Delay in diagnosis of testicular cancer

Abstract

4602 Background: Delay in presentation of a testis tumor may result in an advanced stage of disease at diagnosis, which may affect disease free and overall survival. The aim of this study was to determine variables related to delay in diagnosis of testicular cancer (TC). Methods: A questionnaire was developed to assess patient delay (time from first symptom till first consultation with general practitioner (GP)) and doctor delay (time from first consultation with GP till final diagnosis). In addition, patient and disease characteristics possibly related to patient and/or doctor delay, were collected: age, marital status, educational level, extensiveness of the disease (stage I vs disseminated disease), number of symptoms, change in testicle as a symptom, pain as a symptom, patients' knowledge of TC, appraisal of symptoms as threatening, embarrassment, and whether the doctor referred the patient immediately for further examination. Results: 48 men (median age 25, range 16–44 years) who were consecutively referred to the Groningen University Hospital completed the questionnaire. Median patient delay was 30 (range 1–365) days. Only educational level correlated with patient delay (r=-.30, p=.03). Median doctor delay was 14 (0–240) days. After first consultation, only 20 patients (42%) were immediately referred for further examination. The remaining 28 patients were not immediately referred, which led to a significantly longer doctor delay (median = 23 days, t=-4.47, p90 days. Age was significantly related to total delay (r=-.33, p=.03). Six patients (12.5%) did not have a change in testicle as presenting symptom, but this was not related to delay. Extensiveness of disease was not related to delay. Conclusions: Surprisingly, having disseminated disease and having a change in a testicle as presenting symptom were not related to delay, but younger and lower educated men appeared to be more likely to report delay in diagnosis. Over half of the men were not immediately referred for further examination, resulting in a significantly longer GP delay. This finding stresses the responsibility of GPs in the diagnostic process of TC. No significant financial relationships to disclose.