Are doctors responsible for delay in cancer management?

Abstract

6101 Background: Cancer patients in developing countries are still in advanced stage of their disease by the time they receive anticancer therapy despite rapid advances in medical sciences. It is commonly believed that this occurs due to late presentation of cancer patients to their physicians because of illiteracy, poverty and ignorance but is it true? Material and Methods: Cancer patients attending Surgical Oncology clinics between 2000 -2003 at Regional Cancer Centre, PGIMS, Rohtak in India were studied by detailed questionnaire in two phases to know the time of onset of symptoms, time of presentation of the patients to the physicians, details of the consultation and action taken thereafter by the physicians. Presentation interval (period from onset of symptoms to presentation of the patients), diagnostic interval (period from time of presentation to establishment of diagnosis of cancer) and treatment interval (period from establishment of diagnosis to initiation of anticancer therapy) were calculated. Delay was said to have occurred if presentation & diagnostic intervals exceeded one month each and treatment interval exceeded two weeks. The physicians to whom cancer patients presented first were called as primary care physicians (PCP) and were divided into 3 categories of qualified medical practitioner, qualified non-medical practitioner and unqualified medical practitioner.At the end a total of 1006 patients were available for analysis. Results: Majority of the patients has poor socioeconomic status with very low literacy level and three forth of them were not aware about cancer still 67.3% patients presented to primary care physicians without delay. 75.9% of the patients had delay at diagnosis level and physician was responsible for this delay in 60.4% of the patients. The unqualified physicians and qualified non medical practitioners almost never diagnosed cancer while 2/3rd of the qualified physicians also did not diagnose cancer but gave only symptomatic treatment. Conclusions: Despite poverty, illiteracy and poor cancer awareness majority of the patients presented without delay to their physicians but significant delay occurred in most of the patients at diagnosis level and physician was mainly responsible for this delay. No significant financial relationships to disclose.