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Patterns of Care Associated with Timely and Definitive Diagnosis of Cancer of Unknown Primary (CUP)
AuthorWhite, Larissa Lee
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The purpose of this dissertation was to perform a systematic review of recent population-based studies to summarize evidence on effective CUP diagnostic evaluation practices and examine how definitive and timely diagnosis and diagnostic guideline adherent care of metastatic pancreatic cancer affects survival in older patients who initially present with CUP. Guideline adherent, definitive and timely diagnosis of stage 3 and 4 pancreatic cancer in patients who initially presented with CUP had higher odds of occurring in patients who were a race other than White or Black with fewer or no comorbidities using logistic regression. Guideline adherent, definitive and timely diagnosis had lower odds of occurring in older patients with epithelial/unspecified histology. Survival analyses shared similarities with logistic regression results regarding age, comorbidities, and histology. Definitive diagnosis of stage 3 or 4 pancreatic cancer in those who were initially diagnosed with CUP was associated with a 72% reduction in hazard of death, while diagnostic guideline adherence was associated with a 52% reduction in hazard of death. These findings indicate transition from CUP to metastatic cancer of a known site, diagnosis prior to three months, and utilization of recommended diagnostic guidelines can make a significant impact on the life of the patient. Furthermore, if a patient were Black, Latino, and/or rural-residing, this resulted in statistically significant increased hazard of death. Future research should focus on the patterns of care associated with race, ethnicity, and social determinants of health in patients diagnosed with CUP and pancreatic cancer. By assessing current epidemiological studies on CUP diagnosis in the systematic review, we gained a broader understanding of how patients initially present with CUP and what healthcare utilization looks like for this population. The SEER-Medicare outcomes highlighted elucidate the real-world value of making a definitive and timely diagnosis in the survival of patients with CUP and metastatic pancreatic cancer, as well as the value of evaluating their complex diagnosis utilizing recommended diagnostic guidelines. Furthermore, health disparities identified, namely for older, Black, Latino, and rural-residing patients with multiple comorbidities, require further study to ascertain health care delivery and diagnosis improvement in cancer health services.