Outcomes and characteristics of Danish patients undergoing a lung cancer patient pathway without getting a lung cancer diagnosis. A retrospective cohort study.

Introduction: The organ-specific Danish cancer patient pathways (CPPs) including standard time frames were introduced in 2008-2009 securing fast tracks for cancer diagnosis and treatment. Previous studies of the CPPs have focussed on patients getting the suspected cancer diagnosis, whereas little is known about patients not getting the cancer diagnosis for which they were examined. We aimed to describe the characteristics of patients who completed a lung cancer CPP (LCPP) without getting a LC diagnosis. Furthermore, to assess the proportion of patients who had invasive procedures performed during the LCPP and radiographic examinations of the chest conducted 30 days prior to the LCPP and during the LCPP. Moreover, we aimed to describe the proportion of patients being diagnosed with any other cancer-type than LC or with non-malignant pulmonary diseases (NMPDs) during the LCPP. Methods: The study was a retrospective population-based cohort study based on Danish national registers. Patients completing a LCPP between 1 January 2013 and 31 December 2016 without being diagnosed with LC and who were registered as initiating and completing the LCPP, a total of 35,809, were included in the study. Results: Invasive procedures were performed in 12,986 patients (37.4%) and almost all patients had CT-scans of thorax and lungs conducted 30 days prior to or during the LCPP. During the LCPP other cancer-types than LC were diagnosed in 1,537 patients (4.3% of the study population), including other primary thoracic malignancies in 312 patients, while 6,826 patients (19.1%) were diagnosed with NMPDs, most often infections or chronic respiratory diseases of lower airways. Conclusion: Besides diagnosing LC the LCPP may contribute significantly in diagnosing other primary and secondary cancers as well as non-malignant diseases.

Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals.

This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

Invasive examinations in patients with suspected lung cancer: more may be too many.

The recent article entitled "Principles of biopsy in suspected lung cancer: priority still based on invasion in the era of targeted therapy?" published in Journal of Thoracic Disease by Chen et al., concluded the principles of biopsy in suspected lung cancer should be prioritized in sequence based on weight in clinical management, acquisition of tissue, invasion, efficiency and cost. We reported a patient with a 30-year history of pulmonary silicosis, had been found no evidence of tumor after receiving a series of invasive examinations. We conclude that invasive examinations should be limited in patients with suspected lung cancer who had a defined history of underlying disease. Minimal invasion with careful acquisition of the appropriate quantity and quality of tissue should be adequate.