Validity of a rapid diagnostic programme for head and neck cancer.

INTRODUCTION AND OBJECTIVES: Given the epidemiological knowledge of squamous cell carcinomas of the head and neck (SCHN), the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours. METHODS: A prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A "suspicion algorithm" was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the four years prior to the start of the study. RESULTS: 199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP. Of the patients, 27% were diagnosed in stages I and II, and 73% in stages II and IV, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. CONCLUSIONS: The implementation of a rapid diagnosis pathway for patients who, according to the algorithm created, had a suspected head and neck cancer, has not led to an increase in the diagnosis of these tumours in early stages or a decrease in diagnoses in advanced stages.

Validez de un programa de diagnóstico rápido del cáncer de cabeza y cuello / Validity of a rapid diagnostic programme for head and neck cancer

Introducción y objetivos: Dado el conocimiento epidemiológico del carcinoma escamoso de cabeza y cuello, pronóstico y supervivencia según el estadio al diagnóstico, y ante la ausencia de programas de cribado que hayan demostrado ser coste-efectivos, nos propusimos evaluar un programa de diagnóstico rápido. El objetivo del presente estudio fue analizar si la existencia de un circuito de diagnóstico rápido desde Atención Primaria, con base en una ponderación de síntomas y signos, supondría un cambio en la proporción de diagnósticos en estadios iniciales versus tardíos en estos tumores.MétodosSe ha realizado un estudio observacional prospectivo de pacientes remitidos con la sospecha de un tumor en el área ORL en nuestro centro durante 24 meses consecutivos. Se creó un algoritmo con síntomas y signos de sospecha para utilización por el médico de familia y un circuito de remisión rápida de los pacientes candidatos. Se registraron también los pacientes con sospecha de tumor provenientes de fuentes distintas de este circuito. Los datos obtenidos (edad, sexo, consumo de tóxicos, tiempo y clínica de presentación, localización del tumor y extensión), se han comparado con los de los pacientes recogidos en la base de datos de tumores del Servicio de ORL diagnosticados durante los 4años previos al inicio del estudio.ResultadosSe incluyó en el estudio a 199 pacientes y se diagnosticaron 82 tumores del área ORL. Los médicos de familia remitieron por el circuito de diagnóstico rápido creado un total de 136 pacientes y 35 (26,1%) presentaban una tumoración. Sin embargo, la mayoría de los tumores diagnosticados durante este periodo en el Servicio de ORL (47 pacientes, 57,3% de todos los tumores diagnosticados) no fueron sospechados por su médico de familia y no fueron remitidos al hospital utilizando el circuito de diagnóstico rápido. (AU)

Introduction and objectives: Given the epidemiological knowledge of squamous cell carcinomas of the head and neck, the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours.MethodsA prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A “suspicion algorithm” was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the 4years prior to the start of the study.Results199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP.Of the patients, 27% were diagnosed in stages i and ii, and 73% in stages iii and iv, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. (AU)

Estudio comparativo aleatorizado de la utilidad de órtesis de compresión controlada frente al apósito compresivo en el postoperatorio inmediato de la cirugía conservadora del cáncer de mama / A randomised controlled trial of the efficacy of a controlled compression garment versus compressive bandaging in the immediate postoperative period after breast cancer-conserving surgery

Objetivos. Comparar la incidencia conjunta e individual de complicaciones postoperatorias, comodidad y calidad de vida dependiendo del uso de apósito compresivo o de órtesis específica de compresión controlada. Pacientes y método. Estudio prospectivo aleatorizado sobre 198 casos distribuidos en 2 grupos: apósito (n=88) y órtesis (n=99), recogiendo variables relacionadas con complicaciones inmediatas postoperatorias y satisfacción en la calidad de vida. Se realizó un estudio comparativo y de la evolución temporal de las variables durante el primer mes postoperatorio. Resultados. La incidencia de complicaciones totales fue significativamente menor con órtesis a 7 días (p=0,032) y a 15 días(p=0,009). Se evidenció una reducción significativa del dolor con órtesis a 7 días (p=0,002) y a 15 días (p=0,012) y en la incidencia de lesiones cutáneas: 0-2% en órtesis frente a 35% con apósito (p<0,0005). También se encontraron diferencias significativas en la calidad de vida a favor del uso de órtesis (p<0,0005). Conclusiones. El uso de órtesis de compresión controlada en el postoperatorio inmediato de la cirugía conservadora de cáncer de mama reduce del 32 al 15% la incidencia conjunta de complicaciones posquirúrgicas y mejora en términos de eficacia, seguridad y comodidad al apósito compresivo habitual (AU)

Objectives. To compare the overall and individual incidence of postoperative complications, comfort and quality of life resulting from the use of compressive bandaging versus a specific controlled compression garment. Patients and method. A randomised controlled trial was conducted in 198 patients distributed in 2 groups: bandaging (n=88) and compression garment (n=99). Variables related to immediate postoperative complications and satisfaction with quality of life were collected. Changes in the variables were compared in the 2 groups during the first postoperative month. Results. The incidence of total complications was significantly lower with the compression garment: 7 days (P=.032) and 15 days (P=.009). Pain was significantly reduced with the compression garment: 7 days (P=.002) and 15 days (P=.012). The incidence of skin injury was also significantly reduced: 0-2% with the compression garment versus 35% with bandaging (P<0.0005). Significant differences were found in quality of life in favour of the use of the compression garment (P<0.0005). Conclusions. The use of a specific controlled compression garment in the immediate postoperative period after breast cancer-conserving surgery reduces the likelihood of postoperative complications from 32 to 15% and enhanced efficacy, safety, and patient comfort compared with the usual compressive dressing (AU)