diagnosis motivated us to study 5483 patients diagnosed with multiple myeloma using Medicare claims linked to tumor registries in the Surveillance, Epidemiology and End Results programme. We calculated the time between initial visits for anemia or back pain and for myeloma diagnosis, and used logistic regression to predict the likelihood of diagnostic delay, and also the likelihood of renal or skeletal complications. The median time between sign or symptom and myeloma diagnosis was 99 days. Patients with anemia, back pain and comorbidities were more likely to experience diagnostic delay (OR 1.6, 95% CI 1.3-2.0). Diagnosis while hospitalised (OR 2.5, 95% CI 2.2-2.9) and chemotherapy treatment within 6 months of diagnosis (OR 1.4, 95% CI 1.2-1.6) significantly predicted complications; diagnostic delay did not (OR 0.9, 95% CI 0.8-1.1). Our data suggest that complications are more strongly associated with health status and myeloma severity than with diagnostic delays.

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Section: Introductionmentioning

confidence: 99%

Diagnostic delay and complications for older adults with multiple myeloma

Friese

Abel

Magazu

et al. 2009

Leukemia & Lymphoma

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“…21 The reasons for late presentation of haematologic malignancies in our setting are multi-factorial, and ranges from patient factors, to delays in referral as well as paucity of adequate screening, diagnostic and therapeutic facilities. 10, 25–27 …”

Section: Discussionmentioning

confidence: 99%

“…9 The outcomes in haematologic malignancies can also vary by time of presentation, type of the disease, stage of the tumour at presentation, other co-morbidities, availability and quality of the access to medical care. 10 …”

Section: Introductionmentioning

confidence: 99%

Presentation and survival in patients with hematologic malignancies in Jos, Nigeria: A retrospective cohort analysis

et al. 2018

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Background Haematologic malignancies cause significant morbidity and mortality and are not uncommon in resource-limited-low income countries. However, the types, pattern of presentation and treatment outcomes vary across regions. We assessed the presentation and overall survival over an 11-year period in adult patients presenting with haematologic cancers in Jos, North Central Nigeria Materials and Methods This retrospective outcome study evaluated patients who presented with haematologic malignancies between 2005–2015 at the Jos University Teaching Hospital (JUTH), Jos. Variables of interest were abstracted through chart reviews. Descriptive statistics were used to evaluate baseline and follow-up parameters. Overall survival (OS) was assessed using Kaplan-Meier method. Results Sixty patients, contributing 25,994 person-days of follow-up were evaluated. The mean age was 43+17 years and 61.7% were males. Thirty-one patients (51.7%) presented with leukemia, 45.0% with lymphoma, and 3.3% with multiple myeloma. Forty-two (70.0%) presented with advanced disease, 5 (5.2%) were HIV positive and 4 (6.7%) had died at the end of follow-up. OS was 84.3% (95% CI: 58.1–94.7). Survival differed by disease group (p=0.01) and having fever at presentation (p=0.02) Conclusion We found long-term OS to be impacted by disease type and status of fever at presentation. Disease-specific Strategies to improve early diagnosis and therapies are needed to ensure optimal outcomes in Nigerian patients.

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“…Subsequently, clinicians may need to make additional testing requests. Lack of diagnostic experience in a particular clinic[19] coupled with variable clinical presentations [20-23] may delay referral to a specialist or completion of a diagnostic workup. As diagnostic technologies evolve, differences in clinician awareness of updated information may lead to inconsistent test ordering and variable interpretation of test results [9,10,24].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic testing managed by hematopathology specialty and other laboratories: costs and patient diagnostic outcomes

et al. 2014

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BackgroundSuccessful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests. Our retrospective analysis compared diagnostic uncertainty, resource utilization, and costs for patients with diagnostic bone marrow (BM) tests managed by commercial laboratories.MethodsPatients with BM biopsies and suspected hematologic cancer/condition were identified from claims (2005–2011) within a large US health plan (coverage ≥6 pre- and ≥3-months post-biopsy). Cohorts defined by laboratories performing BM morphologic assessment/directing testing sequence: Genoptix (GX, specialty hematology-testing laboratory), large commercial laboratories (LL), other laboratories (OL). One-year post-biopsy changes in diagnosis or treatments, tests performed, and diagnostic/treatment medical costs (measured as per-patient-per-month [PPPM]) were examined.ResultsThe study population included 1,387 GX, 4,162 LL, and 19,115 OL patients with suspected hematologic malignancy/disease and BM morphology assessment. GX had lower diagnostic uncertainty measured between 2 time periods by diagnostic stability (no conditions the same; 6.16% GX, 8.04% LL, 9.73% OL; p < 0.001) and changes (≥1 condition different; 7.88% GX, 11.19% LL, and 14.08% OL; p < 0.001), fewer repeat BM biopsies, and fewer chemotherapy changes (30-days and 60-days post-initiation). One-year PPPM costs adjusted for patient characteristics differences were $8,202 GX, $7,711 LL, and $10,302 OL (p < 0.05); adjusted PPPM costs (excluding testing period) were $6,019 GX, $6,649 LL, and $7,801 OL (p < 0.05).ConclusionsOur data suggests that a hematopathology specialty laboratory may result in earlier final diagnosis, fewer subsequent diagnosis changes, reduced need for follow-on testing requiring repeat biopsy procedures, and may result in lower downstream healthcare costs. Further evaluations using medical chart abstractions or registries will be valuable.

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Delays in referral and diagnosis for chronic hematologic malignancies: A literature review

Cited by 23 publications

References 50 publications

Diagnostic delay and complications for older adults with multiple myeloma

Diagnostic delay and complications for older adults with multiple myeloma

Presentation and survival in patients with hematologic malignancies in Jos, Nigeria: A retrospective cohort analysis

Diagnostic testing managed by hematopathology specialty and other laboratories: costs and patient diagnostic outcomes

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