Patients wait a mean of four months before seeking a cancer diagnosis, researchers report on the ESMO Asia 2016 Congress in Singapore. Some sufferers waited lower than every week before seeing a physician whereas others waited three years.
“Delaying diagnosis had a significant impact on the treatment eventually received by patients in our study,” stated lead writer Dr Raviteja Miriyala, senior resident, Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. “Patients with longer delays before diagnosis were more likely to receive palliative, rather than curative, treatment because they had advanced disease – and are likely to have poorer outcomes.”
Early diagnosis and remedy enhance the result of most cancers. This research analysed causes of delays and the impression on remedy. A potential audit was carried out of all 162 cancer sufferers referred by main care physicians to the Department of Radiotherapy and Oncology in Chandigarh throughout one month. The following dates have been recorded for every affected person: first cancer associated symptom observed by affected person, first session with main care doctor, first oncology session, date remedy started (and intent of remedy – healing or palliative).
Three delay intervals have been calculated: affected person approaching main care doctor (affected person delay), main care doctor diagnosing/referring to oncologist (doctor delay), and oncologist beginning remedy (oncologist delay). Multivariate evaluation revealed the demographic and socioeconomic elements contributing to the delay, and the impression of this delay on remedy.
There was a mean complete delay of about six months between the primary symptom and the initiation of remedy. Patients and first care physicians contributed statistically vital delays – a mean of four months and three weeks, respectively. Oncologists delayed for a mean of ten days however this didn’t considerably contribute to the general delay.
Dr Miriyala stated: “Patients were found to be the source of most delays in diagnosis – some waited less than a week before seeing a doctor but others waited three years. Less educated patients were significantly less likely to get an early consultation with their doctor than those with higher education. Campaigns are needed to increase patient awareness about symptoms and screening.”
Some main care physicians delayed as much as 5 years before referring sufferers to an oncologist, as an alternative treating sufferers for “presumed non-malignant conditions”. Dr Miriyala stated: “About 25% of patients waited more than one month for their physician to refer them. Doctors in rural areas had significantly longer delays, suggesting that referral systems need improvement. Mandatory continuing medical education (CME) could increase doctors’ awareness about early diagnosis and referral, as could more oncology teaching hours and rotations in the undergraduate curriculum.”
About 6% of sufferers skilled delays of multiple month before their oncologist began remedy. Oncologist delay was considerably correlated to the illness website, with longer delays for head and neck cancer and shorter delays for mind tumours.
Dr Miriyala stated: “This can be attributed to the diagnosis and staging requirements for different malignancies. Most head and neck cancers require endoscopic assessments and biopsies before initiation of treatment, resulting in longer delays, while diagnosis is made after therapeutic surgery for most brain tumours, resulting in shorter delays. Cancers (like brain tumours) that present as medical or surgical emergencies are more likely to be addressed earlier. Improving the quality and quantity of infrastructure at tertiary centres would help reduce the oncologists’ delay.”
Patients with longer delays have been considerably extra more likely to obtain palliative remedy than these with shorter delays. Dr Miriyala stated: “Outcomes were not evaluated in our study but it is common knowledge that treatment with palliative intent leads to inferior outcomes compared to that with curative intent. Our research suggests that reducing delays might improve outcomes for cancer patients.”
Commenting on the findings, Dr Sing-Huang Tan, senior advisor, Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), stated: “Patients might delay seeking medical care due to failure to recognise signs, household or work commitments, or anxiety and worry. Patients in sure elements of Asia particularly might have ingrained cultural beliefs or preferences to self-medicate with conventional remedies, poor entry to healthcare, or socioeconomic limitations which might hypothetically result in lengthy delays before seeing a physician.”
“Primary healthcare providers are sometimes faced with diagnostic dilemmas when a patient presents with ambiguous symptoms,” continued Dr Tan. “A big majority of cancers current symptomatically, however signs could also be delicate particularly within the early levels in sure cancer varieties comparable to gastric, pancreatic or ovarian cancers, versus say a extra apparent palpable mass similar to in breast cancer.”
Dr Tan concluded: “This study highlights the perils of diagnostic delays and how they can lead to changes in treatment intent and presumably ultimately affect cancer outcomes. It is important to educate the general public to recognise suspicious symptoms which demand medical help, and to go for screening tests such as those that identify breast, colon and cervical cancers before symptoms develop.”
Abstract 567P_PR – ‘Diagnostic delay in oncology: Is there a necessity for growing cancer consciousness amongst main care physicians of creating nations?’ shall be introduced by Dr Raviteja Miriyala in the course of the Poster Display session: on Sunday, 18 December, 13:30 – 14:15 SGT.