Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Gastrointest Surg. 2022 Apr;26(4):750-756. doi: 10.1007/s11605-021-05209-5. Epub 2022 Jan 3.
Previous studies have suggested that symptomatic cancer patients often experience delays in diagnosis (DD). However, DD of gastric cancer within the USA and etiology of those delays are not understood. Our study quantifies the proportion of gastric cancer patients experiencing DD and contributing barriers of care.
We conducted a single institution retrospective review of 256 gastric cancer patients treated between 2015 and 2020. Patients with an interval from symptom onset to diagnosis of > 90 days were classified as having DD and categorized into one of the following barriers of care: access, provider knowledge/skills, and patient factors. Chi-square tests were used to analyze categorical group differences. Non-pooled t-tests and ANOVA were used to compare differences in group means.
A total of 59 patients (23%) had DD. Among patients with DD, the mean time from symptom onset to diagnosis was 229 days vs 30 days in the non-delayed group (p < 0.0001). The most common barrier of care was provider knowledge/skills gaps (44%), followed by access (36%) and patient-related factors (20%). Only 5% of patients who experienced delays reported abdominal pain alone, with the remaining 95% of patients reporting more than one symptom including obstruction, gastrointestinal bleeding, or weight loss.
Patients often face lengthy delays in gastric cancer diagnosis which arise from healthcare system factors such as access barriers or gaps in provider knowledge/skills. Understanding concerning alarm symptoms and addressing identified barriers will expedite patient diagnosis and are prime opportunities to improve outcomes for gastric cancer patients.
先前的研究表明，有症状的癌症患者常常在诊断时出现延误（DD）。然而，美国尚未了解胃癌的 DD 情况及其发病原因。我们的研究量化了经历 DD 的胃癌患者的比例以及导致这些延误的护理障碍。
我们对 2015 年至 2020 年间治疗的 256 例胃癌患者进行了单机构回顾性研究。将症状出现到诊断的时间间隔超过 90 天的患者归类为有 DD，并分为以下护理障碍之一：获取途径、提供者知识/技能和患者因素。卡方检验用于分析分类组之间的差异。非合并 t 检验和 ANOVA 用于比较组均值的差异。
共有 59 名患者（23%）有 DD。在有 DD 的患者中，从症状出现到诊断的平均时间为 229 天，而无延迟组为 30 天（p<0.0001）。最常见的护理障碍是提供者知识/技能差距（44%），其次是获取途径（36%）和患者相关因素（20%）。只有 5%的经历延误的患者仅报告腹痛，其余 95%的患者报告了多种症状，包括梗阻、胃肠道出血或体重减轻。
患者在胃癌诊断中常常面临漫长的延误，这些延误源于医疗保健系统因素，如获取途径障碍或提供者知识/技能差距。了解相关的警报症状并解决已确定的障碍将加快患者的诊断，并为改善胃癌患者的预后提供重要机会。
