{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:48:52Z","timestamp":1791251332654,"version":"4.1.0"},"reference-count":39,"publisher":"BMJ","issue":"6","funder":[{"name":"NIHR Oxford CLAHRC"},{"name":"Oxford Primary Care Research Trust Graduate Scholarship"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,4,16]]},"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify the duration of each step of the diagnostic pathway for patients with multiple myeloma from symptom onset to confirmation of diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and selection criteria<\/jats:title>\n                    <jats:p>The MEDLINE and Embase databases were searched up until January 2018 to identify articles that reported time intervals from onset of symptoms to diagnosis. Articles focusing on children or adolescents and on the asymptomatic form of the disease (monoclonal gammopathies and smouldering myeloma) were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data collection and data analysis<\/jats:title>\n                    <jats:p>Data were extracted independently by two reviewers. Weighted estimates of the median and IQR were calculated. Risk of bias was assessed using the Aarhus checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main results<\/jats:title>\n                    <jats:p>Nine studies were included. The patient interval (first symptom to first presentation) had a median of 26.3 days (IQR: 1\u201398, n=465, two studies). Subsequently, the primary care interval (first presentation to first referral) was 21.6 days (IQR: 4.6\u201355.8, n=326, two studies), the diagnostic interval (first presentation to diagnosis) was 108.6 days (IQR: 33.3\u2013241.7, n=5395, seven studies) and the time to diagnosis (first symptom to diagnosis) interval was 163 days (IQR: 84\u2013306, n=341, one study). No studies reported data for the referral to diagnosis interval.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The review demonstrates that there is scope for significant reductions in the time to myeloma diagnosis. At present, many patients experience a diagnostic interval longer than 3 months until diagnosis is confirmed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review registration<\/jats:title>\n                    <jats:p>Not available. Protocol available in the appendix.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-019758","type":"journal-article","created":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T07:59:58Z","timestamp":1529654398000},"page":"e019758","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Quantifying intervals to diagnosis in myeloma: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"8","author":[{"given":"Constantinos","family":"Koshiaris","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Oke","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Abel","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Ramasamy","sequence":"additional","affiliation":[{"name":"Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK"},{"name":"National Institute for Health Research (NIHR) Biomedical Research Center Blood Theme, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Van den Bruel","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,22]]},"reference":[{"key":"2025121223261841000_8.6.e019758.1","unstructured":"England PH . National Cancer Intelligence Network Cancer statistics : availability and location About Public Health England. 2015."},{"key":"2025121223261841000_8.6.e019758.2","unstructured":"Cancer Research UK. Myeloma statistics. http:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/myeloma#heading-Six (accessed 26 Aug 2016)."},{"key":"2025121223261841000_8.6.e019758.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61396-9"},{"key":"2025121223261841000_8.6.e019758.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7400"},{"key":"2025121223261841000_8.6.e019758.5","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp15X683545"},{"key":"2025121223261841000_8.6.e019758.6","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6602714"},{"key":"2025121223261841000_8.6.e019758.7","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70041-4"},{"key":"2025121223261841000_8.6.e019758.8","doi-asserted-by":"publisher","DOI":"10.1080\/10428190902741471"},{"key":"2025121223261841000_8.6.e019758.9","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603089"},{"key":"2025121223261841000_8.6.e019758.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/104546","article-title":"Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement","volume":"2013","author":"Tosi","year":"2013","journal-title":"Scientifica"},{"key":"2025121223261841000_8.6.e019758.11","doi-asserted-by":"publisher","DOI":"10.1186\/1756-9966-27-11"},{"key":"2025121223261841000_8.6.e019758.12","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1038\/bmt.2011.8","article-title":"Renal failure in multiple myeloma: a medical emergency","volume":"46","author":"Wirk","year":"2011","journal-title":"Bone Marrow Transplant"},{"key":"2025121223261841000_8.6.e019758.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3863"},{"key":"2025121223261841000_8.6.e019758.14","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcm077"},{"key":"2025121223261841000_8.6.e019758.15","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/BF01682035","article-title":"Presenting signs and symptoms in multiple myeloma: high percentages of stage III among patients without apparent myeloma-associated symptoms","volume":"70","author":"Ong","year":"1995","journal-title":"Ann Hematol"},{"key":"2025121223261841000_8.6.e019758.16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.242"},{"key":"2025121223261841000_8.6.e019758.17","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605383"},{"key":"2025121223261841000_8.6.e019758.18","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.68"},{"key":"2025121223261841000_8.6.e019758.19","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.48"},{"key":"2025121223261841000_8.6.e019758.20","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.408"},{"key":"2025121223261841000_8.6.e019758.21","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28763"},{"key":"2025121223261841000_8.6.e019758.22","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1038\/bjc.2015.311","article-title":"Risk factors and time to symptomatic presentation in leukaemia, lymphoma and myeloma","volume":"113","author":"Howell","year":"2015","journal-title":"Br J Cancer"},{"key":"2025121223261841000_8.6.e019758.23","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s11596-012-0011-0","article-title":"Renal impairment in multiple myeloma: presenting features in different departments","volume":"32","author":"Li","year":"2012","journal-title":"J Huazhong Univ Sci Technolog Med Sci"},{"key":"2025121223261841000_8.6.e019758.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0127717","article-title":"Age and Gender Variations in Cancer Diagnostic Intervals in 15 Cancers: Analysis of Data from the UK Clinical Practice Research Datalink","volume":"10","author":"Din","year":"2015","journal-title":"PLoS One"},{"key":"2025121223261841000_8.6.e019758.25","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.791"},{"key":"2025121223261841000_8.6.e019758.26","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.1"},{"key":"2025121223261841000_8.6.e019758.27","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1038\/bjc.2015.40","article-title":"The relative length of the patient and the primary care interval in patients with 28 common and rarer cancers","volume":"40","author":"Lyratzopoulos","year":"2015","journal-title":"Br J Cancer"},{"key":"2025121223261841000_8.6.e019758.28","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X694169"},{"key":"2025121223261841000_8.6.e019758.29","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1556\/OH.2014.30000","article-title":"[How long does a myeloma patient currently wait for the diagnosis in Hungary?]","volume":"155","author":"Varga","year":"2014","journal-title":"Orv Hetil"},{"key":"2025121223261841000_8.6.e019758.30","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2016.06.150393"},{"key":"2025121223261841000_8.6.e019758.31","doi-asserted-by":"publisher","DOI":"10.1186\/2052-1839-13-9"},{"key":"2025121223261841000_8.6.e019758.32","unstructured":"RCGP. National Audit of Cancer Diagnosis in Primary Care. London: Royal College of General Practitioners, 2011."},{"key":"2025121223261841000_8.6.e019758.33","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.029264"},{"key":"2025121223261841000_8.6.e019758.34","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1038\/bjc.2014.634","article-title":"Impact of investigations in general practice on timeliness of referral for patients subsequently diagnosed with cancer: analysis of national primary care audit data","volume":"112","author":"Rubin","year":"2015","journal-title":"Br J Cancer"},{"key":"2025121223261841000_8.6.e019758.35","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/bjh.14513","article-title":"Multiple myeloma: routes to diagnosis, clinical characteristics and survival - findings from a UK population-based study","volume":"177","author":"Howell","year":"2017","journal-title":"Br J Haematol"},{"key":"2025121223261841000_8.6.e019758.36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0126608"},{"key":"2025121223261841000_8.6.e019758.37","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1471-2296-9-31","article-title":"Pathways to the diagnosis of lung cancer in the UK: a cohort study","volume":"9","author":"Barrett","year":"2008","journal-title":"BMC Fam Pract"},{"key":"2025121223261841000_8.6.e019758.38","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-636"},{"key":"2025121223261841000_8.6.e019758.39","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu174"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-019758","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T07:26:26Z","timestamp":1765610786000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-019758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,6,22]]},"published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1136\/bmjopen-2017-019758"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-019758","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]}}}