Factors affecting time from symptom onset to ovarian cancer diagnosis in the United States

Abstract

<h3>Objectives:</h3> Little is known about what clinical or demographic factors affect time to diagnosis (TTD) of ovarian cancer. The objectives of our study were to examine the presenting symptoms and physician visit types leading to a diagnosis of ovarian cancer and identify any variables associated with an increased or decreased TTD. <h3>Methods:</h3> A population-based study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was conducted on patients ≥66 years old from 1992-2015 with stage II-IV primary epithelial ovarian cancer. Diagnosis codes and claims data were extracted for analysis; symptoms specifically evaluated were abdominal pain, bloating, difficulty eating, and urinary urgency. TTD was defined from time of first coded symptom in a claim to ovarian cancer diagnosis. One-way ANOVA tests assessed significance of group measures on mean TTD and regression models evaluated number of physicians seen and TTD by covariates. <h3>Results:</h3> Of 18693 women identified for analysis, the mean overall TTD was 5.21 months. The mean TTD was significantly different based on first symptom type (p<.001), number of symptoms (p<.001), and first physician visit type (p<.001) occurring in a claim. Mean TTD by symptom type was 1.0 months with bloating, 2.7 months with abdominal pain, 2.8 months with difficulty eating, and 4.7 months with urinary urgency. Mean TTD increased with an increasing number of symptoms, from 4.6 months with 1 symptom to 5.4 months with 2 symptoms, 6.3 months with 3 symptoms, and 8.1 months with 4 symptoms. The fastest mean TTD by physician visit type was 4.2 months with gynecologic specialties, followed by 4.8 months with emergency medicine, 4.8 months with internal medicine, 6.3 months with gastroenterology, and 6.9 months with urology. In logistic regression models, the odds of seeing >4 physician types in the 30 days leading up to a diagnosis increased over time and was significantly higher in 2011-2015 compared to 1992-1999 (OR 1.17, p=.011). In linear regression models, faster TTD was associated with unmarried status (p<.001), mostly (p=.011) or all rural (p<.001) location, and BlackBlack race (p<.001); slower TTD was associated with older age (p<.001), higher comorbidity score (p<.001), non-Northeast region (p<.001), >4 physician visit types (p<.001), emergency presentation (p<.001), and diagnosis after 1992-1999 (p<.001). <h3>Conclusions:</h3> In our SEER-based database study, the mean time from symptom onset to diagnosis of ovarian cancer was 5.21 months and was influenced by presenting symptom, physician visit type, and clinical and demographic variables. Mean TTD and number of physician visit types have both increased over time, which may reflect broader changes in the United States medical system. Other significant associations warrant further exploration.