ESMO Asia 2016: Patients in India Wait an Average of 4 Months Before Seeking a Cancer Diagnosis
Patients in Chandigarh, India, waited an average of 4 months before seeking a cancer diagnosis, according to a recent study. Some patients waited less than a week before seeing a doctor—while others waited 3 years. The researchers will report their findings at the ESMO Asia 2016 Congress (Abstract 567P_PR), to be held December 16–19 in Singapore.
“Delaying diagnosis had a significant impact on the treatment eventually received by patients in our study,” said lead author Raviteja Miriyala, MD, Senior Resident in the Department of Radiotherapy and Oncology at Postgraduate Institute of Medical Education and Research in Chandigarh. “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.”
Study Design
Early diagnosis and treatment improve the outcome of most cancers. This study analyzed causes of delays and the impact on treatment. A prospective audit was conducted of all 162 cancer patients referred by primary care physicians to the Department of Radiotherapy and Oncology in Chandigarh during 1 month.
The following dates were recorded for each patient: first cancer-related symptom noticed by patient; first consultation with primary care physician; first oncology consultation; and date therapy began (and intent of therapy—curative or palliative).
Three delay intervals were calculated: patient approaching primary care physician (patient delay); primary care physician diagnosing/referring to oncologist (physician delay); and oncologist starting treatment (oncologist delay). Multivariate analysis revealed the demographic and socioeconomic factors contributing to the delay, and the impact of this delay on treatment.
Major Findings
There was an average total delay of about 6 months between the first symptom and the initiation of treatment. Patients and primary care physicians contributed statistically significant delays—an average of 4 months and 3 weeks, respectively. Oncologists delayed for an average of 10 days, but this did not significantly contribute to the overall delay.
Dr. Miriyala said, “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 3 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 primary care physicians delayed up to 5 years before referring patients to an oncologist, instead treating patients for “presumed nonmalignant conditions,” Dr. Miriyala said: “About 25% of patients waited more than 1 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 could increase doctors’ awareness about early diagnosis and referral, as could more oncology teaching hours and rotations in the undergraduate curriculum.”
About 6% of patients experienced delays of more than 1 month before their oncologist started treatment. Oncologist delay was significantly correlated to the disease site, with longer delays for head and neck cancer and shorter delays for brain tumors. Dr. Miriyala said, “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 tumors, resulting in shorter delays. Cancers (like brain tumors) that present as medical or surgical emergencies are more likely to be addressed earlier. Improving the quality and quantity of infrastructure at tertiary centers would help reduce the oncologists’ delay.”
Patients with longer delays were significantly more likely to receive palliative treatment than those with shorter delays. Dr. Miriyala said, “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.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
