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      Do diagnostic delays in cancer matter?

      research-article
      Author(s): 1 , *
      Publication date (Electronic):
      Journal: British Journal of Cancer
      Publisher: Nature Publishing Group
      Keywords: diagnosis, symptoms, primary care, delays

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          Abstract

          Background:

          The United Kingdom has poorer cancer outcomes than many other countries due partly to delays in diagnosing symptomatic cancer, leading to more advanced stage at diagnosis. Delays can occur at the level of patients, primary care, systems and secondary care. There is considerable potential for interventions to minimise delays and lead to earlier-stage diagnosis.

          Methods:

          Scoping review of the published studies, with a focus on methodological issues.

          Results:

          Trial data in this area are lacking and observational studies often show no association or negative ones. This review offers methodological explanations for these counter-intuitive findings.

          Conclusion:

          While diagnostic delays do matter, their importance is uncertain and must be determined through more sophisticated methods.

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          Most cited references53

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          Influence of delay on survival in patients with breast cancer: a systematic review.

          M. A. RICHARDS, A M Westcombe, S B Love … (1999)
          Most patients with breast cancer are detected after symptoms occur rather than through screening. The impact on survival of delays between the onset of symptoms and the start of treatment is controversial and cannot be studied in randomised controlled trials. We did a systematic review of observational studies (worldwide) of duration of symptoms and survival. We identified 87 studies (101,954 patients) with direct data linking delay (including delay by patients) and survival. We classified studies for analysis by type of data in the original reports: category I studies had actual 5-year survival data (38 studies, 53,912 patients); category II used actuarial or multivariate analyses (21 studies, 25,102 patients); and category III was all other types of data (28 studies, 22,940 patients). We tested the main hypothesis that longer delays would be associated with lower survival, and a secondary hypothesis that longer delays were associated with more advanced stage, which would account for lower survival. In category I studies, patients with delays of 3 months or more had 12% lower 5-year survival than those with shorter delays (odds ratio for death 1.47 [95% CI 1.42-1.53]) and those with delays of 3-6 months had 7% lower survival than those with shorter delays (1.24 [1.17-1.30]). In category II, 13 of 14 studies with unrestricted samples showed a significant adverse relation between longer delays and survival, whereas four of five studies of only patients with operable disease showed no significant relation. In category III, all three studies with unrestricted samples supported the primary hypothesis. The 13 informative studies showed that longer delays were associated with more advanced stage. In studies that controlled for stage, longer delay was not associated with shorter survival when the effect of stage on survival was taken into account. Delays of 3-6 months are associated with lower survival. These effects cannot be accounted for by lead-time bias. Efforts should be made to keep delays by patients and providers to a minimum.
          Article 0 comments Cited 167 times – based on 0 reviews     Review now
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            Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer

            V Allgar, R Neal (2005)
            The aim of this paper is to describe and compare components of diagnostic delay (patient, primary care, referral, secondary care) for six cancers (breast, colorectal, lung, ovarian, prostate and non-Hodgkin's lymphoma), and to compare delays in patients who saw their GP prior to diagnosis with those who did not. Secondary data analysis of The National Survey of NHS Patients: Cancer was undertaken (65 192 patients). Breast cancer patients experienced the shortest total delays (mean 55.2 days), followed by lung (88.5), ovarian (90.3), non-Hodgkin's lymphoma (102.8), colorectal (125.7) and prostate (148.5). Trends were similar for all components of delay. Compared with patient and primary care delays, referral delays and secondary care delays were much shorter. Patients who saw their GP prior to diagnosis experienced considerably longer total diagnostic delays than those who did not. There were significant differences in all components of delay between the six cancers. Reducing diagnostic delays with the intention of increasing the proportion of early stage cancers may improve cancer survival in the UK, which is poorer than most other European countries. Interventions aimed at reducing patient and primary care delays need to be developed and their effect on diagnostic stage and psychological distress evaluated.
            Article 0 comments Cited 115 times – based on 0 reviews     Review now
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              Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

              V Arndt, T Stürmer, C Stegmaier … (2002)
              Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month. British Journal of Cancer (2002) 86, 1034–1040. DOI: 10.1038/sj/bjc/6600209 www.bjcancer.com © 2002 Cancer Research UK
              Article 0 comments Cited 85 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Cancer
                Title: British Journal of Cancer
                Publisher: Nature Publishing Group
                ISSN (Print): 0007-0920
                ISSN (Electronic): 1532-1827
                Publication date (Electronic): 03 December 2009
                Publication date (Print): 03 December 2009
                Publication date PMC-release: 03 December 2009
                Volume: 101
                Issue: S2
                Pages: S9-S12
                Affiliations
                [1 ]Department of Primary Care and Public Health, North Wales Clinical School, Cardiff University Gwenfro 5, Wrexham Technology Park, Wrexham LL13 7YP, UK
                Author notes
                [* ]Author for correspondence: nealrd@ 123456cf.ac.uk
                Article
                Publisher Item ID: 6605384
                DOI: 10.1038/sj.bjc.6605384
                PMC ID: 2790696
                PubMed ID: 19956171
                SO-VID: cc99815e-9c0d-4f23-a7f4-7f2fc614f361
                Copyright © Copyright 2009, Cancer Research UK
                History
                Categories
                Subject: Papers

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: delays,symptoms,primary care,diagnosis
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: delays, symptoms, primary care, diagnosis

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