General Practice and Primary Care, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, 1 Horselethill Road, Glasgow, UK.
Br J Cancer. 2009 Dec 3;101 Suppl 2(Suppl 2):S92-S101. doi: 10.1038/sj.bjc.6605398.
It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.
We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.
Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, 'misdiagnosis' occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.
Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately.
与其他欧洲国家相比，英国癌症患者的生存率较低，这一现象可能归因于癌症确诊时的病期更为晚期。因此，有必要了解诊断过程，并确定导致就诊时间延长的风险因素。
我们报告了两项关于患者介导和医生介导的延误的全球系统评价的结果，确定了可能影响这些延误的因素。
在所有癌症部位，对症状严重性的认识不足是导致就诊时间延长的主要患者介导因素。有充分证据表明，年龄较大与乳腺癌患者的延迟就诊相关，社会经济地位较低与上消化道癌和泌尿系统癌的延迟就诊相关，而教育程度较低与乳腺癌和结直肠癌的延迟就诊相关。对癌症的恐惧是导致就诊时间延迟的一个因素，而寻求他人帮助的认可则可以作为缩短就诊时间的有力中介。对于医生延迟，“误诊”是一个重要的主题，它可以通过对患者进行对症治疗或将症状与除癌症以外的健康问题联系起来而发生，这种情况在所有癌症部位都有发生。对于某些癌症，这也可能与患者检查不充分、使用不适当的检查或未能跟进阴性或不确定的检查结果有关。
一旦寻求了针对潜在癌症症状的帮助，医生就必须识别这些症状，并进行适当的检查、调查和转诊。
