Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.
Int J Gynecol Cancer. 2011 Aug;21(6):967-74. doi: 10.1097/IGC.0b013e31821d2770.
To describe the different delay types in women with gynecological cancer and to analyze the relationship between diagnostic delay and a number of characteristics for patients, cancers, and the health care system.
Data were obtained from 4 different questionnaires, the Electronic Patient Journal (EPJ), and the Danish Gynecological Cancer Database (DGCD). A total of 161 women with ovarian cancer (63), endometrial cancer (50), cervical cancer (34), and vulvar cancer (14) were included. Outcome measures were different delay types counted in days and 4 clinically important variables' impact on the diagnostic delay: presence of alarm symptoms, age (divided into 2 groups: ≤60 or >60 years), performance of gynecological examination by the general practitioner (GP), and notification of cancer suspicion on first referral from GP.
Across cancer types, median total delay was 101 days. Some 10% of women experienced the longest delay with a total delay of 436 days or more. Vulva cancer had the longest delay, whereas women with ovarian cancer had the shortest delay. More than one third (39%) of the women consulted their GP for reasons other than the predefined alarm symptoms. Gynecological examination by the GP was less likely to be performed if the woman did not present with vaginal bleeding. The length of the delay was shortened by performance of a gynecological examination by the GP and a primary referral from the GP raising the receiver's suspicion of cancer.
Reducing diagnostic delays should be achievable, particularly for those most delayed, and interventions aimed at reducing delays need to be developed. Creation of new valid instruments for measuring delay is essential in future research.
描述妇科癌症患者的不同延迟类型，并分析诊断延迟与患者、癌症和医疗保健系统的多个特征之间的关系。
数据来自 4 份不同的问卷、电子患者日记（EPJ）和丹麦妇科癌症数据库（DGCD）。共纳入 161 名卵巢癌（63 名）、子宫内膜癌（50 名）、宫颈癌（34 名）和外阴癌（14 名）患者。主要结局指标为以天数计算的不同延迟类型和 4 个临床重要变量对诊断延迟的影响：存在报警症状、年龄（分为两组：≤60 岁或＞60 岁）、全科医生进行妇科检查以及全科医生首次转诊时通知癌症怀疑。
在所有癌症类型中，总延迟的中位数为 101 天。约 10%的患者经历了最长的延迟，总延迟时间为 436 天或更长。外阴癌的延迟时间最长，而卵巢癌患者的延迟时间最短。超过三分之一（39%）的女性因除预先定义的报警症状以外的原因就诊。如果女性没有阴道出血，则不太可能进行 GP 的妇科检查。GP 进行妇科检查和 GP 进行初步转诊以提高患者对癌症的怀疑可以缩短延迟时间。
减少诊断延迟是可以实现的，特别是对于那些延迟时间最长的患者，需要制定减少延迟的干预措施。在未来的研究中，创建新的有效的延迟测量工具至关重要。
