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Volume 2 | Issue 1 | January - June 2018

DIAGNOSTIC DELAY IN ONCOLOGY: IS THERE A NEED FOR INCREASING CANCER AWARENESS AMONG PRIMARY CARE PHYSICIANS OF INDIA?

Article 2, Volume 2, Issue 1, Jan-June 2018, Page 3-8    PDF Download

Type : Orignal  Article

Author : Raviteja Miriyala1#,  Anshuma Bansal1 , Chinnababu Dracham1 ,  Pragyat Thakur1 ,  Sushmita Ghoshal1

1Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India

 

ABSTRACT:

OBJECTIVE: To analyze the factors contributing to delay in diagnosis and initiation of cancer treatment, and evaluate the influence of such delay on treatment intent.

METHODS: All cancer patients referred to the Regional Cancer Centre at our institute through primary care physicians in December 2014 were included in this prospective audit. Details regarding date of first cancer related symptom noticed by the patient, date of first consultation with primary physician and date of first oncology consultation were collected. They were prospectively followed up and date of initiation of first cancer directed therapy and intent of treatment (curative/palliative) were recorded. Delay intervals on behalf of patient, primary care physician and treating oncologist were analyzed and correlated with treatment intent using multivariate analysis.

RESULTS: Median total delay before treatment initiation was 6 months. Maximum contribution to the delay was by the patient (median, 4 months). Median delay in referral by primary physicians was 3 weeks, but it ranged from less than a week to up to 5 years in some cases. Oncologists contributed to a median delay of 10 days. Shorter delays were observed for brain and lung cancers, while longest for head and neck cancers. Significant correlations were observed between patient delay and education status (p=0.03), physician delay and rural habitat (p=0.02), oncologist delay and cancer site (p=0.01). Overall delay was a significant factor determining the intent of treatment (p=0.001).

CONCLUSION: Overall delay has a significant impact on the intent of treatment eventually received by patients. Delays on behalf of patient and primary care physician have significant contribution to overall delay. Apart from educating the population regarding cancer symptoms, increasing awareness among primary care physicians regarding the need for early diagnosis and referral to tertiary centers might improve overall diagnostic delay.

 

Key words: diagnostic delay, oncology, developing countries, primary physicians, cancer awareness

 

 

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