Basu Abhishek, Ghosh Debjit, Mandal Bidyut, Mukherjee Pratyusha, Maji Avik
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India.
Department of Radiotherapy, IPGME and R, Kolkata, West Bengal, India.
South Asian J Cancer. 2019 Oct-Dec;8(4):221-225. doi: 10.4103/sajc.sajc_311_18.
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.
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.
Stage migration was significant with patient delay ( < 0.01). In head and neck squamous cell carcinoma (HNSCC) and Carcinoma lung, a significant correlation was found between referral delay and residence ( < 0.01) and treatment delay and reason for referral (HNSCC only) ( = 0.04). Referral delay and treatment delay were correlated to response in breast and cervix, respectively ( < 0.01).
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.
传统上，大多数癌症差异研究主要集中在两个关键结果上，即获得适当治疗的机会和生存率，但它们并未涵盖以患者为中心的护理的重要方面，如诊断和治疗的及时性。症状出现与治疗开始之间的时间间隔延长会增加临床结果较差的风险，并与患者随后的癌症护理体验较差相关。本研究旨在评估从症状出现到确定治疗开始的延迟情况，并确定可能的促成因素及其对头颈癌、乳腺癌、宫颈癌和肺癌反应的影响。
这是一项对2015年至2017年期间登记患者的回顾性研究。填写了一份关于社会经济方面、患者病史、肿瘤数据、评估患者的专业人员以及各自时间延迟的问卷。统计检验包括曼-惠特尼U检验、单变量和多变量检验以及单因素方差分析以评估相关性。
分期迁移与患者延迟显著相关（<0.01）。在头颈部鳞状细胞癌（HNSCC）和肺癌中，发现转诊延迟与居住地之间存在显著相关性（<0.01），治疗延迟与转诊原因（仅HNSCC）之间存在显著相关性（=0.04）。转诊延迟和治疗延迟分别与乳腺癌和宫颈癌的反应相关（<0.01）。
社会意识、定期向初级保健医生更新癌症的警示症状、制定识别这些症状的指南、促进护理的连续性以及通过及时转诊使患者能够获得专家专业知识，都应有助于预防癌症诊断的延迟。
