Improved Wait Time Intervals for Prostate Cancer Patients in a Multi-Disciplinary Rapid Diagnostic Unit Compared to a Community-Based Referral Pattern

Sethukavalan, Perakaa; Zhang, Liying; Jethava, Vibhuti; Stevens, Christiaan; Flax, Stanley; Buckley, Roger; Bondy, Susan; Loblaw, Andrew

doi:10.5489/cuaj.181

Cited by 6 publications

(16 citation statements)

References 9 publications

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“…Details about the characteristics of each diagnostic centre can be found in the Supplementary File . Sixteen quasi-experimental studies [ 14 , 15 , 17 – 23 , 25 – 28 , 30 , 31 , 33 ], three economic evaluations [ 29 , 32 , 37 ] and one randomised controlled trial (RCT) [ 38 ] were included. The studies were conducted in Spain ( n = 11), UK ( n = 5), and Canada ( n = 4), and were published between 1998 and 2021.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies described diagnostic centres located within hospital settings ( n = 19) with only one study describing a diagnostic service located within the community setting [ 15 ]. Ten studies were specific to cancer diagnoses [ 14 , 19 – 21 , 25 , 27 , 30 , 31 , 37 , 38 ], six reported on the diagnosis of several health conditions [ 18 , 22 , 23 , 29 , 32 , 33 ] and three studies covered a single health condition including severe anaemia ( n = 1) [ 28 ], fever of uncertain nature (FUN) ( n = 1) [ 17 ], and multiple sclerosis (MS) ( n = 1) [ 26 ]. One study did not report a health condition of interest [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

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The Effectiveness and Cost-Effectiveness of Community Diagnostic Centres: A Rapid Review

Wale,

Okolie,

Everitt

et al. 2024

Int J Public Health

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Objectives: To examine the effectiveness of community diagnostic centres as a potential solution to increasing capacity and reducing pressure on secondary care in the UK.Methods: A comprehensive search for relevant primary studies was conducted in a range of electronic sources in August 2022. Screening and critical appraisal were undertaken by two independent reviewers. There were no geographical restrictions or limits to year of publication. A narrative synthesis approach was used to analyse data and present findings.Results: Twenty primary studies evaluating twelve individual diagnostic centres were included. Most studies were specific to cancer diagnosis and evaluated diagnostic centres located within hospitals. The evidence of effectiveness appeared mixed. There is evidence to suggest diagnostic centres can reduce various waiting times and reduce pressure on secondary care. However, cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Most included studies used weak methodologies that may be inadequate to infer effectiveness.Conclusion: Further well-designed, quality research is needed to better understand the effectiveness and cost-effectiveness of community diagnostic centres.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Effectiveness and Cost-Effectiveness of Community Diagnostic Centres: A Rapid Review

Wale,

Okolie,

Everitt

et al. 2024

Int J Public Health

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“…The goal act of DAP is to improve timely access to care for prostate cancer patients. Early evidence showed that the DAP reduced wait times from cancer suspicion to radiotherapy by on average 2 months compared to standard community practice (7). In the efforts to reduce waiting time, multiparametric magnetic resonant imaging (mpMRI) is strongly recommended in men candidate for prostate biopsy or in men enrolled in active surveillance protocols (8).…”

Section: Original Papermentioning

confidence: 99%

Diagnostic assessment program for prostate cancer: Lessons learned after 2 years and degree of compliance to Canadian guidelines

Shabana

Kotb

Tesolin

et al. 2021

Arch Ital Urol Androl

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Background: In 2018, our Institute launched the Diagnostic Assessment Program (DAP) for prostate cancer. It enabled quick access to a urologist for patients presented to family physician with elevated PSA and allowed fast multidisciplinary patient care. We aim to document our data over 2 years in comparison to data before implementation of DAP and its impact on the degree of adherence to Canadian guidelines. Methods: From April 2016 to April 2020, 880 patients who were evaluated for prostate cancer at Thunder Bay Regional Health Sciences Centre (TBRHSC) were included in this study. Patients’ characteristics, clinical data, waiting times and line of treatment before and after implementation of DAP were calculated and statistically analysed. Results: The median waiting time to urology consultation was significantly reduced from 68 (IQR 27-168) days to 34 (23-44) days (p < 0.001). The time from patient’s referral to prostate biopsy decreased substantially from 34 (20-66) days to 18(11- 25) days after DAP (p < 0.001). After DAP, the percentage of Gleason 6 detected prostate cancers were significantly increased (19.7% to 30%) (p = 0.02). After DAP, rate for intermediate-risk patients elected for external beam radiotherapy (from 53.5% to 57.9%, p = 0.53) and radical prostatectomy (from 34.5% to 39.4%, p = 0.47) increased. More compliance to Canadian guidelines was observed in intermediate risk patients (88% vs 97.3%, p =.008). Conclusions: Implementation of DAP has led to a notable reduction of waiting time to urology consult and prostate biopsy. There is significant increase in Gleason 6 detected prostate cancer. Increased compliance to Canadian guidelines was detected in intermediate risk patients.

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“…Our group has already shown that wait times from suspicion to radiation treatment is, on average, two months shorter in the GGWPC vs. standard community practice (183 vs. 138 days, p=0.046). 6 Patients are referred from general practitioners or community urologists if they have an elevated prostate-specific antigen (PSA) in the absence of instrumentation, abnormal digital rectal examination (DRE) or abnormal imaging suggestive of PCa. Patients are seen by one of five urologists and their prostate cancer risk assessed within two weeks of referral.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

Guy

Ghanem

Loblaw

et al. 2016

CUAJ

Self Cite

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Introduction: We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends. Methods: From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records. Results: 1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed (p<0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management; 57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions were made in those who attended the MDC compared to those who only saw a urologist (p<0.0001). Conclusions: In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low-to intermediate-risk disease over time. Timely multidisciplinary consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multidisciplinary DAP. IntroductionIn 2015, an estimated 24 000 men in Canada will be diagnosed with prostate cancer (PCa) and will need to decide between a variety of management options.1 For many, this can be distressing and lead to post-treatment regret and worse quality of life.2,3 Most commonly, a patient diagnosed with PCa will meet with their urologist to learn about management options. Sometimes a referral for consultation with a radiation oncologist is made. The literature has reported that each specialist is more likely to recommend treatment that they provide. 4 In anticipation for an increase in the number of PCa diagnoses in the coming years, an understanding of the decision-making process is exceedingly important. 1,5 In 2007, the Gale and Graham Wright Prostate Centre (GGWPC), in collaboration with the Odette Cancer Centre (OCC), was established at North York General Hospital (NYGH). As a diagnostic assessment program (DAP), the goal is to improve timely access and the quality of care provided to men with PCa. Our group has already shown that wait times from suspicion to radiation treatment is, on average, two months shorter in the GGWPC vs. standard community practice (183 vs. 138 days, p=0.046). 6Patients are referred from general practitioners or community urologists if they have an elevated prostate-specific antig...

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Improved Wait Time Intervals for Prostate Cancer Patients in a Multi-Disciplinary Rapid Diagnostic Unit Compared to a Community-Based Referral Pattern

Cited by 6 publications

References 9 publications

The Effectiveness and Cost-Effectiveness of Community Diagnostic Centres: A Rapid Review

The Effectiveness and Cost-Effectiveness of Community Diagnostic Centres: A Rapid Review

Diagnostic assessment program for prostate cancer: Lessons learned after 2 years and degree of compliance to Canadian guidelines

Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

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