Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review.

BACKGROUND: National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care. METHODS: Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis. RESULTS: Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I-IIIA disease. CONCLUSION: There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment.

NHS librarians collaborate to develop a search bank peer reviewing and sharing COVID-19 searches: an evaluation.

BACKGROUND: Responding to the COVID-19 pandemic, Health Education England (HEE) mobilised a group of expert searchers from NHS libraries in England to develop a platform for librarians to share peer reviewed search strategies and results on the Knowledge for Healthcare website. OBJECTIVES: (1) To document the origins of the COVID-19 search bank, (2) evaluate attitudes of NHS librarians in England towards the search bank and (3) identify lessons learned and consider whether the initiative might be developed further. METHODS: Structured interviews with the peer reviewers (n = 10) were conducted, and a questionnaire survey of the NHS library community using the search bank was undertaken. RESULTS: The interviews confirmed the value of collaboration. Expert searchers worked in pairs to peer review submitted search strategies. The survey (85 responses) indicated that a majority had used the search bank, and approved of the project, with some differences of opinion on functionality and future developments. DISCUSSION: Collaborative working for the search bank probably saved time for individual NHS librarians. The quality of the searches submitted was variable as were librarians' approaches to presentation and development of search strategies. Peer review benefits from a buddy approach among expert searchers and agreement about feedback provided to contributors. CONCLUSION: Search strategies are the most useful element of a search bank. Peer review can be challenging and would benefit from a formal structure, but it is professionally rewarding.

Preoperative risk assessment tools for morbidity after cardiac surgery: a systematic review.

BACKGROUND: Postoperative morbidity places considerable burden on health and resources. Thus, strategies to identify, predict, and reduce postoperative morbidity are needed. AIMS: To identify and explore existing preoperative risk assessment tools for morbidity after cardiac surgery. METHODS: Electronic databases (including MEDLINE, CINAHL, and Embase) were searched to December 2020 for preoperative risk assessment models for morbidity after adult cardiac surgery. Models exploring one isolated postoperative morbidity and those in patients having heart transplantation or congenital surgery were excluded. Data extraction and quality assessments were undertaken by two authors. RESULTS: From 2251 identified papers, 22 models were found. The majority (54.5%) were developed in the USA or Canada, defined morbidity outcome within the in-hospital period (90.9%), and focused on major morbidity. Considerable variation in morbidity definition was identified, with morbidity incidence between 4.3% and 52%. The majority (45.5%) defined morbidity and mortality separately but combined them to develop one model, while seven studies (33.3%) constructed a morbidity-specific model. Models contained between 5 and 50 variables. Commonly included variables were age, emergency surgery, left ventricular dysfunction, and reoperation/previous cardiac surgery, although definition differences across studies were observed. All models demonstrated at least reasonable discriminatory power [area under the receiver operating curve (0.61-0.82)]. CONCLUSION: Despite the methodological heterogeneity across models, all demonstrated at least reasonable discriminatory power and could be implemented depending on local preferences. Future strategies to identify, predict, and reduce morbidity after cardiac surgery should consider the ageing population and those with minor and/or multiple complex morbidities.

Adrenalectomy for isolated metastasis from operable non-small-cell lung cancer.

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'in [patients with isolated adrenal metastasis from operable/operated non-small cell lung cancer] is [adrenalectomy] superior [to chemo/radiotherapy alone for achieving long-term survival]?' Altogether >160 papers were found using the reported search, of which 3 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the body of evidence is small, retrospective and not formally controlled. As such interpretation is limited by selection bias in assignment of patients. These limitations notwithstanding, surgical resection is associated with prolonged survival for patients with isolated adrenal metastasis from non-small cell lung cancer (NSCLC). Patient selection is probably critical. Factors that are important are: otherwise early tumour, node (TN) status of the lung primary and R0 resection, long disease-free interval and confidence that there are no other sites of metastasis. Patients with ipsilateral adrenal metastasis may derive the greatest survival benefit from adrenalectomy, since spread to the ipsilateral gland may occur via direct lymphatic channels in the retroperitoneum. Involvement of the contralateral adrenal may signify haematogenous spread and therefore, a more aggressive process. Adrenalectomy must be accompanied by regional lymph node clearance to reduce the chance of further spread from the adrenal itself.