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乌干达癌症研究所成人头颈部癌症患者的诊断时间线及影响延迟诊断因素的描述性研究。

A descriptive study on diagnostic timelines, and factors influencing delayed diagnosis among adult head and neck cancer patients at Uganda cancer institute.

机构信息

Department of Ear, Nose and Throat, Moroto Regional Referral Hospital, P.O. Box 12, Moroto, Uganda.

Department of Ear, Nose and Throat, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.

出版信息

World J Surg Oncol. 2024 May 16;22(1):130. doi: 10.1186/s12957-024-03407-4.

Abstract

BACKGROUND

Many patients with head and neck cancer (HNC) often present with advanced disease. This may result from delay in deciding to seek care, delay in reaching the healthcare facility and or delay in accessing care in the healthcare facility. We therefore set out to determine the time to definitive diagnosis and factors associated with delayed diagnosis among patients with HNC at the Uganda Cancer Institute (UCI).

METHODS

A cross-sectional study was conducted at UCI, patients with HNC were recruited. An interviewer administered questionnaire was used to collect data on sociodemographic factors and clinical characteristics, including timelines in months, from symptom onset to deciding to seek care, to reaching the health care facility and to definitive diagnosis. Multivariate Poisson regression analysis was used to calculate odds ratios (ORs) for the factors of association with delayed diagnosis.

RESULTS

We recruited 160 HNC patients, and 134 patients were analyzed. The median age was 49.5 years (IQR 26.5), 70% (94 of 134) were male, 48% (69 of 134) had below secondary school education, 49% (65 of 134) had a household income < 54 USD. 56% (76 of 134) were sole bread winners, 67% (89 of 134) had good access road condition to the nearest health unit and 70% (91 of 134) presented with tumor stage 4. Median time from onset of symptoms to definitive diagnosis was 8.1 months (IQR 15.1) and 65% (87 of 134) of patients had delayed diagnosis. Good access roads (aOR: 0.26, p = 0.006), secondary school education (aOR: 0.17, p = 0.038), and household income > 136 USD (aOR: 0.27, p = 0.043) were associated with lower odds of delayed diagnosis. Being the sole bread winner (aOR: 2.15, p = 0.050) increased the odds of delayed diagnosis.

CONCLUSION

Most of HNC patients (65%) at UCI had delayed diagnosis. A national care pathway for individuals with suspected HNC should be established and consider rotation of Ear, Nose and Throat surgeons to underserved regions, to mitigate diagnostic delay.

摘要

背景

许多头颈部癌症(HNC)患者常表现为晚期疾病。这可能是由于决定寻求治疗的时间延迟、到达医疗机构的时间延迟或在医疗机构获得治疗的时间延迟。因此,我们着手确定乌干达癌症研究所(UCI)HNC 患者的明确诊断时间,并确定与诊断延迟相关的因素。

方法

在 UCI 进行了一项横断面研究,招募了 HNC 患者。使用访谈者管理的问卷收集社会人口统计学因素和临床特征数据,包括从症状出现到决定寻求治疗、到达医疗保健机构和明确诊断的时间(以月为单位)。使用多变量泊松回归分析计算与诊断延迟相关因素的比值比(OR)。

结果

我们招募了 160 名 HNC 患者,其中 134 名患者进行了分析。中位年龄为 49.5 岁(IQR 26.5),70%(94/134)为男性,48%(69/134)受教育程度低于中学,49%(65/134)家庭收入<54 美元。56%(76/134)为唯一养家糊口的人,67%(89/134)到最近的卫生单位的道路状况良好,70%(91/134)表现为肿瘤 4 期。从症状出现到明确诊断的中位时间为 8.1 个月(IQR 15.1),65%(87/134)的患者存在诊断延迟。良好的道路条件(aOR:0.26,p=0.006)、中学教育(aOR:0.17,p=0.038)和家庭收入>136 美元(aOR:0.27,p=0.043)与较低的诊断延迟几率相关。作为唯一养家糊口的人(aOR:2.15,p=0.050)增加了诊断延迟的几率。

结论

UCI 大多数 HNC 患者(65%)存在诊断延迟。应该为疑似 HNC 患者建立国家护理途径,并考虑将耳鼻喉科医生轮换到服务不足的地区,以减轻诊断延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/62b5/11097497/6a028c737979/12957_2024_3407_Fig1_HTML.jpg

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