Kayamba V, Kelly P
Tropical Gastroenterology & Nutrition group, Department of Internal Medicine, PO Box 50398, Nationalist Road, Lusaka, Zambia.
University of Zambia School of Medicine, Department of Internal Medicine, PO Box 50110, Nationalist Road, Lusaka, Zambia.
Health Press. 2019 Feb;3(2):14-19.
There is evidence that 15 % of gastric cancer patients in Zambia survive more than one-year after diagnosis. The major contributing factor to these poor outcomes is late case detection. We set out to investigate the time course of gastric cancer diagnosis in Zambia. The study was conducted at the University Teaching Hospital, in Lusaka. Consenting patients presenting to the endoscopy unit were enrolled and their endoscopic findings recorded. An interviewer-administered questionnaire was used to collect information on basic characteristics, presenting symptoms and duration. We enrolled 388 patients, 92 (24%) of whom had gastric cancer. About two-thirds of the gastric cancers were located in the distal part of the stomach. The median time to endoscopic gastric cancer diagnosis was 12 weeks, IQR 4-32 weeks after the first health care consultation. This was despite gastric cancer patients seeking healthcare attention within a median of 2 weeks, IQR 0-4 weeks of noticing the symptoms. Patients presenting with persistent vomiting or evidence of blood loss had significantly shorter delays than those with abdominal pain (p<0.05 and p<0.001 respectively). Delayed referral for diagnostic endoscopy is a contributing factor to late gastric cancer diagnosis in Zambia. The delay is highest in patients presenting with abdominal pain.
有证据表明，赞比亚15%的胃癌患者在确诊后存活时间超过一年。导致这些不良结果的主要因素是病例发现较晚。我们着手调查赞比亚胃癌诊断的时间过程。该研究在卢萨卡的大学教学医院进行。纳入了在内镜科就诊并同意参与的患者，并记录他们的内镜检查结果。通过访谈者填写的问卷收集有关基本特征、出现的症状和病程的信息。我们纳入了388名患者，其中92名（24%）患有胃癌。约三分之二的胃癌位于胃的远端。内镜诊断胃癌的中位时间为首次就医咨询后12周，四分位间距为4 - 32周。尽管胃癌患者在注意到症状后的中位时间为2周（四分位间距为0 - 4周）就寻求医疗关注。出现持续性呕吐或失血迹象的患者的延迟时间明显短于腹痛患者（分别为p<0.05和p<0.001）。诊断性内镜检查的转诊延迟是赞比亚胃癌诊断延迟的一个促成因素。在出现腹痛的患者中延迟时间最长。
