Patient's and doctors’ delays in the diagnosis of chest tumors
Introduction
Lung cancer is, according to the official cancer statistics, one of the most common forms of cancer in Sweden, even if the incidence is lower than in most industrialized countries. Survival is short in most cases. Lung cancer is the second most common cause of cancer death in both men and women in Sweden, prostate cancer and mammary carcinoma being the first for men and women, respectively.
The most important factor for survival is the stage at diagnosis, which in turn is dependent on how the tumor is discovered, and when the patient contacts his physician. Unfortunately, most lung cancers are discovered too late for cure. There is often a long ‘patient's delay’ from the onset of symptoms until the patient seeks medical assistance. Many symptoms can also be masked by symptoms due to other diseases, such as chronic bronchitis or heart disease. Of importance are also factors such as how rapidly a patient with a suspected lung cancer is referred to the specialist and how the work-up is done. Details on these important factors are rare in the literature. With the present economic pressure on health care, the delays by doctors might in fact have increased over the last few years.
In the county of Gaevleborg, Sweden, with around 280 000 inhabitants, there are 70–90 new cases of lung cancer every year. In the county there are five small towns, one of which is larger than the others and where the Department of Pulmonary Medicine is situated. There is a consultant-led out-patient clinic at the hospitals in the other towns, and therefore practically all cases of lung cancer will eventually be seen by a lung specialist. Thus, the prospects are good for investigating factors such as patient's and doctors' delays in a total material of patients with lung cancer.
The aim of the present study was to prospectively investigate a material of lung cancer patients in order to measure the delays, both by the patient and by the doctors.
The investigation was approved by the Ethical committee of the Uppsala University (Ups 97056).
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Study subjects
All patients with symptoms from the airways or findings suggestive of lung cancer who had been referred to the Department of Respiratory Medicine in Gaevle from February 1, 1997, to February 28, 1998, were investigated prospectively. A few patients recorded in the local cancer registry but never seen at the department were included retrospectively. In all, 134 cases of lung cancer or other chest tumors were diagnosed, 84 (62.7%) in men and 50 (37.3%) in women. The mean age in men was 71.6 years
Type of tumor, staging, and smoking habits.
The types of chest tumor are presented in Table 1. Specimens for histology were taken and a diagnosis was established in 105 patients. In 29 patients a histological diagnosis was not available for ethical reasons. The majority of the patients presented in stage IIIb or IV (Table 2).
Patient's delay.
The mean delay of the patients was 43 days with a median of 21 days (Table 3). Nine patients were not included because they were asymptomatic and the tumor accidentally discovered or discovered first at autopsy.
Doctors' delays
For
Discussion
The results of the present study are probably representative of the Swedish health care system today. A mean of 7 months (203 days) from first symptom until treatment seems high. The median was 189 days, so part of the long mean is due to patients with very long delays, but even 189 days is fairly long. Of the 7 months, 1 are due to the patient's delay—and thus, 5 months are due to the doctors'. The mean figures, as opposed to the median values, are high due to the fact that in a few
Acknowledgements
This study was supported by grants from the Swedish Heart Lung Foundation, the Gaevle Cancer Fund, the Research and Development Forum of the County of Gaevleborg, and Karolinska Institutet, Stockholm, Sweden.
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