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"textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">With the aim of reducing referral and diagnosis intervals to improve survival in cancer patients, over the first two decades of the 2000s multiple countries in Europe created various urgent Routes to Diagnosis for Cancer (RtDC) models. The most extensively described models are the 2-week-wait (2<span class="elsevierStyleHsp" style=""></span>WW) in the United Kingdom and the cancer patient pathways (CPP) in Denmark, Sweden, and Norway.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Both routes select patients with organ-specific symptoms suspected to be cancer in accordance with clinical referral guidelines. A new emerging route created in Denmark, subsequently implemented in other countries due to its diagnostic yield, is the CPP for patients with non-specific symptoms and signs of cancer (NSSC-CPP).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> Quick diagnosis units (QDU) as an alternative to hospitalisation, despite being created to prevent unnecessary hospitalisation, share the goal of quickly diagnosing potentially serious diseases, particularly those indicative of cancer.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a> Their efficacy as a diagnostic tool for cancer and potentially serious benign processes has been widely demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">During the initial stages of the new coronavirus pandemic (SARS-CoV-2), health care activity focused on patients with the coronavirus-19 illness (COVID-19). The situation caused unprecedented disruption to care, particularly to access to care, delayed visits, care for vulnerable groups, surgical scheduling, and diagnostic processes.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–16</span></a> While the impact of the pandemic on the cancer population has been reported in short-term studies, there are few medium-term descriptions or reports from urgent RtDC, including QDU.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study was to analyse the impact, after two years of the pandemic, on the volume of registries, referral and diagnosis times, incidence and stages of patients with cancer and diagnoses of benign diseases.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and setting</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective observational study was conducted with all patients recorded in the QDU between 1 March 2019 and 28 February 2022. It was a regional study conducted at Sant Camil Hospital, with a service area of about 146,800 inhabitants. The region’s health system is made up of an acute care hospital that comprises specialised care (SC), two nursing homes, and six primary care areas (PC). The unit’s care model is multidisciplinary, coordinated, and dependent on Internal Medicine and includes pulmonary and general surgery specialists.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population</span><p id="par0025" class="elsevierStylePara elsevierViewall">The inclusion criteria were age ≥18 years and suitability of the reasons for referral. Rapid diagnosis pathways for colorectal (CRC) and lung cancer have been included in the implementation of the oncology master plan of the Catalan Health Service since 2006, and patients with endoscopic indication of CRC have been detected in screening programs since 2016. The following exclusion criteria were considered: losses during the diagnostic process, death prior to diagnosis, and the need for hospitalisation during the diagnostic process.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">The variables were extracted from the unit database, the CRC screening program registry, and the medical history. The variables analysed are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The first visit interval (FVI) was defined as the time between the date of referral and the first visit, while the diagnosis interval (DI) was defined as the time between the first visit and diagnosis. In cancer patients, the DI and the FVDI, defined as the time between the referral date and diagnosis was considered the date of histopathological confirmation. The diagnostic yield of cancer was determined via the conversion rate (proportion of referrals resulting in cancer diagnosis).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The adequacy of the timing of intervals in patients with cancer was evaluated according to the “National Healthcare System Cancer Strategy” recommendations which standardises a median of ≤7 days for the FVI and ≤15 days for the DI.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The stages of solid tumours and lymphoproliferative syndromes were recorded.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Three periods were defined within the study:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0040" class="elsevierStylePara elsevierViewall">The pre-pandemic year (PPY) from 01/03/2019 to 29/02/2020.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0045" class="elsevierStylePara elsevierViewall">The first year of the pandemic (FYP) from 01/03/2020 to 28/02/2021.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0050" class="elsevierStylePara elsevierViewall">The second year of the pandemic (SYP) from 01/03/2021 to 28/02/2022.</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">The results from the three years were analysed and compared. The analyses were performed on the total sample and in the subgroup of patients with cancer. The variables were analysed using the statistical program SPSS® version 26.0.0.1 The univariate analysis used the absolute value and percentage for qualitative variables and the mean, median, standard deviation (SD), and interquartile range (IQR) for quantitative variables. In the bivariate analysis, the chi-squared test was used for the qualitative variables and Student’s <span class="elsevierStyleItalic">t</span>-test or the Mann–Whitney <span class="elsevierStyleItalic">U</span> test, as appropriate, were used for the quantitative variables. A statistical significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span> 0.05 was established.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical aspects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the principles of the Declaration of Helsinki and with the approval of the relevant Research Ethics Committee (Act 11/22 of 26 May 2022).</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 3184 patients were recorded during the three-year study. A total of 147 (3.1%) were excluded, 91 due to the need for hospitalisation, 53 due to losses and 3 died, resulting in a final study population of 3037 patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Referrals decreased by 4.2% in the FYP and increased by 17.7% in the SYP. A decrease in referrals was only observed in the first wave (-32.6%), with an increase of 8.1% between the second wave and the end of the FYP. The general characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Over the two years of the pandemic, there was a sustained increase in the FVI and PC referrals and a decrease in emergency referrals. In the FYP, there was a decrease in patients from the CRC screening program who required an endoscopic exam (−73.3%) and CRC diagnoses via this route (−68.7%), with an incomplete recovery (−14.7%) observed in the SYP compared to the PPY.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Suspected CRC, anaemia, and radiological alterations indicative of malignancy were the main reasons for consultation, representing ∼60% of the patients. The most common diseases were: digestive (44–46.5 %), pulmonary (11.8–14.2 %), haematological (5.7–7.8 %), and infectious (5.2−8.1%). Digestive tract tumours, anaemia due to digestive losses, and blood disorders were the most common benign processes.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Patients diagnosed with cancer increased during the two pandemic years (FYP: +2.7%; SYP: +15.7%), exceeding the PPY rate (18.7%) with 20% in the FYP and 19.2% in the SYP. The conversion rates for the main reasons for consultation were: suspected CRC (16–25.7 %), suspected lung cancer (36.5–42.1 %), and radiological alterations indicative of malignancy (22.3–36.4 %). <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> details the characteristics of this patient group. In the FYP there was a significant increase in referrals from PC and a reduction in referrals from CRC screening and emergency referrals. The median FVI saw an increase in the FYP and an incomplete recovery in the SYP. In the three years of the study, the mean FVI was lower in patients with cancer (PPY: 8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.04 days vs. 10.09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.27 days: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001; FYP: 10.56±6.38 days vs. 13.53±8.79 days: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001; SYP: 9.16±5.85 days vs. 12.91±10.1 days: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001). No variations were observed in the reason for referrals and the cancer locations. In terms of stages, the only significant finding was the reduction of stage 0 CRC in the FYP. While the DI increased in the SYP, the median did not exceed 15 days. In patients with cancer, the mean DI was shorter than for benign processes (PPY: 15.44 days vs. 18.25 days: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.060; FYP: 14.03 days vs. 21.61 days: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001; SYP: 17.65 days vs. 19.53 days: <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.181). The interval times according to the main locations are listed in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. In the majority of locations, the FVI increased during the FYP and recovered in the SYP. A DI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>15 days was only identified in lung cancer and lymphoproliferative syndromes. With the exception of lymphoproliferative syndromes, the median FVDI was less than 28 days.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The interpretation of the results must be contextualised within the setting of a regional study at a multidisciplinary QDU over a two-year period. Our study features various aspects of interest. On the one hand, it offers the possibility to highlight the benefits of urgent use of RtDC and, on the other hand, to evaluate and compare with similar studies the changes attributable to the pandemic in terms of volume and source of referrals, diagnostic cancer yield, and delays in intervals.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In 2012 Ellis-Brookes et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>, in a study with 739,667 patients with cancer (2006−2008) taken from the United Kingdom National Cancer Data Repository, categorised RtDC into 8 groups: screening, emergency PC referrals in the 2<span class="elsevierStyleHsp" style=""></span>WW route, emergency, regular or emergency PC referrals not following the 2<span class="elsevierStyleHsp" style=""></span>WW route, hospitalisation, outpatient, death certificate, and unknown. The study identified three predominant routes, the 2<span class="elsevierStyleHsp" style=""></span>WW (26%), emergency (24%), and PC referrals not following the 2<span class="elsevierStyleHsp" style=""></span>WW route (21%). In 2021 Danckert et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> in a study of 144,635 cases from the Danish cancer registry (2014–2017), modified the original categorisation by adding two emergency routes, which included CPPs and NSSC-CPPs in patients referred from PC and SC, and replacing the emergency route with unplanned hospital admission due to acute processes in the 30 days prior to cancer diagnosis. In the study it was observed that 66.3% of patients had followed an emergency route, 46.2% were referred from PC, and 20.1% from SC. Both authors agreed on the variability of prognosis according to the route followed, reporting higher mortality in the emergency route (20–40 %)<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and in the unplanned hospitalisation (53%) and unknown routes (33,7%), as compared to the urgent PC (15.6%) and SC routes (22.6%).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The diagnostic yield shows differences according to the RtDC model. Due to the strict referral criteria and variability in compliance, the 2<span class="elsevierStyleHsp" style=""></span>WW route is the organ-specific CPP with the lowest conversion rate (8–11%).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> On the other hand, in the NSSC-CPP route, rates between 7 and 12% have been reported in the United Kingdom and 11–22.1% in Scandinavian countries. The Danish model stands out due to its higher predictive value as it includes an initial study phase in PC with computed tomography.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> By including non-specific and specific signs and symptoms among the reasons for referral, QDUs achieve higher conversion rates (19–26.4%) than most urgent RtDC.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Different studies during the first two waves of the pandemic confirmed serious disruption in cancer care, including decreases in new diagnoses, treatment delays, fewer clinical trials, and fewer participants in screening programs.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16,20</span></a> In a systematic review, Riera et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported a decrease of between 10 and 78% in the number of expected new cases. While the trend after two years of pandemic has been one of gradual recovery, recent studies show that pre-pandemic numbers have not yet been reached.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,21,22</span></a> Ribes et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> described in the Catalan pathology registry from March 2020 to January 2022 a 12% decrease in new diagnoses compared to the pre-pandemic period.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The impact of the SARS-CoV-2 pandemic on QDUs has only been reported in one Barcelona university hospital by Bosch et al.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23–25</span></a> Two short-term studies confirmed a decrease in PC referrals during the lockdown period (36.6%) and in cancer diagnoses in patients coming from PC (-54%) and emergency routes compared to the pre-pandemic period (5.7% vs. 21.3%).<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a> These data are similar to those reported in various other studies of rapid diagnosis routes for cancer during the first two waves of the pandemic.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26–30</span></a> While our results are similar to those reported in the first wave, they differ starting with the second wave, when an increase in cancer referrals and diagnoses was observed. This may be attributable to delays in identifying and referring potentially severe processes during the lockdown period, redirecting patients who under other circumstances would have followed other diagnostic routes, and the accessibility of the unit.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The decrease in participants in the CRC screening program coincides with that observed in the Mazidimoradi et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> systematic review, which quantified the decrease at between 28–100%, with full operational capacity only maintained at 2–2.5% of centres.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The diagnostic yield in suspected CRC and lung cancer falls in line with the quick diagnosis pathways in Catalonia, which reported rates between 28.7% and 40% in CRC and 40.2% and 51.5% in lung cancer.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Studies conducted during the first waves showed an increase in stages, although some showed a later trend towards recovery.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,33–35</span></a> Bosch et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> observed a higher proportion of stage IV disease in pancreas, lung and stomach cancers limited to the second and third wave. The lack of variation in stages in our cancer population, although of undeniable value in lung and CRC, must be interpreted with caution due to the length of the study and the low incidence of diverse locations such as the pancreas, head and neck, and cancer of unknown primary origin.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In patients with cancer, extended interval times are associated with more advanced stages and higher mortality.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> We agree with the study from Bosch et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> on the change in all these intervals. Despite the increase in DI, the global median was below the standard (≤15 days) recommended by our National Healthcare System.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The 15 days was only surpassed in lung cancer and lymphoproliferative syndromes, locations that tend to require broader staging. The small increase in DI was due to prioritising, due to its high predictive value, the three primary reasons for referral (suspected CRC, suspected lung cancer, and radiological alterations indicative of malignancy) which tend to represent ∼60% of all cancers. For the majority of the locations, even during the pandemic period, our FVDI was shorter than those reported by Petrova et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> in a broad meta-analysis on intervals in patients with cancer conducted prior to the pandemic.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The efficacy and efficiency of QDUs has been widely verified.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–12,37–39</span></a> Our study corroborates its use as an alternative to hospitalisation and as a route for patients with suspected cancer thanks to its diagnostic yield, even during the pandemic.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The main study limitations where its length in terms of the still uncertain evolution of the pandemic, and the comparison of the data with the only QDU that reported impact and with cancer registries that do not detail the diagnosis routes used. The bias attributable to the low number of exclusions represents a relative limitation in the interpretation of the results. It was not possible to compare and correlate the changes identified in the study with those that occurred in the overall care provided at our centre (hospitalisation, external consultations, and emergency), which would have enabled an improved evaluation of the trends of the parameters analysed in relation to the total population seen at the hospital.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion, the pandemic did not produce significant clinical changes, with the exception of a higher proportion of cancer diagnoses due to the increase in referrals starting in the second wave. We consider the increase in PC referrals, to the detriment of the emergency route, to be relevant due to its prognostic significance, should the trend continue. Despite the increase in the time intervals, the DI always stayed within the recommended standards. The study verifies the participation and consolidation of QDUs as urgent RtDC, representing a diagnostic route that supplements those already established by the national health systems.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical considerations</span><p id="par0140" class="elsevierStylePara elsevierViewall">This study was conducted in compliance with the World Medical Association Code of Ethics (Declaration of Helsinki), the ethics of scientific publishing, and with the approval of the relevant Clinical Research Ethics Committee.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">This research did not receive any specific funding from agencies from the public sector, commercial sector, or not-for-profit organisations.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>"
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"resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first two years of the SARS-CoV-2 pandemic in a quick diagnosis unit.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was carried out during the prepandemic year (March 1, 2019, to February 29, 2020) and the first two years of the pandemic (March 1, 2020, to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">During the first pandemic wave, there was a reduction in referrals (−32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the two years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the three years of the study the median was <15 days.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitutes and urgent complementary cancer diagnostic route with a high diagnosis yield.</p></span>"
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"resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Analizar el impacto en la actividad asistencial, tiempo de los intervalos de derivación y diagnósticos y la incidencia de cáncer durante los dos primeros años de pandemia por SARS-CoV-2 en una Unidad de Diagnóstico Rápido.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo observacional realizado durante el año prepandémico (1 marzo 2019-29 febrero 2020) y los dos primeros años de pandemia (1 marzo 2020-28 febrero 2022). Se evaluaron y compararon variables demográficas, clínicas, el intervalo de la primera visita, el intervalo diagnóstico y el intervalo primera visita-diagnóstico.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Durante la primera ola pandémica hubo una reducción de derivaciones (-32,6%), registrándose desde la segunda ola hasta el final del primer año y segundo año de pandemia un incremento del 8,1% y del 17,7%, respectivamente. Se identificó un incremento de derivaciones de atención primaria y disminución de urgencias. El aumento de diagnósticos de cáncer del 2,7% y 15,7% en los dos años de pandemia fue proporcional al incremento de derivaciones. No se observaron cambios en procesos benignos ni en las localizaciones y estadiajes del cáncer. El intervalo de la primera vista fue superior en enfermedades benignas (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001). Se objetivó una prolongación del intervalo diagnóstico en pacientes con cáncer, aunque durante los tres años del estudio la mediana fue < 15 días.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El impacto de la pandemia incidió en el tiempo de los intervalos y en las procedencias de las derivaciones. La unidad de diagnóstico rápido constituye una ruta diagnóstica de cáncer complementaria de carácter urgente con un alto rendimiento diagnóstico.</p></span>"
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1 => array:2 [
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"titulo" => "Material y métodos"
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2 => array:2 [
"identificador" => "abst0035"
"titulo" => "Resultados"
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3 => array:2 [
"identificador" => "abst0040"
"titulo" => "Conclusiones"
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]
]
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"etiqueta" => "Figure 1"
"tipo" => "MULTIMEDIAFIGURA"
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"figura" => array:1 [
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"en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Study flow chart.</p>"
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"etiqueta" => "Table 1"
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0 => array:3 [
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<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Demographic</span>SexAge<span class="elsevierStyleBold">Source of referrals</span>Primary careEmergency departmentHospital specialtiesColorectal cancer screening<span class="elsevierStyleBold">Reason for referrals</span><span class="elsevierStyleBold">Isolated involuntary weight loss (></span>5% <span class="elsevierStyleBold">of body weight)</span><span class="elsevierStyleBold">Prolonged fever of an unknown cause</span><span class="elsevierStyleBold">Anaemia</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleBold">Recent onset adenopathies</span>Radiological alterations indicative of malignancySuspected colorectal cancerSuspected lung cancer<span class="elsevierStyleBold">Chronic diarrhoea (> 3 weeks and negative microbiological test)</span>Pleural effusionAscitesJaundiceSuspected systemic and autoimmune diseases<span class="elsevierStyleBold">Nonspecific abdominal pain</span>Abdominal massesDeep vein thrombosis with suspected paraneoplastic syndromeAnalytical abnormalities indicative of severe disease<span class="elsevierStyleBold">Diagnoses</span>Benign diseasesCancer<span class="elsevierStyleBold">Management indicators</span>First visit intervalDiagnosis intervalFirst visit-diagnosis interval<span class="elsevierStyleBold">Tertiary hospital referral</span> \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
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0 => array:3 [
"identificador" => "tblfn0005"
"etiqueta" => "a"
"nota" => "<p class="elsevierStyleNotepara" id="npar0005">Iron deficiency or normocytic anaemia with positive faecal occult blood and progressive and/or severe anaemia of unknown cause.</p>"
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]
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"descripcion" => array:1 [
"en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Study variables.</p>"
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"identificador" => "tbl0010"
"etiqueta" => "Table 2"
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"mostrarFloat" => true
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0 => array:3 [
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"leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PPY: pre-pandemic year; FYP: first year of pandemic; SYP: second year of pandemic; COPD: chronic obstructive pulmonary disease; FVI: first visit interval; DI: diagnosis interval; SD: standard deviation. PPY vs. FYP: * <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05; ** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01: *** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. FYP vs. SYP: * <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05; ** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01: *** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. SYP vs. PPY: * <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05; ** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01: *** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001.</p>"
"tablatextoimagen" => array:1 [
0 => array:2 [
"tabla" => array:1 [
0 => """
<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPY1 March 2019−29 February 2020<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>984 \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">FYP1 March 2020−28 February 2021<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>943 \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">SYP1 March 2021−28 February 2022<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1110 \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Age, mean (SD)</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">64.91<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.04 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">63.88<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.67 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">65.10<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.81 \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Sex, n (%)</span>MaleFemale \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">534 (54.2)450 (45.8) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">480 (50.9)463 (49.1) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">574 (51.7)536 (48.3) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">FVI (days), mean (SD)</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">9.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.10*** \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">12.97<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.44 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">12.19<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.41*** \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Source, n (%)</span>Primary careEmergency departmentHospital specialties<span class="elsevierStyleBold">Screening</span> colorectal cancerOther \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">461 (46.8) **273 (27.7) **231 (23.6)16 (1.6) *3 (0.3) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">508 (53.8)212 (22.6)216 (22.9)5 (0.5)2 (0.2) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">577 (52) *238 (21.4) ***277 (25)14 (1.2)4 (0.4) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Main reasons for consultation, n (%)</span>Suspected colorectal cancerAnaemiaIndicative radiological alterationsAbdominal painSuspected lung cancerIsolated involuntary weight lossAdenopathiesChronic diarrhoeaSerositisSuspected systemic diseaseDysphagiaProlonged fever or of an unknown cause \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">228 (23.1)132 (13.4)88 (9)81 (8.2) *76 (7.7)69 (7)56 (5.7)56 (5.7)19 (2)12 (1.2)34 (3.4)8 (0.8) ** \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">221 (23.4)116 (12.3)90 (9.5)108 (11.4)68 (7.2)72 (7.6)47 (5)42 (4.4)9 (0.9)9 (0.9)22 (2.3)30 (3.2) ** \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">247 (22.2)126 (11.3)128 (11.5)122 (11)90 (8.1)99 (8.9)73 (6.6)37 (3.3) *15 (1.3)11 (0.9)29 (2.6)14 (1.2) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Principal diseases, n (%)</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"> \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Digestive</span>CancerBenign tumoursInflammatory bowel diseaseDigestive haemorrhages<span class="elsevierStyleBold">Pulmonary</span>CancerSolitary pulmonary noduleCOPDInterstitial lung disease<span class="elsevierStyleBold">Haematology</span>Malignant blood disordersBenign disorders<span class="elsevierStyleBold">Infections</span><span class="elsevierStyleItalic">Helicobacter Pylori</span> infectionRespiratory infectionsDigestive infectionsViral infections<span class="elsevierStyleBold">Liver, bile duct, and pancreas</span>CancerChronic liver diseaseBile duct lithiasis<span class="elsevierStyleBold">Kidney and urinary tract</span>CancerChronic kidney failure<span class="elsevierStyleBold">Mental disorders</span><span class="elsevierStyleBold">Gynaecological</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">433 (44)86 (19.9)97 (22.4)15 (3.5)57 (13.1)136 (13.9)41 (30.1)25 (18.4)11 (8)7 (5.1)77 (7.8)13 (16.9)64 (83.1) *56 (5.7) *17 (30.3)19 (34)8 (14.3)7 (12.5)45 (4.6)17 (37.7)14 (31.1)7 (15.5)27 (2.7)16 (59.2)6 (22.2)23 (2.3)17 (1.7) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">439 (46.5)89 (20.3)81 (18.4)21 (4.8)62 (14.1)112 (11.8)34 (30.3)28 (25)10 (8.9)7 (6.2)54 (5.7)13 (24)41 (76)77 (8.1) **24 (31.2)16 (20.7)8 (10.4) *10 (13)60 (6.3)14 (23.3)17 (28.3)10 (16.6)31 (3.3)8 (25.8)11 (35.5)14 (1.9)11 (1.2) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">512 (46.1)105 (20.5)95 (18.5)14 (2.7)88 (17.1)158 (14.2)49 (31)33 (20.8)11 (6.9)4 (2.5)75 (6.7)19 (25.3)56 (74.7)58 (5.2)22 (38)18 (31)0**3 (5.2)58 (5.2)17 (29.3)15 (25.8)6 (10.3)29 (2.6)10 (34.5)11 (37.9)20 (1.8)10 (0.9) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Cancer, n (%)</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">184 (18.7) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">189 (20) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">213 (19.2) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">DI (days), mean (SD)</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">17.72<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.26** \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">20.09<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.94 \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">19.17<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.57 \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Tertiary hospital referral, n (%)</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">14 (1.4) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">10 (1.1) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">16 (1.4) \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
]
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0 => "xTab3505648.png"
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"en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients registered in the quick diagnosis unit during the three years of the study.</p>"
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]
3 => array:8 [
"identificador" => "tbl0015"
"etiqueta" => "Table 3"
"tipo" => "MULTIMEDIATABLA"
"mostrarFloat" => true
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"detalles" => array:1 [
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"leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">PPY: pre-pandemic year; FYP: first year of pandemic; SYP: second year of pandemic; SD: standard deviation; IQR: interquartile range 25–75. PPY vs. FYP: * <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05; ** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01; *** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. FYP vs. SYP: * <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05; ** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01; *** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001. SYP vs. PPY: * <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05; ** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01; *** <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001.</p>"
"tablatextoimagen" => array:1 [
0 => array:2 [
"tabla" => array:1 [
0 => """
<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPY<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>184 \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">FYP<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>189 \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">SYP<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>213 \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Age, mean (SD)</span><span class="elsevierStyleBold">Sex, n (%)</span>Male<span class="elsevierStyleBold">Source, n (%)</span>Primary careEmergency departmentHospital specialties<span class="elsevierStyleBold">Screening</span> colorectal cancerOther<span class="elsevierStyleBold">Time intervals (days), median (IQR)</span>First visit intervalDiagnosis intervalFirst visit-diagnosis interval \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">70<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.67120 (65.2)57 (30.9) *42 (22.8) *69 (37.5)16 (8.8) *07 (4−11) **11 (3−24.7)21 (10−33) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">69.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.10122 (64.5) *81 (42.8)24 (12.7)79 (41.8)5 (2.7)011 (6−14) *11 (6−20) *22 (14−32) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">70.43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.42115 (54) *75 (35.2)30 (14.1)93 (43.7)14 (6.6)1 (0.4)8 (5−13)14 (7−24.5) *23 (14−35) * \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Main reasons for consultation, n (%)</span>Suspected colorectal cancerSuspected lung cancerIndicative radiological alterationsAnaemiaAdenopathiesAbdominal painDysphagiaIsolated involuntary weight loss \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">50 (27.1)32 (17.4)32 (17.4)22 (12)14 (7.6)10 (5.4)9 (4.9)2 (1) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">64 (33.9)28 (14.8)22 (11.6)14 (7.4)14 (7.4)7 (3.7)4 (2.1)7 (3.7) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">74 (34.7)36 (16.9)32 (15)13 (6.1)21 (9.8)7 (3.2)7 (3.2)6 (2.8) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Solid tumour staging, n (%)</span>Stage 0Stage IStage IIStage IIIStage IV \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">7 (4.1) *23 (13.4)28 (16.4)42 (24.6)71 (41.5) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">1 (0.7)28 (15.9)32 (18.1)51 (28.9)64 (36.4) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">3 (1.5)27 (13.9)40 (20.6)46 (23.7)78 (40.3) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Location and staging, n (%)</span><span class="elsevierStyleBold">Colorectal</span>Stage 0Stage I-IIStage III-IV<span class="elsevierStyleBold">Lung</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Gastrointestinal tract</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Lymphoproliferative syndromes</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Prostate</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Pancreas</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Liver and bile duct</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Kidney and urinary tracts</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Cancer of unknown primary origin</span>Stage I-IIStage III-IV<span class="elsevierStyleBold">Neuroendocrine tumours</span>Stage I-IIStage III-IV \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">71 (38.5)7 (9.8) *36 (50.7)28 (39.5)41 (22.4)8 (19.5)33 (80.5)15 (8.1)2 (13.3)13 (86.7)11 ()2 (18.2)9 (81.8)10 (5.4) **010 (100)8 (4.3)1 (12.5)7 (87.5)7 (3.4)3 (42.8)4 (57.2)6 (3.3)3 (50)3 (50)5 (2.7)05 (100)4 (2.1)2 (50)2 (50) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">79 (41.8)1 (1.2)39 (49.4)39 (49.4)34 (17.9)6 (17.6)28 (82.4)10 (5.3)010 (100)9 (4.7)5 (55.5)4 (44.5)1 (0.5)01 (100)7 (3.7)2 (28.6)5 (71.4)6 (3.1)1 (16.6)5 (83.4)7 (3.7)3 (42.8)4 (57.2)6 (3.1)06 (100)5 (2.6)2 (40)3 (60) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">92 (43.2)3 (3.2)45 (49)44 (47.8)48 (22.5)10 (20.8)38 (79.2)13 (6.1)4 (30.7)9 (69.3)16 (7.5)3 (18.7)13 (81.3)7 (3.3)07 (100)7 (3.3)1 (14.3)6 (85.7)7 (3.3)2 (28.5)5 (71.5)3 (1.4)2 (66.6)1 (33.4)4 (1.8)04 (100)1 (0.4)1 (100)0 \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
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"descripcion" => array:1 [
"en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patients with a cancer diagnosis: general characteristics, principal locations, and disease stages.</p>"
]
]
4 => array:8 [
"identificador" => "tbl0020"
"etiqueta" => "Table 4"
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"leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">PPY: pre-pandemic year; FYP: first year of pandemic; SYP: second year of pandemic; FVI: first visit interval; DI: diagnostic interval; FVDI: first visit-diagnosis interval; IQR: interquartile range: 25–75.</p>"
"tablatextoimagen" => array:1 [
0 => array:2 [
"tabla" => array:1 [
0 => """
<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cancer locations \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPY \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">FYP \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">SYP \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t"><span class="elsevierStyleBold">Colorectal</span>FVI (days), median (IQR)DI (days), median (IQR)FVDI (days), median (IQR)<span class="elsevierStyleBold">Lung</span>FVI (days), median (IQR)DI (days), median (IQR)FVDI (days), median (IQR)<span class="elsevierStyleBold">Gastrointestinal tract</span>FVI (days), median (IQR)DI (days), median (IQR)FVDI (days), median (IQR)<span class="elsevierStyleBold">Lymphoproliferative syndromes</span>FVI (days), median (IQR)DI (days), median (IQR)FVDI (days), median (IQR)<span class="elsevierStyleBold">Pancreas</span>FVI (days), median (IQR)DI (days), median (IQR)FVDI (days), median (IQR)<span class="elsevierStyleBold">Liver and bile duct</span>FVI (days), median (IQR)DI (days), median (IQR)FVDI (days), median (IQR) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">8 (6−13)8 (3−23)20 (12−33)7 (3−8)18 (10.5−27)24 (15.5−33)9 (5−14)14 (3−37)23 (6−49)7 (1−12)33 (28−50)44 (34−57)5.5 (3.5−7.7)6.5 (2−11)11.5 (6.25)6 (4−8)12 (5−14)18 (14−21) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">12 (7−14)10 (5−20)22 (14−33)8 (4−12.5)18 (10−21.5)25.5 (17.7−34)12 (6.7−12.7)9 (6.7−17.2)21 (12.75−30.5)7 (4−12.5)22 (19−37.5)35 (25.5−42.5)12 (4−13)6 (2−8)20 (4−23)7 (3.5−9.2)12 (1−17.5)19.5 (12.2−23.7) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">9.5 (6−14)13 (6−22)22 (14−34.5)6 (3−10)23 (14−29.5)27.5 (20−40.5)6 (3−8.5)9 (1−15)15 (8−22)8 (6−12.7)22 (13.5−41.7)34 (19.7−48.7)6 (4−13)9 (8−15)23 (13−25)8 (3−12)13 (9−13)18 (15−23) \t\t\t\t\t\t\n
\t\t\t\t</td></tr></tbody></table>
"""
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"descripcion" => array:1 [
"en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Time of referral intervals and diagnosis intervals for the principal cancer locations in the three study periods.</p>"
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]
"bibliografia" => array:2 [
"titulo" => "References"
"seccion" => array:1 [
0 => array:2 [
"identificador" => "bibs0005"
"bibliografiaReferencia" => array:39 [
0 => array:3 [
"identificador" => "bib0005"
"etiqueta" => "1"
"referencia" => array:1 [
0 => array:2 [
"contribucion" => array:1 [
0 => array:2 [
"titulo" => "Implementing the 2-week wait rule for cancer referral in the UK: general practitioners’ views and practices"
"autores" => array:1 [
0 => array:2 [
"etal" => false
"autores" => array:4 [
0 => "W. Dodds"
1 => "M. Morgan"
2 => "C. Wolfe"
3 => "K.S. Raju"
]
]
]
]
]
"host" => array:1 [
0 => array:2 [
"doi" => "10.1111/j.1365-2354.2004.00447.x"
"Revista" => array:6 [
"tituloSerie" => "Eur J Cancer Care (Engl)"
"fecha" => "2004"
"volumen" => "13"
"paginaInicial" => "82"
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