Referring patients with possible lymphoma to a nurse practitioner-led lymphoma rapid diagnosis clinic (LRDC) may result in decreased time to diagnosis and initiation of treatment compared with historical controls, according to study results published in the Journal of Oncology Practice.
The highly variable differential diagnosis of peripheral lymphadenopathy can delay a diagnosis of lymphoma, which, in turn, can negatively affect therapeutic outcomes, particularly for more aggressive lymphomas such as diffuse large B-cell lymphoma.
Researchers established an LRDC and referred 126 patients with possible lymphoma to the clinic between June 2015 and November 2017. They compared the results from these patients with historical control data from patients diagnosed with lymphoma at a single center between 2008 and 2012.
Of the referred patients, 52% had lymphoma. Median time to diagnosis was just 16 days, which was nearly 2 weeks shorter compared with time to diagnosis for historical controls (28 days; P <.001). Referral to the LRDC was associated with reductions in total number of biopsies needed to make a diagnosis.
Because not every patient with lymphoma requires treatment after diagnosis, researchers assessed time to treatment for aggressive lymphomas requiring treatment at the LRDC and compared that data with data from historical controls. Time to treatment was a median of 29 days in patients referred to the LRDC (interquartile range, 19-48), compared with 48 days in historical controls (interquartile range, 28-78).
Results from univariate analysis indicated lymph node size larger than 3.4 cm and presence of mediastinal or abdominal adenopathy increased the chances of diagnosis of lymphoma. On the other hand, younger age, being a nonsmoker, and a history of a rheumatologic condition were correlated with a decreased likelihood of diagnosis of lymphoma.
In multivariate analysis, lymph node size, patient age, and history of a rheumatologic condition retained their predictive associations.
Of note, this study achieved its improvements in time to diagnosis by relying on nurse practitioners, whereas previous studies have established similar clinics with “internists, consultant medical oncologists, and clinical nurse specialists.”
“We did not directly examine the effectiveness of the nurse practitioner role in our study,” the researchers wrote. “However, previous studies have shown that nurse practitioners have comparable diagnostic reasoning abilities to physicians and have successfully provided timely, accurate, and cost-effective care for oncology patients in other diagnostic settings.”
- Nixon S, Bezverbnaya K, Maganti M, et al. Evaluation of lymphadenopathy and suspected lymphoma in a lymphoma rapid diagnosis clinic [published online October 1, 2019]. J Oncol Pract. doi:10.1200/JOP.19.00202