Abstract
BackgroundDelay in cancer diagnosis may be important for cancer prognosis. Large individual variations in the duration of delay have been observed. This study examines whether patients' socioeconomic characteristics are predictors of long patient-, doctor- and system-related delay in cancer diagnosis.MethodsDanish population-based cohort study. From September 2004 to September 2005, newly diagnosed cancer patients were enrolled from administrative registries. A total of 467 general practitioners in the County of Aarhus, Denmark, completed questionnaires on 2,212 cancer patients' diagnostic pathways. A total of 1,252 cancer patients filled in questionnaires on their socioeconomic characteristics (e.g. marital status, education, occupation, household income and fortune). Delay was categorised as short or long based on quartiles. Predictors of long delay were assessed in a logistic regression model using odds ratios (ORs) as a proxy of relative risks.ResultsIn regard to patient delay, retired female patients experienced shorter delays (OR 0.35, 95% confidence interval (95%CI) 0.13 to 0.98) than employed female patients, while female smokers experienced longer delays (OR 2.42, 95%CI 1.21 to 4.85) than female non-smokers.In regard to doctor delay, female patients with a large household fortune experienced shorter delays (OR 0.07, 95%CI 0.01 to 0.45) than economically less privileged female patients. Well-educated men experienced shorter delays (OR 0.40, 95%CI 0.16 to 1.00) than men with short education. Male patients experienced longer doctor delays (OR 2.11, 95%CI 1.11 to 4.02) than women when gender-specific cancers were excluded.In regard to system delay, female patients with a large household fortune experienced shorter delays (OR 0.46, 95%CI 0.21 to 0.99) than economically less privileged women, while female patients with a high alcohol intake experienced longer delays (OR 2.82, 95%CI 1.18 to 6.72) than women with an average intake.ConclusionWe found socioeconomic predictors of delay that allow us to hypothesize social inequalities in the distribution of delay, but, in general, only a few socioeconomic variables predicted delay in cancer diagnosis. Future research should examine a broader array of patients' personal characteristics.
Highlights
Delay in cancer diagnosis may be important for cancer prognosis
Patients' interaction with the general practitioners (GPs) and the secondary health care sector may depend on their socioeconomic characteristics, which may play an important role for their help-seeking behaviour
If such associations do exist between socioeconomic patient characteristics and delay, this should influence the design of tailored, targeted interventions aimed at reducing delay
Summary
Delay in cancer diagnosis may be important for cancer prognosis. Large individual variations in the duration of delay have been observed. It has been hypothesized that men are more reluctant than women to consult their general practitioners (GPs) when they experience potentially cancer-related symptoms [7,13,14] This may reflect gender differences in the way patients cope with symptoms. Patients' interaction with the GPs and the secondary health care sector may depend on their socioeconomic characteristics, which may play an important role for their help-seeking behaviour. If such associations do exist between socioeconomic patient characteristics and delay, this should influence the design of tailored, targeted interventions aimed at reducing delay (e.g. campaigns targeted at specific age groups, social classes etc.)
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