区域转诊网络中优化头颈癌诊疗协作的获益
Benefits of optimizing cooperation in head and neck cancer care in a regional referral network.
文献信息
| PMID | 42867666 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Henrieke W Schutte |
| 作者单位 | Radboud Institute for Health Sciences (RIHS), Department of Otorhinolaryngology, Head & Neck Surgery, Radboud University Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands. Henrieke.Schutte@radboudumc.nl. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 缩短治疗时间可改善头颈癌（HNC）患者的结局，包括生存。在一个大型、被认可的头颈肿瘤中心（HNOC）实施多项本地干预以优化HNC诊疗组织后，本观察性研究评估了在更广泛的诊疗路径优化项目中，区域转诊协议实施后，首次就诊于我们HNOC之前的诊断路径变化。
方法： 将2008年所有新诊断HNC患者与2016年诊断的患者进行比较，比较在与转诊医院达成协议前后，即根据临床怀疑癌症立即转诊患者并避免任何额外诊断操作。
结果： 在559例符合纳入条件的疑似HNC患者中，2008年纳入266例，2016年纳入293例。从转诊专科医生初次会诊到转诊至我们HNOC的时间显著缩短，从中位数16天降至11天（p = 0.002）。总体而言，从转诊专科医生初次会诊到在HNOC开始治疗的时间间隔从中位数56天降至38天（p < 0.001）。有趣的是，这也导致刚性喉咽镜检查减少了47.6%，CT和MR成像减少了38.9%（p < 0.001）。
结论： 在诊疗路径优化后，患者更早开始治疗，并且在全身麻醉下进行的诊断操作数量减少，从而降低了相关风险和成本。本研究表明，在网络和三级中心层面协调的路径优化可能有助于更高效的肿瘤诊疗。
英文摘要
PURPOSE: Reducing the time to treatment improves outcomes, including survival, in patients with head and neck cancer (HNC). After implementing multiple local interventions to optimise organisation of HNC care in a large, recognized head and neck oncological centre (HNOC), this observational study evaluates changes in the diagnostic pathway before the first visit to our HNOC following the implementation of a regional referral agreement within a broader programme of care pathway optimisation.
METHODS: All patients with newly diagnosed HNC in 2008 were compared with those diagnosed in 2016 before and after the agreement with referring hospitals to immediately refer patients based on clinical suspicion of cancer and refrain from any additional diagnostic procedures.
RESULTS: Of the 559 patients with suspected HNC who were eligible for inclusion, 266 were included in 2008 and 293 in 2016. The time from the initial consultation with the referring medical specialist to referral to our HNOC decreased significantly from 16 to 11 days (median, p = 0.002). Overall, the interval from the initial consultation with the referring medical specialist to the start of treatment at an HNOC decreased from 56 days to 38 days (median, p < 0.001). Interestingly, this also resulted in a 47.6% decrease in rigid laryngopharyngoscopies and a 38.9% reduction in CT and MR imaging (p < 0.001).
CONCLUSION: Following the care pathway optimisation, patients started treatment earlier, and the number of diagnostic procedures performed under general anesthesia decreased, reducing associated risks and costs. This study demonstrates that coordinated pathway optimisation at both network and tertiary-centre level may contribute to more efficient oncological care.