Henry Jensen

Migrants are often diagnosed with cancer at more advanced stages than the background population, resulting in poorer prognosis. The route to cancer diagnos

The objective was to investigate how patient characteristics, clinical characteristics and prognosis were associated with lymphoma diagnoses in unplanned pathways. We included 7,157 consecutive patients diagnosed with lymphoma in a nationwide register-based study in Denmark. An unplanned pathway was defined as an acute admission within 30 days before diagnosis and compared to all other pathways combined. A total of 21% of patients were diagnosed in unplanned pathways, varying from 13% in indolent non-Hodgkin lymphoma to 32% in aggressive non-Hodgkin lymphoma. The probability of being diagnosed in an unplanned pathway was higher for patients with comorbidity, B-symptoms, abnormal blood test results, advanced disease stage and poor performance score (PS) at diagnosis. Diagnosis in an unplanned pathway was associated with higher mortality, for example, HR 2.03 (95% CI:1.74-2.38 for PS 0). Increased disease severity at diagnosis was associated with unplanned diagnostic pathways. Diagnosis in an unplanned pathway was associated with higher mortality.

Background: Evidence on quality of care and sociodemographics in patients with COPD needing care during the COVID-19 pandemic is scarce. We aimed to examine indicators of quality and clinical outcomes (eg, readmissions, death) and sociodemographics in patients with COPD in need of hospital care during the COVID-19 pandemic compared to before the pandemic. Methods: This was a nationwide register-based study of subjects with a hospital contact due to COPD from January 1, 2015–December 15, 2021, in Denmark. A generalized linear model using Poisson distribution was used to estimate prevalence ratios (PRs) for variables of interest. Results: During the pandemic, the early average of admissions was 36% lower than before the pandemic; the average number of out-patients was 23% lower. The proportion of readmissions for exacerbation within 30 d of discharge decreased during the pandemic (PR 0.93 [95% CI 0.90–0.96]). The proportion of subjects who died within 30 d of admission remained unchanged (PR 0.98 [0.94–1.03]). Among out-patients, the proportion with 2 or more exacerbations in the preceding year was lower during the pandemic (PR 0.82 [0.80–0.84]). During the pandemic, both in-patients and out-patients were less likely to be younger, to live alone, and to have a lower educational level. Conclusions: In this nationwide study of subjects with COPD, hospital contacts decreased during the pandemic due to lockdowns and isolation, which led to a decrease in infections overall in the society. Meanwhile, in-hospital care remained unaltered. However, concerns are raised about patients with COPD and low educational level and immigrants not seeking relevant health care.

BACKGROUND: Evidence on quality of care and sociodemographics in patients with COPD needing care during the COVID-19 pandemic is scarce. We aimed to examine indicators of quality and clinical outcomes (eg, readmissions, death) and sociodemographics in patients with COPD in need of hospital care during the COVID-19 pandemic compared to before the pandemic. METHODS: This was a nationwide register-based study of subjects with a hospital contact due to COPD from January 1, 2015–December 15, 2021, in Denmark. A generalized linear model using Poisson distribution was used to estimate prevalence ratios (PRs) for variables of interest. RESULTS: During the pandemic, the early average of admissions was 36% lower than before the pandemic; the average number of out-patients was 23% lower. The proportion of readmissions for exacerbation within 30 d of discharge decreased during the pandemic (PR 0.93 [95% CI 0.90–0.96]). The proportion of subjects who died within 30 d of admission remained unchanged (PR 0.98 [0.94–1.03]). Among out-patients, the proportion with 2 or more exacerbations in the preceding year was lower during the pandemic (PR 0.82 [0.80–0.84]). During the pandemic, both in-patients and out-patients were less likely to be younger, to live alone, and to have a lower educational level. CONCLUSIONS: In this nationwide study of subjects with COPD, hospital contacts decreased during the pandemic due to lockdowns and isolation, which led to a decrease in infections overall in the society. Meanwhile, in-hospital care remained unaltered. However, concerns are raised about patients with COPD and low educational level and immigrants not seeking relevant health care.

Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. Cross-sectional study using questionnaire and register data. General practice in Denmark. Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation.[Box: see text]. A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.

Purpose To investigate the association between fear of cancer recurrence (FCR) and healthcare use in general practice among cancer survivors. Methods We linked nationwide register data to survey data on FCR in cancer survivors at 2.5 years after a cancer diagnosis. Multiple regression models were used to analyse the association between high FCR level and quartiles of healthcare use at 18–30 months before the cancer diagnosis (habitual healthcare use) and between high FCR level and healthcare use at 18–30 months after the cancer diagnosis (survivorship healthcare use). Results We included 1538 cancer survivors in the study. High habitual healthcare use was associated with a high level of FCR (odds ratio = 2.07 (95% confidence interval (CI): 1.36–3.15)) for the 4th quartile of healthcare use compared to the 1st quartile. A high FCR score was also associated with higher healthcare use during cancer survivorship (incidence rate ratio (IRR) = 1.26 (95% CI: 1.14–1.40)). This association remained statistically significant when adjusting for habitual healthcare use (IRR = 1.20 (95% CI: 1.09–1.33)). Conclusion High healthcare use before the cancer diagnosis was associated with high FCR during survivorship. This indicates that FCR is partly explained by a general (pre-diagnostic) health concern. High FCR predicted high healthcare use during cancer survivorship, even when adjusting for habitual healthcare use. Implications for Cancer Survivors Our results suggest that FCR in cancer survivors is triggered by a general high level of health concern, and the cancer diagnosis may further exacerbate this concern.