The lived experience during the peri-diagnostic period of breast cancer: A scoping review.

OBJECTIVES: The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer. METHODS: Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches. RESULTS: A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period. CONCLUSIONS: The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity. PRACTICE IMPLICATIONS: Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.

Disease Behaviour During the Peri-Diagnostic Period in Patients with Suspected Interstitial Lung Disease: The STARLINER Study.

INTRODUCTION: Disease behaviour may guide diagnosis and treatment decisions in patients with interstitial lung disease (ILD). STARLINER aimed to characterise disease behaviour in patients with suspected ILD during the peri-diagnostic period using real-time home-based assessments. METHODS: STARLINER (NCT03261037) was an international, multicentre study. Patients ≥ 50 years old with suspected ILD were followed throughout the peri-diagnostic period, consisting of a pre-diagnostic period (from enrolment to diagnosis) and a post-diagnostic period (from diagnosis to treatment initiation). Study length was variable (≤ 18 months). The primary endpoint was time-adjusted semi-annual forced vital capacity (FVC) change measured during the peri-diagnostic period using daily home spirometry in patients with idiopathic pulmonary fibrosis (IPF). Secondary outcomes included changes in FVC (home spirometry) in patients with non-IPF ILD, changes in FVC (site spirometry), changes in physical functional capacity measured by daily home accelerometry and site 6-min walk distance (6MWD), and changes in patient-reported outcomes (PROs) in IPF or non-IPF ILD. RESULTS: Of the 178 patients enrolled in the study, 68 patients were diagnosed with IPF, 62 patients were diagnosed with non-IPF ILD, 9 patients received a non-ILD diagnosis and 39 patients did not receive a diagnosis. Technical and analytical issues led to problems in applying the prespecified linear regression model to analyse the home FVC data. Time-adjusted median (quartile [Q]1, Q3) semi-annual FVC change during the peri-diagnostic period measured using home and site spirometry, respectively, was - 147.7 (- 723.8, 376.2) ml and - 149.0 (- 314.6, 163.9) ml for IPF and 19.1 (- 194.9, 519.0) ml and - 23.4 (- 117.9, 133.5) ml in non-IPF ILD. A greater decline in steps per day was observed for IPF versus non-IPF ILD, whereas an increase in 6MWD was observed for patients with IPF versus a decline in 6MWD for patients with non-IPF ILD. No clear patterns of disease behaviour were observed for IPF versus non-IPF ILD for PROs. CONCLUSIONS: Despite home spirometry being feasible for most patients and centres, technical and analytical challenges in the home-based assessments prevented firm conclusions regarding disease behaviour. This highlights that further optimisation of the technology and analysis methods is required before widespread implementation. TRIAL REGISTRATION: NCT03261037.

Are socio-economic inequalities in breast cancer survival explained by peri-diagnostic factors?

BACKGROUND: Patients living in more deprived localities have lower cancer survival in England, but the role of individual health status at diagnosis and the utilisation of primary health care in explaining these differentials has not been widely considered. We set out to evaluate whether pre-existing individual health status at diagnosis and primary care consultation history (peri-diagnostic factors) could explain socio-economic differentials in survival amongst women diagnosed with breast cancer. METHODS: We conducted a retrospective cohort study of women aged 15-99 years diagnosed in England using linked routine data. Ecologically-derived measures of income deprivation were combined with individually-linked data from the English National Cancer Registry, Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. Smoking status, alcohol consumption, BMI, comorbidity, and consultation histories were derived for all patients. Time to breast surgery was derived for women diagnosed after 2005. We estimated net survival and modelled the excess hazard ratio of breast cancer death using flexible parametric models. We accounted for missing data using multiple imputation. RESULTS: Net survival was lower amongst more deprived women, with a single unit increase in deprivation quintile inferring a 4.4% (95% CI 1.4-8.8) increase in excess mortality. Peri-diagnostic co-variables varied by deprivation but did not explain the differentials in multivariable analyses. CONCLUSIONS: These data show that socio-economic inequalities in survival cannot be explained by consultation history or by pre-existing individual health status, as measured in primary care. Differentials in the effectiveness of treatment, beyond those measuring the inclusion of breast surgery and the timing of surgery, should be considered as part of the wider effort to reduce inequalities in premature mortality.

Epidemiological status and survival rate of liver cancer in Yangpu District of Shanghai， 2002-2016 / 上海预防医学

Objective:To analyze the prevalence trend and survival of liver cancer in Yangpu District， Shanghai， from 2002 to 2016. Methods:Data on liver cancer incidence and mortality from 2002 to 2016 were collected from the Shanghai cancer registry system for the registered population in Yangpu District and the number of the registered population published by the public security department. The standardized liver cancer incidence and mortality rates were calculated using the world standard population to analyze the trends of the liver cancer incidence and mortality， in general， by gender and by age. Life table method was used to calculate the survival rate， and log-rank test was used to analyze the difference of 5-year survival rates and the period of diagnosis between patients with liver cancer by gender. Results:The overall incidence and mortality of liver cancer showed a decreasing trend from 2002 to 2016. After removing the influence of community aging， the standardized annual percentage change （APC） of morbidity and mortality was -3.10% （P<0.01） and -3.44% （P<0.01）， respectively. The morbidity and mortality of males were significantly higher than that of females （P<0.01） by Z test. The incidence of liver cancer started to rise obviously from 40 years old， and the death rate raised obviously from 50 years old. 4 007 liver cancer patients were followed up for 5 years. The 5 years observed survival rate was 12.45%， and the median survival time was 281.48 days. The 5-year survival rate of male liver cancer patients was higher than that of female patients， and there was a significant difference（P<0.01）.46.58% of liver cancer patients were diagnosed in the advanced stage， and only 13.46% was diagnosed at the early-stage. There was no statistical difference in the proportion between men and women at different stages （P=0.11）. Conclusion:The overall incidence and mortality rates of liver cancer from 2002 to 2016 show a slowly decreasing trend， with higher incidence and mortality rates in men than in women. Middle-aged and elderly people are still the main population of morbidity and death. The five-year survival rate is low， and the diagnostic periods are mostly in the middle and late stages of cancer.

Perspective: Current Pitfalls in the Search for Future Treatments and Prevention of Parkinson's Disease.

We are gradually becoming aware that there is more to Parkinson's disease (PD) than meets the eye. Accumulating evidence has unveiled a disease complexity that has not (yet) been incorporated into ongoing efforts aimed at slowing, halting or reversing the course of PD, likely underlying their lack of success. There is a substantial latency between the actual onset of PD pathology and our ability to confirm diagnosis, during which accumulating structural and functional damage might be too advanced for effective modification or protection. Identification at the earliest stages of the disease course in the absence of Parkinsonism is crucial if we are to intervene when it matters most. Prognostic and therapeutic inferences can only be successful if we are able to accurately predict who is at risk for developing PD and if we can differentiate amongst the considerable clinicopathologic diversity. Biomarkers can greatly improve our identification and differentiation abilities if we are able to disentangle cause and effect.

Violent offending in schizophrenia spectrum disorders preceding and following diagnosis.

OBJECTIVE: People affected by schizophrenia spectrum disorders are at a higher risk of offending violently. This study aims to investigate risk factors in relation to the peri-diagnostic period and possible predictors of post-diagnostic violence of people diagnosed for the first time in the public mental health system. METHODS: The study compared various risk factors for post-diagnostic violence in patients ( n = 1453) diagnosed with a schizophrenia spectrum disorder. Patients were grouped according to the occurrence of peri-diagnostic violence. Of the 246 violent offenders, 164 committed their first offence pre-diagnosis. Mental health and criminological variables were evaluated across the lifespan (median age at end of follow-up = 34.22 years, range = 17.02-55.80 years). RESULTS: Gender, employment, non-violent offending, family incidents, violent and non-violent victimisation, substance use, personality disorder, number of in-patient admissions and history of non-compliance differed significantly across violent and non-violent subgroups (all p ⩽ 0.01 and at least small effect size). More frequent and longer inpatient admissions were found in the violent subgroups (all p ⩽ 0.01). For the whole sample, sex, number of violent offences, non-violent offences, violent victimisation, substance use and number of inpatient admissions predicted post-diagnostic violence (χ2 (6) = 188.13, p < 0.001). Among patients with a history of pre-diagnostic violence, a history of non-violent offending in the 18-month period pre-diagnosis was the strongest predictor of future violence (odds ratio = 3.08, 95% confidence interval [1.32, 7.21]). CONCLUSION: At triage, violence risk assessment should consider the presence of antisocial behaviour and violent victimisation, substance use, male gender and frequency of inpatient admissions. Common treatment targets for the prevention of post-diagnostic violence include criminality and victimisation. Treatment of positive symptoms should be of greater emphasis for individuals without a history of pre-diagnostic violence.