Skin cancers occur commonly worldwide. The prognosis and disease burden are highly dependent on the cancer type and disease stage at diagnosis. We systematically reviewed studies on artificial ...intelligence and machine learning (AI/ML) algorithms that aim to facilitate the early diagnosis of skin cancers, focusing on their application in primary and community care settings. We searched MEDLINE, Embase, Scopus, and Web of Science (from Jan 1, 2000, to Aug 9, 2021) for all studies providing evidence on applying AI/ML algorithms to the early diagnosis of skin cancer, including all study designs and languages. The primary outcome was diagnostic accuracy of the algorithms for skin cancers. The secondary outcomes included an overview of AI/ML methods, evaluation approaches, cost-effectiveness, and acceptability to patients and clinicians. We identified 14 224 studies. Only two studies used data from clinical settings with a low prevalence of skin cancers. We reported data from all 272 studies that could be relevant in primary care. The primary outcomes showed reasonable mean diagnostic accuracy for melanoma (89·5% range 59·7–100%), squamous cell carcinoma (85·3% 71·0–97·8%), and basal cell carcinoma (87·6% 70·0–99·7%). The secondary outcomes showed a heterogeneity of AI/ML methods and study designs, with high amounts of incomplete reporting (eg, patient demographics and methods of data collection). Few studies used data on populations with a low prevalence of skin cancers to train and test their algorithms; therefore, the widespread adoption into community and primary care practice cannot currently be recommended until efficacy in these populations is shown. We did not identify any health economic, patient, or clinician acceptability data for any of the included studies. We propose a methodological checklist for use in the development of new AI/ML algorithms to detect skin cancer, to facilitate their design, evaluation, and implementation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally.
A telephone survey of a random sample of ...individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying.
Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal).
At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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Background: The increased burden of cancer has driven the development of health system level initiatives worldwide promoting early diagnosis. Although it is challenging to synthesize ...results of such complex, diverse initiatives, it is crucial to review the evidence to inform future programs and enhance transparency and accountability. Aim: We aimed to systematically review the literature on health system level initiatives promoting early diagnosis among the adult population, describing and categorizing their components, stakeholders, target populations, and outcomes. Methods: We have searched databases (including Embase, PsycInfo, Medline and ASSIA), Web sites (including charities, governmental and nongovernmental agencies) and reference lists of included studies and relevant systematic reviews for peer-reviewed publications and gray literature. We included quantitative, qualitative, mixed-methods studies and reviews/overviews about a single initiative in high-income countries as defined by the World Bank. We included initiatives: 1) targeting adults aged 18 or older; 2) aiming to promote early diagnosis; 3) addressing the patient/public and at least two more levels of contextual influence (according to a model of multilevel influences on cancer care); 4) implemented at a national level or equivalent. Study selection, quality assessment and data extraction were carried out independently by two reviewers. Narrative synthesis was used to analyze the findings. The review protocol has been published by BMJ Open and registered at PROSPERO (CRD42016047233). Results: Twenty initiatives from 10 countries were identified in 263 publications. Data were extracted from 104 core publications about 19 initiatives. It was possible to assess the quality of 35 core publications. Initiatives focused on fast-track for patients with alarm symptoms or other referral pathways for those with other symptoms or abnormal test results (n=11), national awareness campaigns for the public (n=4), and strategies with multiple components (n=4). Tools developed for professionals included referral guidelines and online referral systems. Initiatives focusing on referral pathways showed some improvements in diagnostic intervals, and limited evidence on the impact on staging. Performance targets were often not met. Results from awareness campaigns indicated improvement in awareness, but evidence about changes in health-seeking behavior was limited. Barriers and facilitators were described, including availability of specialist staff. Conclusion: Robustness of methods/outcomes could not always be assessed as several publications were reports or government documents. Evidence on the impact of initiatives regarding longer-term outcomes is limited. Described barriers and facilitators may help to inform future initiatives. Findings may be useful to researchers, policy makers, and governments developing early diagnosis programs and assessing cancer outcomes.
Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally.
A telephone survey of a random sample of ...individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying.
Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal).
At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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