The faster the better?—A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways

Abstract

Distress in the diagnostic phase of cancer is a major problem and the rapid decrease of anxiety in patients eventually not diagnosed with cancer suggests a benefit of rapid diagnostic programs. The available evidence however is limited and shows some inconsistencies. Studies differ in subjects, objective and are limited by quality and quantity. Conflicting results prohibit a conclusion on patients ultimately diagnosed with cancer.

The psychological impact of the rapid diagnostic centres in cancer screening: A systematic review

“…Therefore, in this systematic review, we have decided to look at significant results from studies looking at anxiety, stress and depression outcomes up to six weeks post cancer screening as short-term outcomes and more than six weeks as long-term outcomes. This definition is also in accordance to the systematic review done by Brocken, Prins, Dekhuijzen, and Van der Heijden (2012) looking at distress of the diagnostic phase of cancer, as well as the influence of the rapid diagnosis pathway (Brocken et al, 2012). …”

“…The rapid assessment style of clinic was brought about by patients' dissatisfaction with the fragmented process of screening, further testing and diagnosis that often took place between different locations and involved multiple appointments and wait times (Gray, 1997). The effectiveness of these rapid diagnostic clinics has been shown to decrease patient anxiety (Brocken, Prins, Dekhuijzen, & Van der Heijden, 2012;Gagliardi, Grunfeld & Evans, 2004) and increase patient satisfaction (Gagliardi, Grunfeld & Evans, 2004). Considering that one in three women are likely to have a false-positive result from a screening mammogram if they undergo 10 screenings in their lifetime, it is easy to assume that rapid results of a benign outcome are beneficial to these women (Castells, Molins, & Macià, 2006).…”

“…Considering that one in three women are likely to have a false-positive result from a screening mammogram if they undergo 10 screenings in their lifetime, it is easy to assume that rapid results of a benign outcome are beneficial to these women (Castells, Molins, & Macià, 2006). However, there has been limited research and conflicting results in systematic reviews (Brocken, Prins, Dekhuijzen, & Van der Heijden, 2012;Gagliardi, Grunfeld & Evans, 2004) on the psychological impact that a rapid result may have on women undergoing breast cancer assessment.…”

Can a supervised algorithmic assessment of men for prostate cancer improve the quality of care? A retrospective evaluation of a prostate assessment pathway in Saskatchewan

“…One-fifth to half of cancer patients identify cancer diagnosis as a major source of distress and suspected cancer patients may be more negatively affected by anxiety compared to cancer patients with confirmed diagnoses. 5 Men with prostate cancer in Canada have longer wait times for diagnosis and treatment than other cancers 2,6 and prolonged wait times for cancer diagnosis and treatment have been associated with increased anxiety, distress, and a feeling of powerlessness. 6 There is evidence that it is the uncertainty about their prostate cancer that causes men the most distress 11,12 and the faster they can move on to diagnosis and treatment, the better they are able to cope with their illness.…”

“…2 Although the evidence on the impact of wait times on prostate cancer mortality is inconclusive, diagnosis and treatment delays have been shown to impact patient and family psychosocial distress. [3][4][5][6] The Saskatoon Prostate Assessment Pathway (SPAP) was established with several goals in mind, one of which was to reduce the time from physician referral to biopsy, thus shortening the diagnostic wait time. This study does not assess the appropriateness of using PSA as a screening tool or whether prostate cancer screening should be performed.…”