Barriers and explanatory mechanisms in diagnostic delay in four cancers – A health-care disparity?

Abhishek Basu; Debjit Ghosh; Bidyut Mandal; Pratyusha Mukherjee; Avik Maji

doi:10.4103/sajc.sajc_311_18

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ORIGINAL ARTICLE: Epidemiology of Cancer and Cancer Screening

08 (

); 221-225

doi:

10.4103/sajc.sajc_311_18

Barriers and explanatory mechanisms in diagnostic delay in four cancers – A health-care disparity?

Abhishek Basu^1,, Debjit Ghosh¹, Bidyut Mandal¹, Pratyusha Mukherjee², Avik Maji³

1 Department of Radiotherapy, Medical College, Kolkata, West Bengal

2 Department of Radiotherapy, IPGME and R, Kolkata, West Bengal

3 Diamond Harbour District Hospital, Diamond Harbour, West Bengal

*Corresponding author: Dr. Abhishek Basu. dr.abhishekbasu123@gmail.com

Published: 2020-12-14

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Introduction: Most cancer disparities research has traditionally focused on two key outcomes, access to appropriate treatment and survival, but they do not encompass important aspects of patient-centered care such as the timeliness of diagnosis and treatment. Prolonged time intervals between symptom onset and treatment initiation increase the risk of poorer clinical outcomes and are associated with worse patient experience of subsequent cancer care. This study aims to assess the delay from symptom onset to the start of definitive treatment and to identify the possible contributory factors and its impact on response in cancers of head and neck, breast, cervix, and lung. Materials and Methods: This was a retrospective study of patients enrolled between 2015 and 2017. A questionnaire was filled in about socioeconomic aspects, patient history, tumor data, professionals who evaluated the patients, and the respective time delays. Statistical test included Mann–Whitney U test, univariate and multivariate test, and one-way ANOVA to evaluate the correlations. Results: Stage migration was significant with patient delay (P < 0.01). In head and neck squamous cell carcinoma (HNSCC) and Carcinoma lung, a significant correlation was found between referral delay and residence (P < 0.01) and treatment delay and reason for referral (HNSCC only) (P = 0.04). Referral delay and treatment delay were correlated to response in breast and cervix, respectively (P < 0.01). Conclusion: Social awareness, regularly updating primary care physicians about alarming symptoms of cancer, developing guidelines to identify these symptoms, promoting continuity of care, and enabling access to specialist expertise through prompt referral should all help prevent delays in cancer diagnosis.

Keywords

Acknowledgment

Colleagues of Dept of Radiotherapy, MCH, KOLKATA and patients of this study for their utmost cooperation.

References

World Health Organization. Cancer- Fact Sheet. World Health Organization; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs297/en. [Last accessed on 2016 May 09].
National Institute of Cancer Prevention and Research. Cancer Statistics Fact Sheet. National Institute of Cancer Prevention and Research; 2018. Available from: http://www.cancerindia.org.in/statistics/. [Last accessed on 2018 Jun 06].
Harford JB. Breast-cancer early detection in low-income and middle-income countries: Do what you can versus one size fits all. Lancet Oncol 2011;12:306-12.
Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015;112 Suppl 1:S92-107.
Koo MM, Zhou Y, Lyratzopoulos G. Delays in diagnosis and treatment of lung cancer: Lessons from US healthcare settings. Cancer Epidemiol 2015;39:1145-7.
Brouha XD, Tromp DM, Koole R, Hordijk GJ, Winnubst JA, de Leeuw JR, et al. Professional delay in head and neck cancer patients: Analysis of the diagnostic pathway. Oral Oncol 2007;43:551-6.
Goy J, Hall SF, Feldman-Stewart D, Groome PA. Diagnostic delay and disease stage in head and neck cancer: A systematic review. Laryngoscope 2009;119:889-98.
Tromp DM, Brouha XD, De Leeuw JR, Hordijk GJ, Winnubst JA. Psychological factors and patient delay in patients with head and neck cancer. Eur J Cancer 2004;40:1509-16.
Diaconescu R, Lafond C, Whittom R. Treatment delays in non-small cell lung cancer and their prognostic implications. J Thorac Oncol 2011;6:1254-9.
Allgar VL, Neal RD. Delays in the diagnosis of six cancers: Analysis of data from the national survey of NHS patients: Cancer. Br J Cancer 2005;92:1959-70.
Carvalho AL, Pintos J, Schlecht NF, Oliveira BV, Fava AS, Curado MP, et al. Predictive factors for diagnosis of advanced-stage squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 2002;128:313-8.
Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: A prospective cohort study. Br J Cancer 2015;112 Suppl 1:S6-13.
Withers HR, Taylor JM, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988;27:131-46.
Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992;23:457-67.
González Ferreira JA, Jaén Olasolo J, Azinovic I, Jeremic B. Effect of radiotherapy delay in overall treatment time on local control and survival in head and neck cancer: Review of the literature. Rep Pract Oncol Radiother 2015;20:328-39.
Jensen AR, Mainz J, Overgaard J. Impact of delay on diagnosis and treatment of primary lung cancer. Acta Oncol 2002;41:147-52.
Myrdal G, Lambe M, Hillerdal G, Lamberg K, Agustsson T, Ståhle E, et al. Effect of delays on prognosis in patients with non-small cell lung cancer. Thorax 2004;59:45-9.
BTS recommendations to respiratory physicians for organising the care of patients with lung cancer. The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee. Thorax 1998;53 Suppl 1:S1-8.
Yorio JT, Xie Y, Yan J, Gerber DE. Lung cancer diagnostic and treatment intervals in the United States: A health care disparity? J Thorac Oncol 2009;4:1322-30.
Radzikowska E, Roszkowski-Sliz K, Chabowski M, Glaz P. Influence of delays in diagnosis and treatment on survival in small cell lung cancer patients. Adv Exp Med Biol 2013;788:355-62.
Basu A, Mandal B, Ghosh D, Maji A. Patterns of care and factors affecting it in small cell lung cancer – Analysis of 3 years data from a tertiary care hospital in India. J Cancer Tumor Int 2018;7:1-7.
Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer 1999;79:858-64.
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: A systematic review. Lancet 1999;353:1119-26.
Nosarti C, Crayford T, Roberts JV, Elias E, McKenzie K, David AS, et al. Delay in presentation of symptomatic referrals to a breast clinic: Patient and system factors. Br J Cancer 2000;82:742-8.
Risberg T, Sørbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Res 1996;16:995-9.
Miriyala R, Bansal A, Dracham C, Thakur P, Ghoshal S. Diagnostic delay in oncology: Is there a need for increasing cancer awareness among primary care physicians of developing countries? Ann Oncol 2016;27 Suppl 9:ix184-9.
Spellman P, Smith I, Bruce E, Neal RD. The Cancer Journey to Secondary Care of Patients with Suspected Cancer of the Colon or Lung: A Perspective from General Practice. Leeds: Nuffield Portfolio Programme; 1999.

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[1] World Health Organization. Cancer- Fact Sheet. World Health Organization; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs297/en. [Last accessed on 2016 May 09].

[2] National Institute of Cancer Prevention and Research. Cancer Statistics Fact Sheet. National Institute of Cancer Prevention and Research; 2018. Available from: http://www.cancerindia.org.in/statistics/. [Last accessed on 2018 Jun 06].

[3] Harford JB. Breast-cancer early detection in low-income and middle-income countries: Do what you can versus one size fits all. Lancet Oncol 2011;12:306-12.

[4] Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015;112 Suppl 1:S92-107.

[5] Koo MM, Zhou Y, Lyratzopoulos G. Delays in diagnosis and treatment of lung cancer: Lessons from US healthcare settings. Cancer Epidemiol 2015;39:1145-7.

[6] Brouha XD, Tromp DM, Koole R, Hordijk GJ, Winnubst JA, de Leeuw JR, et al. Professional delay in head and neck cancer patients: Analysis of the diagnostic pathway. Oral Oncol 2007;43:551-6.

[7] Goy J, Hall SF, Feldman-Stewart D, Groome PA. Diagnostic delay and disease stage in head and neck cancer: A systematic review. Laryngoscope 2009;119:889-98.

[8] Tromp DM, Brouha XD, De Leeuw JR, Hordijk GJ, Winnubst JA. Psychological factors and patient delay in patients with head and neck cancer. Eur J Cancer 2004;40:1509-16.

[9] Diaconescu R, Lafond C, Whittom R. Treatment delays in non-small cell lung cancer and their prognostic implications. J Thorac Oncol 2011;6:1254-9.

[10] Allgar VL, Neal RD. Delays in the diagnosis of six cancers: Analysis of data from the national survey of NHS patients: Cancer. Br J Cancer 2005;92:1959-70.

[11] Carvalho AL, Pintos J, Schlecht NF, Oliveira BV, Fava AS, Curado MP, et al. Predictive factors for diagnosis of advanced-stage squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 2002;128:313-8.

[12] Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: A prospective cohort study. Br J Cancer 2015;112 Suppl 1:S6-13.

[13] Withers HR, Taylor JM, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988;27:131-46.

[14] Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 1992;23:457-67.

[15] González Ferreira JA, Jaén Olasolo J, Azinovic I, Jeremic B. Effect of radiotherapy delay in overall treatment time on local control and survival in head and neck cancer: Review of the literature. Rep Pract Oncol Radiother 2015;20:328-39.

[16] Jensen AR, Mainz J, Overgaard J. Impact of delay on diagnosis and treatment of primary lung cancer. Acta Oncol 2002;41:147-52.

[17] Myrdal G, Lambe M, Hillerdal G, Lamberg K, Agustsson T, Ståhle E, et al. Effect of delays on prognosis in patients with non-small cell lung cancer. Thorax 2004;59:45-9.

[18] BTS recommendations to respiratory physicians for organising the care of patients with lung cancer. The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee. Thorax 1998;53 Suppl 1:S1-8.

[19] Yorio JT, Xie Y, Yan J, Gerber DE. Lung cancer diagnostic and treatment intervals in the United States: A health care disparity? J Thorac Oncol 2009;4:1322-30.

[20] Radzikowska E, Roszkowski-Sliz K, Chabowski M, Glaz P. Influence of delays in diagnosis and treatment on survival in small cell lung cancer patients. Adv Exp Med Biol 2013;788:355-62.

[21] Basu A, Mandal B, Ghosh D, Maji A. Patterns of care and factors affecting it in small cell lung cancer – Analysis of 3 years data from a tertiary care hospital in India. J Cancer Tumor Int 2018;7:1-7.

[22] Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer 1999;79:858-64.

[23] Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: A systematic review. Lancet 1999;353:1119-26.

[24] Nosarti C, Crayford T, Roberts JV, Elias E, McKenzie K, David AS, et al. Delay in presentation of symptomatic referrals to a breast clinic: Patient and system factors. Br J Cancer 2000;82:742-8.

[25] Risberg T, Sørbye SW, Norum J, Wist EA. Diagnostic delay causes more psychological distress in female than in male cancer patients. Anticancer Res 1996;16:995-9.

[26] Miriyala R, Bansal A, Dracham C, Thakur P, Ghoshal S. Diagnostic delay in oncology: Is there a need for increasing cancer awareness among primary care physicians of developing countries? Ann Oncol 2016;27 Suppl 9:ix184-9.

[27] Spellman P, Smith I, Bruce E, Neal RD. The Cancer Journey to Secondary Care of Patients with Suspected Cancer of the Colon or Lung: A Perspective from General Practice. Leeds: Nuffield Portfolio Programme; 1999.

Barriers and explanatory mechanisms in diagnostic delay in four cancers – A health-care disparity?

Abstract

Abstract

Keywords

Acknowledgment

References

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