Determining patient and primary care delay in the diagnosis of cancer – lessons from a pilot study of patients referred for suspected cancer

AimsTo study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya.Methods200 women, aged 22 to 75 years with breast cancer diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3–6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records.ResultsThe median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3–6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001).ConclusionsDiagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.

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“…A previous report suggests that the collection of data from medical records is more accurate than the patient interview alone [18]. …”

Section: Methodsmentioning

confidence: 99%

Diagnosis delay in Libyan female breast cancer

et al. 2012

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“…These factors are also associated with the way individuals access hospital care for cancer 26. Methodological differences might be blamed for inconsistencies in findings between studies of patient delay 27. However, overcoming such differences will not in itself provide explanations for correlations between ‘factors’ such as socioeconomic circumstance and delay, or provide deeper understanding of the social processes through which these relationships are produced.…”

Section: Delaymentioning

confidence: 99%

The influence of social processes on the timing of cancer diagnosis: a research agenda

Corner

Brindle

2010

Journal of Epidemiology & Community Health

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This paper sets out to review the influence of social processes on the timing of the diagnosis of cancer and to explore the potential for promoting earlier diagnosis by addressing social factors that influence symptom recognition and the diagnostic process. Social processes refer to the means by which culture and social organisation may impact on timely cancer diagnosis. The paper calls for concerted action around an important and developing research agenda that may prove highly valuable in the quest to secure prompt diagnosis for cancer and through it improved outcomes for individuals.Cancer survival rates have improved dramatically over the past 30 years although they remain stubbornly poor among certain groups such as patients with lung and pancreatic cancer, the socioeconomically deprived and minority ethnic groups.

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“…Several instruments to estimate the likelihood of delay in seeking medical attention if a cancer symptom were to present have been validated in asymptomatic patients [18,19], but no studies have assessed delay among breast cancer patients. Some breast cancer delay studies refer to questionnaires based on previous study results or describe the results of pilot studies, but no validity and reliability measures are specified [20-22]. We found only one study in which the reliability and validity of self-reported symptoms and dates of diagnostic tests was measured, but this study surveyed patients with colon cancer [23], which is characterised by a completely different set of symptoms, natural history and illness behaviour compared to breast cancer [24-27].…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a questionnaire to assess delay in treatment for breast cancer

2012

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BackgroundThis study reports the reliability and validity of a questionnaire designed to measure the time from detection of a breast cancer to arrival at a cancer hospital, as well as the factors that are associated with delay.MethodsThe proposed questionnaire measures dates for estimation of the patient, provider and total intervals from detection to treatment, as well as factors that could be related to delays: means of problem identification (self-discovery or screening), the patients’ initial interpretations of symptoms, patients’ perceptions of delay, reasons for delay in initial seeking of medical care, barriers perceived to have caused provider delay, prior utilisation of health services, use of alternative medicine, cancer-screening knowledge and practices, and aspects of the social network of support for medical attention. The questionnaire was assembled with consideration for previous research results from a review of the literature and qualitative interviews of patients with breast cancer symptoms. It was tested for face validity, content validity, reliability, internal consistency, convergent and divergent validity, sensitivity and specificity in a series of 4 tests with 602 patients.ResultsThe instrument showed good face and content validity. It allowed discrimination of patients with different types and degrees of delay, had quite good reliability for the time intervals (with no significant mean differences between the two measurements), and fairly good internal consistency of the item dimensions (with Cronbach’s alpha values for each dimension between 0.42 and 0.85). Finally, sensitivity and specificity were 74.68% and 48.81%, respectively.ConclusionsTo the best of our knowledge, this is the first published report of the development and validation of a questionnaire for estimation of breast cancer delay and its correlated factors. It is a valid, reliable and sensitive instrument.

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Determining patient and primary care delay in the diagnosis of cancer – lessons from a pilot study of patients referred for suspected cancer

Abstract: Background: There is no validated way of measuring diagnostic delay in cancer, especially covering patient and primary care delays. An instrument is needed in order to determine the effect of potential interventions to reduce delay and improve cancer morbidity and mortality.

Cited by 24 publications

References 8 publications

Diagnosis delay in Libyan female breast cancer

Diagnosis delay in Libyan female breast cancer

The influence of social processes on the timing of cancer diagnosis: a research agenda

Development and validation of a questionnaire to assess delay in treatment for breast cancer

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