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Cancer of unknown primary: Registered procedures compared with national integrated cancer pathway for illuminating external validity.

Abstract Cancer of unknown primary (CUP) ranges within top 10 cancers in both incidence and mortality. As primary identification is crucial to choosing treatment, guidelines on CUP emphasize the diagnostic strategy. Whether guidelines are complied with, or if they are indeed helpful, is however unclear. We compared procedures performed in suspected CUP patients with recommendations of national guidelines to assess external validity of guidelines.The Danish National Patient Registry (NPR) comprising population data was utilized to identify the suspected CUP patients during 2009 to 2010 and explore exposure to procedures and patient survival. The cohort was investigated in terms of validity of diagnosis through cross-referencing with the Cancer Registry (CR), which served as gold standard for cancer diagnoses and patients' cancer histories.The NPR cohort consisted of 542 patients (275 males, 264 females) of whom 210 (38.7%) had a CUP diagnosis confirmed. Within the cohort, 347 patients (64.0%) had a registration in CR matching with the NPR registration. Exposure to diagnostic procedures included biopsy (n = 439, 81.0%) and image modalities (n = 532, 98.2%). Survival was poor with 67 (12.4%) individuals alive after 4 years.The validity of a CUP diagnosis in NPR was low when using data from CR as reference. More than half the suspected CUP patients had a previous cancer diagnosis with CUP being the most frequent. Patients were diagnosed in compliance with guidelines indicating high external validity, but less than 1 quarter had their primary identified and the 1-year survival was approximately 20%. Research is needed to develop efficacious methods for primary detection.
PMID
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Authors

Mayor MeshTerms

Practice Guidelines as Topic

Keywords
Journal Title medicine
Publication Year Start




PMID- 28422885
OWN - NLM
STAT- MEDLINE
DA  - 20170419
DCOM- 20170509
LR  - 20170509
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Cancer of unknown primary: Registered procedures compared with national
      integrated cancer pathway for illuminating external validity.
PG  - e6693
LID - 10.1097/MD.0000000000006693 [doi]
AB  - Cancer of unknown primary (CUP) ranges within top 10 cancers in both incidence
      and mortality. As primary identification is crucial to choosing treatment,
      guidelines on CUP emphasize the diagnostic strategy. Whether guidelines are
      complied with, or if they are indeed helpful, is however unclear. We compared
      procedures performed in suspected CUP patients with recommendations of national
      guidelines to assess external validity of guidelines.The Danish National Patient 
      Registry (NPR) comprising population data was utilized to identify the suspected 
      CUP patients during 2009 to 2010 and explore exposure to procedures and patient
      survival. The cohort was investigated in terms of validity of diagnosis through
      cross-referencing with the Cancer Registry (CR), which served as gold standard
      for cancer diagnoses and patients' cancer histories.The NPR cohort consisted of
      542 patients (275 males, 264 females) of whom 210 (38.7%) had a CUP diagnosis
      confirmed. Within the cohort, 347 patients (64.0%) had a registration in CR
      matching with the NPR registration. Exposure to diagnostic procedures included
      biopsy (n = 439, 81.0%) and image modalities (n = 532, 98.2%). Survival was poor 
      with 67 (12.4%) individuals alive after 4 years.The validity of a CUP diagnosis
      in NPR was low when using data from CR as reference. More than half the suspected
      CUP patients had a previous cancer diagnosis with CUP being the most frequent.
      Patients were diagnosed in compliance with guidelines indicating high external
      validity, but less than 1 quarter had their primary identified and the 1-year
      survival was approximately 20%. Research is needed to develop efficacious methods
      for primary detection.
FAU - Dyrvig, Anne-Kirstine
AU  - Dyrvig AK
AD  - aCentre for Innovative Medical Technology, Odense C bDepartment of Surgery,
      Svendborg cDepartment of Endocrinology dDepartment of Nuclear Medicine, Odense
      University Hospital, Odense C eCentre of Health Economics Research, University of
      Southern Denmark, Odense M fOdense Patient data Explorative Network (OPEN),
      Odense University Hospital gDepartment of Clinical Research, University of
      Southern Denmark, Odense C hDepartment of Radiology and Nuclear Medicine,
      Hospital South West Jutland, Esbjerg, Denmark.
FAU - Yderstraede, Knud Bonnet
AU  - Yderstraede KB
FAU - Gerke, Oke
AU  - Gerke O
FAU - Jensen, Peter Bjodstrup
AU  - Jensen PB
FAU - Hess, Soren
AU  - Hess S
FAU - Hoilund-Carlsen, Poul Flemming
AU  - Hoilund-Carlsen PF
FAU - Green, Anders
AU  - Green A
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Denmark
MH  - Female
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Neoplasms, Unknown Primary/*diagnosis/mortality
MH  - *Practice Guidelines as Topic
MH  - Registries/*standards
MH  - Survival Analysis
MH  - Young Adult
PMC - PMC5406101
EDAT- 2017/04/20 06:00
MHDA- 2017/05/10 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006693 [doi]
AID - 00005792-201704210-00066 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6693. doi: 10.1097/MD.0000000000006693.

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