Abstract
Background
The association of diagnostic intervals and outcomes is poorly understood in adolescents and young adults with cancer (AYA). We investigated associations between diagnostic intervals and health-related quality of life (HRQoL), anxiety and depression in a large AYA cohort.
Methods
Participants aged 12–24 completed interviews post-diagnosis, providing data on diagnostic experiences and the patient-reported outcomes (PROs) HRQoL, anxiety and depression. Demographic and cancer information were obtained from clinical and national records. Six diagnostic intervals were considered. Relationships between intervals and PROs were examined using regression models.
Results
Eight hundred and thirty participants completed interviews. In adjusted models, across 28 of 30 associations, longer intervals were associated with poorer PROs. Patient intervals (symptom onset to first seeing a GP) of ≥1 month were associated with greater depression (adjusted odds ratio (aOR):1.7, 95% Confidence Interval (CI):1.1–2.5) compared to <1 month. ≥3 pre-referral GP consultations were associated with greater anxiety (aOR:1.6, CI:1.1–2.3) compared to 1–2 consultations. Symptom onset to first oncology appointment intervals of ≥2 months was associated with impaired HRQoL (aOR:1.8, CI:1.2–2.5) compared to <2 months.
Conclusions
Prolonged diagnostic intervals in AYA are associated with an increased risk of impaired HRQoL, anxiety and depression. Identifying and delivering interventions for this high-risk group is a priority.
The association of diagnostic intervals and outcomes is poorly understood in adolescents and young adults with cancer (AYA). We investigated associations between diagnostic intervals and health-related quality of life (HRQoL), anxiety and depression in a large AYA cohort.
Methods
Participants aged 12–24 completed interviews post-diagnosis, providing data on diagnostic experiences and the patient-reported outcomes (PROs) HRQoL, anxiety and depression. Demographic and cancer information were obtained from clinical and national records. Six diagnostic intervals were considered. Relationships between intervals and PROs were examined using regression models.
Results
Eight hundred and thirty participants completed interviews. In adjusted models, across 28 of 30 associations, longer intervals were associated with poorer PROs. Patient intervals (symptom onset to first seeing a GP) of ≥1 month were associated with greater depression (adjusted odds ratio (aOR):1.7, 95% Confidence Interval (CI):1.1–2.5) compared to <1 month. ≥3 pre-referral GP consultations were associated with greater anxiety (aOR:1.6, CI:1.1–2.3) compared to 1–2 consultations. Symptom onset to first oncology appointment intervals of ≥2 months was associated with impaired HRQoL (aOR:1.8, CI:1.2–2.5) compared to <2 months.
Conclusions
Prolonged diagnostic intervals in AYA are associated with an increased risk of impaired HRQoL, anxiety and depression. Identifying and delivering interventions for this high-risk group is a priority.
| Original language | English |
|---|---|
| Article number | 1725–1734 |
| Pages (from-to) | 1725-1734 |
| Number of pages | 10 |
| Journal | British Journal of Cancer |
| Volume | 126 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 22 Feb 2022 |
Bibliographical note
Funding Information:We would like to thank the 1114 young people who consented to participate in BRIGHTLIGHT and the healthcare professionals who approached and consented young people. We would also like to thank members of BRIGHTLIGHT Young Advisory Panel (YAP) for their ongoing support for BRIGHTLIGHT and interpretation of the results. This manuscript is dedicated to the memory of YAP member Poppy Richards who contributed to YAP workshops informing this research and additional BRIGHTLIGHT studies over the past 5 years. Poppy sadly died from her cancer during manuscript preparation. The BRIGHTLIGHT team are grateful for her support and vivacious contribution to ensuring her experience contributed to improving outcomes for other young people with cancer. We would also like to acknowledge Mathew Cooke, Amy Lang, Stephen Sutton and Lara Veitch, additional members of the BRIGHTLIGHT YAP who died from their cancer during the BRIGHTLIGHT study. We would like to thank Dr Anika Petrella, Mr Luke Hughes, Mr Ben Connors, Miss Liane Hazell for their help and support for the PPI work during the study. The Quality of Life study described in this paper was carried out using the PedsQL, developed by Dr James W Varni. This project involves data derived from patient-level information collected by the NHS as part of the care and support of patients with cancer, collated, maintained and quality assured by the National Cancer Registration and Analysis Service, which is part of Public Health England.
Funding Information:
This work was supported by Cancer Research UK award C34672/A29737. This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-1209-10013). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The BRIGHTLIGHT Team acknowledges the support of the NIHR, through the Cancer Research Network. LAF is funded by Teenage Cancer Trust and GL is supported by a Cancer Research UK Clinician Advanced Scientist Fellowship (grant number C18081/A18180). GL is an Associate Director (co-investigator), AF a Principal Research Fellow and MK a Research Associate of the multi-institutional CanTest Collaborative, which is funded by Cancer Research UK (C8640/A23385). RMT is funded through the NIHR as a Senior Nurse Research Leader and UCLH Charity. FG is supported in part by the NIHR Great Ormond Street Hospital Biomedical Research Centre. None of the funding bodies have been involved with study concept, design or decision to submit the manuscript.
Publisher Copyright:
© 2022, The Author(s).
Keywords
- cancer
- Cancer epidemiology
- Diagnosis
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