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Breast Cancer Patients Face Increasing Number of Imaging Sessions Before Surgery

By MedImaging International staff writers
Posted on 27 Dec 2011

Breast cancer patients frequently undergo imaging tests such as mammograms or ultrasound scanning between their first breast cancer-related physician visit and surgery to remove the tumor.

Assessments of these scans help physicians better understand an individual’s disease and determine the best course of treatment. In recent years, however, imaging has increased in dramatic and substantial ways.

More patients have repeat visits for imaging more than they had 20 years ago, and single imaging appointments increasingly include multiple types of imaging. The researchers, led by Richard Bleicher, MD, a surgical oncologist from Fox Chase Cancer Center (Philadelphia, PA, USA), discovered that between 1992 and 2005, the percentage of patients who had multiple (2+) imaging visits nearly quadrupled. Dr. Bleicher reported that additional visits present a burden to patients, many of whom are elderly, but the stress may be alleviated through better coordination and evaluation by physicians. Dr. Bleicher presented his group’s findings at the 2011 CTRC-AACR San Antonio (TX, USA) Breast Cancer Symposium, in December 2011.

“The burden to the patient is increasing substantially,” Dr. Bleicher said. “The number of days patients are having mammograms, MRIs [magnetic resonance imaging], and ultrasounds is going up steadily year by year. They’re having imaging done more frequently on separate dates during the preoperative interval than ever before. It’s surprising.”

The preoperative interval starts when a patient first reports to a physician with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. For the more than 65,000 patients involved in the study, the preoperative interval lasted 37 days on average. The Fox Chase researchers found that in 1992, about one in 20 cancer patients (4.9%) diagnosed with invasive, nonmetastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in five (19.4%). In the extreme instance, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.

The researchers also found that only one imaging visit increasingly includes multiple imaging types. In 1992, 4.3% of patients underwent multiple types of imaging; in 2005, that rate increased to 27.1%. With the increased use of imaging, Dr. Bleicher stated that for physicians, “the question becomes, ‘How are we affecting patients overall with what we’re ordering nowadays?’”

Earlier research has assessed patient burden in terms of cost, however, Dr. Bleicher noted that he has not seen studies that focus on the patient burden in terms of the patient’s time. “I wanted to take a look at how things have been changing for patients and how many times they have to travel back and forth to get more imaging,” he said. “Physicians need to keep in mind that it’s hard enough for working people to take off from work and trek back and forth to appointments, but older people have infirmities, and it’s harder to get around. The coordination of care is very important. We need to focus more on the burden to the patient.”

Other studies have shown an increase in the cost of breast cancer care--but the cost of imaging is rising even faster. “We know the costs are going up, but we don’t know why,” Dr. Bleicher remarked. “One reason might be the frequency and amount of imaging.” He pointed out that when more than one set of imaging is done on the same day, “There are perversities of the reimbursement system that may foster these separate visits, although I don’t know if that’s why we're seeing this phenomenon.”

The researchers discovered the rising trend after studying data on US Medicare patients from the US National Cancer Institute’s (Bethesda, MD, USA) Surveillance Epidemiology and End Results (SEER) program. Their findings came from the records of 67,751 women who were treated for invasive, nonmetastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or ductal carcinoma in situ (DCIS because those types of breast cancer require different approaches to imaging and treatment. The average age of the study participants was 75.

Dr. Bleicher noted that the patient’s worry might be reduced if patients ask their providers the reason why imaging is being performed, and work together to make the process smoother. “If they do need imaging, then they might ask their physician, especially if they're of an older age, whether or not they think they’re going to need additional types of imaging and if those can be scheduled together,” he said.

The researchers are now going deeper into their data to understand the trend and look for a better way to help breast cancer patients with imaging, according to Dr. Bleicher. “We want to see whether or not there is a more efficient method of imaging the patients so that we’re improving outcomes without increasing costs.”

Related Links:
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57 (501.87110900879): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1661.0622406006): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 16426.086425781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

60 (!!!!! 59022.903442383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

61 (!!!!! 3317.8329467773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

62 (!!!!! 3381.0138702393): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

63 (576.01928710938): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (811.10000610352): SELECT fid FROM jos_deeppockets WHERE id=294738613 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738613 AND published='1' LIMIT 1

65 (406.98051452637): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

66 (175.95291137695): select jos_twitters.link from jos_twitters where cat=10

67 (473.0224609375): select jos_facebook.link from jos_facebook where cat=10

68 (65.088272094727): select jos_google_plus.link from jos_google_plus where cat=10

69 (52.928924560547): select jos_linkedin.link from jos_linkedin where cat=10

70 (442.0280456543): SELECT fid FROM jos_deeppockets WHERE id=294738613 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738613 AND published='1' LIMIT 1

71 (62.942504882812): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

72 (869.0357208252): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (!!!!! 2027.9884338379): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (107.0499420166): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (!!!!! 1750.9460449219): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (78.916549682617): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (586.98654174805): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (231.98127746582): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (982.04612731934): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (293.01643371582): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (324.96452331543): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (237.94174194336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (196.93374633789): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (515.93780517578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (566.00570678711): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (55.789947509766): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (!!!!! 3801.1074066162): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (380.03921508789): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (225.06713867188): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (!!!!! 1895.1892852783): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (289.9169921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (185.01281738281): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (125.16975402832): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (741.95861816406): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (385.99967956543): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (309.94415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (733.85238647461): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (264.88304138184): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 5526.065826416): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 2011.0607147217): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

107 (553.13110351562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

108 (516.17622375488): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 1005.8879852295): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 3419.1608428955): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

111 (580.0724029541): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

112 (!!!!! 1411.9148254395): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 1493.9308166504): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 7534.0270996094): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (!!!!! 8239.0308380127): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (!!!!! 7165.9088134766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

117 (!!!!! 8475.0652313232): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

118 (!!!!! 7698.0590820312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

119 (!!!!! 7992.9828643799): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

120 (!!!!! 5213.0222320557): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

121 (!!!!! 5994.7967529297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

122 (!!!!! 7678.9855957031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

123 (!!!!! 4787.9219055176): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

124 (893.83125305176): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 163130.04493713): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (!!!!! 1828.9089202881): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738613 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738613 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 1666.0690307617): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (!!!!! 3772.0203399658): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

129 (854.9690246582): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (!!!!! 1339.9124145508): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

131 (90.122222900391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

133 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

135 (51.975250244141): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

137 (!!!!! 10720.96824646): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (547.17063903809): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (!!!!! 2359.15184021): SELECT name FROM jos_deeppockets WHERE id=214

140 (104.90417480469): SELECT name FROM jos_deeppockets WHERE id=214

141 (822.06726074219): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (!!!!! 4738.0924224854): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (!!!!! 7570.9819793701): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

144 (288.96331787109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

145 (!!!!! 35561.084747314): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 1811.9812011719): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 3995.8953857422): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738613 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (566.95938110352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (!!!!! 1727.819442749): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (!!!!! 2762.0792388916): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

151 (499.01008605957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

152 (!!!!! 2141.9525146484): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (123.97766113281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

154 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

155 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738613 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738613 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (51.975250244141): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

157 (41.961669921875): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

158 (72.002410888672): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (!!!!! 2292.8714752197): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

160 (!!!!! 1962.9001617432): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738613 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738613 AND published='1' LIMIT 1

161 (!!!!! 3547.9068756104): select jos_twitters.link from jos_twitters where cat=10

162 (61.988830566406): select jos_facebook.link from jos_facebook where cat=10

163 (46.014785766602): select jos_google_plus.link from jos_google_plus where cat=10

164 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

165 (!!!!! 16976.118087769): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

166 (!!!!! 2414.9417877197): insert into jos_banners_delta values (14202,'2025-08-12 15:42:03','216.73.216.186','view'),(14203,'2025-08-12 15:42:03','216.73.216.186','view')

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