Routes to Diagnosis for Suspected Sarcoma: The Impact of Symptoms and Clinical Findings on the Diagnostic Process

Abstract

Background and Objectives. Sarcoma patients often experience delay before diagnosis. We examined the association between presenting symptoms/signs and time intervals for suspected sarcoma patients. Methods. 545 consecutive patients suspected for sarcoma referred over a one-year period were included. Median time intervals in routes to diagnosis were collected from medical records and questionnaires. Results. 102 patients (18.7%) had a sarcoma; 68 (12.5%) had other malignancies. Median interval for the patient (time from first symptom to first doctor visit), primary care, local hospital, sarcoma center, diagnostic, and total interval for sarcoma patients were 77, 17, 29, 17, 65, and 176 days, respectively. Sarcoma patients visited more hospital departments and had longer median primary care (+10 days) and diagnostic intervals (+19 days) than patients with benign conditions. Median primary care (−19 days) and sarcoma center (−4 days) intervals were shorter for patients with a lump versus no lump. Median patient (+40 days), primary care (+12 days), diagnostic (+17 days), and total intervals (+78 days) were longer for patients presenting with pain versus no pain. GP suspicion of malignancy shortened local hospital (−20 days) and total intervals (−104 days). Conclusions. The main part of delay could be attributed to the patient and local hospitals. Length of time intervals was associated with presenting symptoms/signs and GP suspicion.

The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes

“…Thirty-six studies investigated the total interval for STS (table 3). 27 30–35 38 42–69 A combined total of 16 845 patients were included and, reflecting STS heterogeneity, the total interval varied tremendously; between 4.3 and 614.9 weeks.…”

“…Eleven studies examined the length of one or more components of the total interval 30 38 44 47 50–52 54 58 59 63. Patient intervals varied between a median of 1.3–17.2 weeks, the primary care interval lasted 0.1–13.3 weeks, the secondary care interval varied between 1.1 and 6.9 weeks and the tertiary care interval was 2.1–7.9 weeks.…”

“…Another single centre study of 545 patients with suspected sarcoma referred to a specialist clinic in Denmark reported a median total interval of 25.1 weeks59; 102 patients (19%) had a sarcoma (88 soft tissue, 14 BS), 68 patients (12%) had another malignancy 58. Patients referred to the centre with prior investigations in their local hospital had a longer total interval than those with investigations in the sarcoma centre (median 13.3 vs 23.7 weeks).…”

Age-related sarcoma patient experience: results from a national survey in England

“…This may be due to low clinical suspicion of cancer in this age group and may lead to delay in diagnosis. Overall, given the low incidence of sarcomas, professionals may only encounter one case in their career [ 24 ]. In addition, only approximately one in 100 soft tissue lumps are malignant, leading to low clinical suspicion [ 24 ].…”

Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

“… 10 In cases of recently-emerged soft-tissue swellings, a preceding trauma is sometimes described. 11 Especially in elderly patients under anticoagulation therapy, this could be indicative of haematoma. On the other hand, lumps quickly increasing in size in the absence of bruising should prompt further investigation.…”