Doctor's Delay Research Articles

Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway.

Incidence rates for cutaneous malignant melanoma are increasing worldwide. Estimates of the future number of melanoma cases are important for strategic planning of the care pathway. The aim of this study was to use system dynamics modelling to evaluate the long-term effects of changes in incidence, population growth and preventive interventions. Historical data on invasive melanoma cases in Western Sweden from 1990 to 2006 were obtained. Using computer simulation software, a model estimating the accumulated number of melanoma cases for 2014 to 2023 was developed. Five future scenarios were designed: stable incidence, business-as-usual, 25% reduced patient's delay, 50% reduced doctor's delay, and a combination of the last two, called improved overall secondary prevention. After 10 years, improved overall secondary prevention would have resulted in a 42% decrease in melanomas > 4 mm and a 10% increase in melanomas ≤ 1 mm, compared with business-as-usual. System dynamics is a valuable tool, which can help policymakers choose the preventive interventions with the greatest impact.

Delay in Diagnosis of Testicular Cancer; A Need for Awareness Programs

Background AimTo gain insight into patient and doctor delay in testicular cancer (TC) and factors associated with delay.Materials and MethodsSixty of the 66 eligible men; median age 26 (range 17–45) years, diagnosed with TC at the University Medical Center Groningen completed a questionnaire on patients’ delay: interval from symptom onset to first consultation with a general practitioner (GP) and doctors’ delay: interval between GP and specialist visit.ResultsMedian patient reported delay was 30 (range 1–365) days. Patient delay and TC tumor stage were associated (p = .01). Lower educated men and men embarrassed about their scrotal change reported longer patient delay (r = -.25, r = .79 respectively). Age, marital status, TC awareness, warning signals, nor perceived limitations were associated with patient delay. Median patient reported time from GP to specialist (doctors’ delay) was 7 (range 0–240) days. Referral time and disease stage were associated (p = .04). Six patients never reported a scrotal change. Of the 54 patients reporting a testicular change, 29 (54%) patients were initially ‘misdiagnosed’, leading to a median doctors’ delay of 14 (1–240) days, which was longer (p< .001) than in the 25 (46%) patients whose GP suspected TC (median doctors’ delay 1(0–7 days).ConclusionsHigh variation in patients’ and doctors’ delay was found. Most important risk variables for longer patient delay were embarrassment and lower education. Most important risk variable in GP’s was ‘misdiagnosis’. TC awareness programs for men and physicians are required to decrease delay in the diagnosis of TC and improve disease free survival.

An assessment of clinical pathways and missed opportunities for the diagnosis of nodular melanoma versus superficial spreading melanoma.

Missed opportunities in the diagnosis of nodular melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. NM contributes disproportionately to melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated.

Sa1275 The Diagnostic Delay in Celiac Disease Is Significantly Increased in Women Due to Doctor's but Not Patient's Delay

Background: The majority of celiac disease (CD) cases remain undiagnosed (tip of the iceberg phenomenon) due to a variety of reasons, such as silent disease or unspecific symptoms with overlap to other diseases and insufficient awareness in both patients as well as physicians. The total diagnostic delay can be subdivided into patient's (gap between beginning of symptoms and first medical consultation) and doctor's (gap between first medical consultation and definitive diagnosis of CD) delay. There is insufficient data on diagnostic delay and associated factors in CD. In addition, it remains to be clarified, whether its extent has an impact on the course of the disease. Methods: We performed a large systematic patient survey study among unselected CD patients in Switzerland. Results were analyzed in total as well as in among selected subgroup of patients by means of descriptive statistics with a special focus on diagnostic delay. Results: A total of 1673 patients (76.1% female; mean age 41.1 y, range 0-92y, mean age at diagnosis 31y, range 0-83y) were analyzed. We found a mean total diagnostic delay of 72.1 months (median 18, IQR 4-72), with an enormous range from 0 up to 780 months and roughly equal fractions of patient's and doctor's delay with 39.5 (median 3, IQR 0-24) and 39.6 (median 4, IQR 0-28) months, respectively. While the mean age of diagnosis was not different in female vs. male patients (30.8 vs. 31.1 y), both, total (76.1 vs. 56.4, p=0.026) and doctor's (43.5 vs. 25.1, p 2 years, with no difference per se in freedom from symptoms between men vs. women. Treatment of nutritional deficiencies states was significantly more frequent in the long vs. short delay patients (74 vs. 58.5%, p<0.001). Conclusions: There is a substantial diagnostic delay in CD, due to both patient's and doctor's delay. Diagnostic delay is significantly longer in patients with older age at diagnosis and in female patients. This increased diagnostic delay in women is due to doctor's but not patient's delay, indicative of an insufficient awareness in physicians for CD especially in women. In addition, an increased diagnostic delay above two years is associated with a lower chance of clinical remission 6 and 12 months after diagnosis.

Treatment seeking behaviour and prevalence of treatment delay among malaria patients along Thailand-Myanmar border in Tak province

ObjectiveTo investigate treatment seeking behaviour and the prevalence of treatment delay of malaria patients. MethodsA cross-sectional study was conducted with malaria patients along the Thailand-Myanmar border in Tak province, Thailand. ResultsMost of patients (70.0%) were treated for fever before receiving treatment at a malaria clinic or public hospital. The sources of initial treatments were self-treatment (64.0%), malaria clinics (20.0%), public hospital (11.0%), sub-district health promotion hospital (3.3%), and malaria posts (1.1%). Prevalence of patients delayed more than one day after onset of symptoms was 79.4%, but doctor delay of more than one day occurred in only 1.3%. The prevalence of treatment delay (total delay) of more than one day was 79.6%. Patient delay and treatment delay were found to be significantly higher among hill tribe than Thai subjects (P=0.004 and 0.003, respectively) but, there was no significant association between ethnicity and doctor delay (P=0.669). ConclusionPatient delay in seeking treatment is a major problem along the Thailand-Myanmar border in Tak province, especially in hill tribe people. Self-treatment accounted for most of initial treatment sought by patients.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey

AimThe early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. Materials and methodsA total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. ResultsThe patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DiscussionThe extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.

Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery.

EXAMINATION OF TUBERCULOSIS OUTBREAK INDEX CASES IN OSAKA CITY

To analyze tuberculosis outbreak index cases in order to improve preventative measures. Outbreaks reported in Osaka City between 2008 and 2014 were investigated. The index cases were examined according to category group, sex, age, chest radiograph findings, sputum smear examination, patient delay, doctor delay, total delay in case finding, and adherence to regular health examinations. As controls, 467 patients in Osaka City with newly registered sputum smear-positive pulmonary tuberculosis in 2011 were included. Thirteen outbreaks occurred. The group categories included enterprises (9 outbreaks), preparatory schools (2), a junior high school (1), and other (1). The group of index cases consisted of 12 men (92.3%) and one woman (7.7%), with a mean age of 39.1 years; 11 (84.6%) were 30 to 50 years of age. Their ages ranged from 15 to 54 years. Of the control group of patients with sputum smear-positive pulmonary tuberculosis, 69.2% were 60 years or older, with a mean age of 65.4 years. These results suggest that the index case group was significantly younger (p < 0.001). There were ten cases (76.9%) of patient delay (initial visit 2 months or more after onset), and 8 (61.5%) of total delay (diagnosed 3 months or more after onset). These rates were significantly higher than those in the control group (p < 0.001). There were regular health examinations in four cases; among those, one did not see a doctor and another did not receive further examination. Chest radiographs revealed cavities in 12 cases (92.3%). All sputum smears were positive, with grades of 1 + in one case (7.7%), 2 + in two cases (15.4%), and 3 + in 10 cases (76.9%). These cases had a significantly higher rate of smear positivity than those in the control group (p < 0.001). The index cases were predominantly male, in their prime, and had higher infectivity rates. These findings suggest the importance of preventing delays in case findings and receiving regular and adequate health examinations.

Delayed Presentation of Patients with Gynaecological Malignancies in Kano, North-Western Nigeria

The diagnosis and management of gynaecological cancers are still challenging in low- and middle-income countries. In patients with gynaecological malignancies delay at any point increases morbidity and mortality. This study evaluated the factors that may delay presentation, diagnosis and treatment of patients with malignant gynaecological cancers, and described the duration of each delay. It was a prospective cross-sectional study. A total number of 96 patients diagnosed to have gynaecological malignancy were enrolled in the study between the April 2014 and April 2015. The median age was 47.5 years (range of 18 - 84 years). The diagnoses on admission were cervical malignancy 34 (35.42%), ovarian malignancy 32 (33.33%), chorio carcinoma 15 (15.63%), cancers of uterine body (endometrial and leiomyosarcoma) 10 (10.42%) and vulval malignancies 5 (5.2%). Majority of the patients 65 (67.7%) presented late at either stage III or IV. At presentation, 36 patients (37.5%) had severe anaemia; 10 patients (10.41%) had obstructive uropathy; 3 (3.13%) developed fistula; 19 (19.79%) died on admission from complication of their disease. Most patients 61 (63.54%) had delayed presentation of more than 90 days (“patients delay”). Time in decision ranged between 3 days to maximum of 2920 days and median of 150 days. 58 (60.42%) gave a reason for such delay as lack of knowledge of their presenting symptoms, as a warning sign of possible malignancy; 80 (83.33%) had delay in diagnosis (“doctor delay”); 40 (41.67%) reported that the medical practitioner did not make referral to the center with available gynaecological services; “hospital delay” was observed in 66 (68.75%) of patients. The reason for delayed treatment in 35 (36.46%) of patients was severe patients condition that warrant stabilization (blood transfusion and dialysis) and 29 (30.21%) could not afford the treatment. Late presentation is a great problem in the management of oncological patients in this environment. High cost of care is the major challenge for the patients and gynaecologist in north-western part of Nigeria.

Diagnostic and therapeutic errors in cluster headache: a hospital-based study.

BackgroundCluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. CH patients may thus face: misdiagnosis, unnecessary investigations and delays in accessing adequate treatment. This study was conducted to investigate the occurrence of diagnostic and therapeutic errors with a view to improving the clinical and instrumental work-up in affected patients.MethodsOur study comprised 144 episodic CH patients: 116 from Italy and 28 from Eastern European countries (Moldova, Ukraine, Bulgaria). One hundred six patients (73.6%) were examined personally and 38 (26.4%) were evaluated through telephone interviews conducted by headache specialists using an ad hoc questionnaire developed by the authors.ResultsThe sample was predominantly male (M:F ratio 2.79:1) and had a mean age of 42.4 ± 9.8 years; approximately 76% of the patients had already consulted a physician about their CH at the onset of the disease. The mean interval between onset of the disease and first consultation at a headache center was 4.1 ± 5.6 years. The patients had consulted different specialists prior to receiving their CH diagnosis: neurologists (49%), primary care physicians (35%), ENT specialists (10%), dentists (3%), etc. Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average “diagnostic delay” was 5.3 ± 6.4 years and the condition was diagnosed approximately (“doctor delay”: one year). Instrumental and laboratory investigations were carried out in 93% of the patients prior to diagnosis of CH. Some of the patients had never received abortive or preventive medications, either before or after diagnosis. Medical prescription compliance: 88% of the cases.ConclusionsOur results emphasize the need to improve specialist education in this field in order to improve recognition of the clinical picture of CH and increase knowledge of the proper medical treatments for de novo CH. Continuous medical education on CH should target general neurologists, primary care physicians, ENT specialists and dentists. A study on a larger population of CH patients may further improve error-avoidance strategies.

Factors Associated With Delayed Diagnosis of Breast Cancer in Northeast Thailand

BackgroundWe identified factors associated with delayed first consultation for breast symptoms (patient delay), delayed diagnosis after first consultation (doctor delay), and advanced pathologic stage at presentation among 180 women with breast cancer in Thailand.MethodsIn this cross-sectional study 180 patients with invasive breast cancer were interviewed about potential risk factors and markers of delayed presentation. Patient delay was defined as time from onset of symptoms to first consultation with a health care provider, and doctor delay was defined as time from first consultation with a health care provider to diagnosis of breast cancer. Linear regression and logistic regression were used for the data analyses.ResultsAmong the 180 patients, 17% delayed seeking consultation for longer than 3 months, and 42% reported a doctor delay of longer than 3 months. In multivariate linear analysis, a significant increase in patient delay was associated with higher family income and smoking; factors associated with increased doctor delay were previous breast symptoms, self-treatment, and travel time to the hospital. In multiple logistic regression, doctor delay was related to age at first birth (P = 0.003), previous breast symptoms (P = 0.01), and number of consultations with a surgeon before diagnosis (P = 0.007). Regarding stage of breast cancer, there were significant associations with age at diagnosis (P for trend = 0.04), education (P for trend = 0.01), family income (P for trend = 0.02), time to referral (P = 0.01), and number of consultations with a surgeon before diagnosis (P < 0.01).ConclusionsHospital referral from a health care provider was a major contributor to delayed diagnosis. Breast cancer awareness campaigns in Thailand should target individuals in low- and high-income groups, as well as practitioners.

Appendicitis in children: evaluation of the pediatric appendicitis score in younger and older children.

Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS), diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years (n = 102) and <4 years (n = 20). Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; P = 0.005), despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; P = 0.001). PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis.

肺結核患者の受診までの遅れ(patient's delay)と診断までの遅れ(doctor's delay)の現状と影響要因

肺結核患者の受診までの遅れ(patient's delay)と診断までの遅れ(doctor's delay)の現状と影響要因

Patient and doctor delays in smear-negative and smear-positive pulmonary tuberculosis patients attending a referral hospital in Istanbul, Turkey.

Objectives. To measure delays from onset of symptoms to initiation of treatment in patients with smear-negative and smear-positive pulmonary tuberculosis and to identify reasons for these delays. Methods. A total of 136 newly diagnosed pulmonary tuberculosis patients were interviewed using a structured questionnaire. Results. The patients were divided into two groups. Group 1 included 65 smear-negative patients. There were 71 smear-positive patients in group 2. The median application interval was 10 days in group 1 and 14 days in group 2. While 24.6% of the patients had patient delay in group 1, patient delay was present in 33.8% of the patients in group 2 (P > 0.05). The median health care system interval was 41 days in group 1 and 16 days in group 2 (P < 0.0001). The most common reason for patient delay was neglect of symptoms by patient in both groups. A low index of suspicion for tuberculosis by physicians was the most common reason for doctor delays. Conclusions. Delays are common problem in smear-negative and smear-positive pulmonary tuberculosis patients. Delays should be reduced to reach an effective tuberculosis control. Education of public and physicians about tuberculosis is the most important effort to reduce delays.

Time to diagnosis of brain tumors in children: A single‐centre experience

The aim of the study was to analyze the pre-diagnostic symptomatic interval (PSI) of children with brain tumors with regard to the parental and doctor's delay and the clinical symptoms. A retrospective review of all children with brain tumors diagnosed in a single centre over a period of 11 years was carried out. Seventy-nine patients (35 boys, 44 girls), with a mean age of 9.2 years (0.2-23.5 years), were analyzed. PSI was 28 weeks with a parental delay of 11.1 weeks and a doctor's delay of 16.9 weeks. Main clinical symptoms were headache (66.7%), vomiting (57.7%), vision (46.2%) and gait (41.6) disorders and fatigue (41.0%) followed by other neurological signs. Diagnosis of pediatric brain tumors is often delayed in relation to the presenting symptoms. If parents report a combination of headache with other neurological abnormalities, a brain tumor should always be considered.

Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist

Delays in the diagnosis of oral cancer have been the subject of several cases recently reported in the media. Different types of delays include patient delays, doctor delays and system delays. Although diagnostic delays in primary care constitute a minority of these cases they are potentially modifiable and therefore an important aspect of care to address. GDPs need to be aware of several different factors when assessing the risk for oral cancer including the changing epidemiology of oral cancer and new trends in tobacco consumption, for example the increasing use of waterpipes (shishah/hookah). However several problems in fully assessing patients for oral cancer have been reported. These include time constraints, a lack of remuneration and little training in assessing risk factors and conducting a soft tissue examination. This article reviews these issues and puts forward the case for oral cancer detection as a compulsory CPD topic and a national oral cancer checklist as a tool to ensure all aspects of the oral cancer assessment are considered, which can then be audited and remunerated.

Symptoms and Factors Associated with Delayed Diagnosis of Pulmonary Tuberculosis

Background/Aims: Delayed diagnosis and treatment of pulmonary tuberculosis (TB) can result in progressive disease and contribute to the spread of TB. Presenting symptoms and factors associated with delayed diagnosis of pulmonary TB were evaluated in a tertiary university hospital in South Korea. Methods: Patients with pulmonary TB diagnosed from July 2011 to July 2012 were interviewed with questionnaires regarding symptoms of pulmonary TB and the type of health care facilities first visited. Medical records were also reviewed to evaluate the extent of diagnostic delay and factors associated with delayed diagnosis. Results: Of 107 patients with pulmonary TB, 85 (79.4%) were diagnosed after visiting doctors for evaluation of pulmonary TB symptoms and 22 (20.6%) were diagnosed after medical check-ups. Among patients diagnosed with pulmonary TB symptoms, the mean patient delay (time from symptom onset to initial doctor visit) was 16.7 ± 15.1 days, and the mean doctor delay (time from initial doctor visit to diagnosis of pulmonary TB) was 22.2 ± 21.3 days. First visit to a drugstore was associated with longer patient delays (hazard ratio [HR], 2.533; 95% confidence interval [CI], 1.424-4.506). First visit to a primary clinic was associated with longer doctor delays compared with first visit to a public health center or secondary/tertiary hospital (HR, 1.767; 95% CI, 1.003-3.114). The presence of hemoptysis was associated with shorter doctor delays (HR, 0.438; 95% CI, 0.203-0.944). Conclusions: To reduce delays in diagnosis of pulmonary TB, patients should be educated to quickly consult with a doctor when they have symptoms of pulmonary TB, and primary clinic doctors should be educated to maintain a high index of suspicion for pulmonary TB. (Korean J Med 2013;84:221-228)

Evaluation of therapeutic care delay among Latina- and European-American cervical cancer survivors

ObjectivesCervical cancer (CCA) ranks among the deadliest of cancers. Globally CCA claims 275,000 lives yearly. Severe delays, in cancer diagnostic or therapeutic care, that approach ≥60days negatively affect survival and survivorship outcomes. This study investigated socioeconomic and healthcare system factors influencing therapeutic care delays among cervical cancer survivors (CCS). Methods291 CCS (132 European-, 50 English-proficient (EP) Latina- and 109 limited English-proficient (LEP) Latina-Americans) were recruited from cancer registries. CCS retrospectively noted the days of delay in obtaining therapeutic care and reasons for delays. ResultsCCS who were LEP Latina-Americans, had lower income and education reported severe therapeutic delays (≥60days). LEP Latina-Americans experienced delays due to financial issues, doctor's delay, and healthcare system issues (p<0.001). Doctor and healthcare system delays significantly influenced therapeutic care delay in the logistic regression model. ConclusionsHealthcare system delays are primary contributors to ethnic differences in access to appropriately-timed care observed in this study. Healthcare professionals need to develop a fuller appreciation of the multilevel factors that contribute to healthcare barriers to better inform effective interventions to increase access to life saving care.

Abstract A47: Evaluating therapeutic care delay among Latina and European American cervical cancer survivors.

Abstract Purpose: Severe delays, in cancer diagnostic or therapeutic care, approaching ≥60 days negatively affect survival and survivorship outcomes. The purpose of this study was to investigate socioeconomic and healthcare system factors influencing therapeutic care delays among European- and Latina-American cervical cancer survivors (CCS). Methods: 291 CCS (132 European-, 50 English-proficient (EP) Latina-, and 109 limited English-proficient (LEP) Latina-Americans) were recruited from the California Cancer Registry and hospital registries. CCS completed a self-report questionnaire assessing demographic and cancer-related factors. CCS retrospectively noted the days of delay in obtaining therapeutic care and reasons for delays. Results: CCS who were LEP Latina-Americans, had lower income and education reported severe therapeutic delays (≥60 days). LEP Latina-Americans experienced more comorbidities (i.e., diabetes) and delays due to financial issues, doctor's delay, and healthcare system issues (p&amp;lt;0.001). Doctor and healthcare system delays were significant predictors of delayed therapeutic care in the logistic regression model. Conclusions: It is well documented that timely access to therapeutic care for cancers results in better prognosis and less costly treatments; thus reducing the human and economic cost of CCA. Healthcare system delays, patient health status, income, and education significantly influenced access to appropriately-timed care. Yet, the interaction of provider-actions and patient factors remains largely unexplained and needs further comprehensive investigation with larger samples. Our findings indicate that healthcare system administrators, providers, and researchers need to develop a fuller appreciation of the multilevel factors that contribute to health care barriers to better inform effective interventions to increase access to life saving care. Citation Format: Monica Rosales, Kimlin Ashing-Giwa. Evaluating therapeutic care delay among Latina and European American cervical cancer survivors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A47.

Early symptoms of bone and soft tissue sarcomas: could they be diagnosed earlier?

INTRODUCTIONDelays in diagnosis are common for patients with bone and soft tissue sarcoma (STS) despite guidance produced by the National Institute for Health and Clinical Excellence. This study set out to identify early symptoms experienced by patients and reasons for delays in making a definitive diagnosis.METHODSRetrospective interviews were carried out with 107 patients (66 with an STS and 41 with a bone sarcoma) presenting to a specialist centre. Symptoms were determined prior to definitive diagnosis and the occurrence of patient and doctor delays in reaching specialist care.RESULTSThe median patient delay was 1 month while the median doctor delay was 3.2 months from first symptoms to diagnosis for all sarcomas. Forty-nine patients with STS (74%) presented initially to their general practitioner with at least one guideline feature to prompt urgent referral. Only 2 patients (4%), however, were referred directly to a sarcoma unit, with 21 (43%) referred to secondary care for investigation. Patients with a lump increasing in size exhibited longer patient delays while doctor delay was shorter for deep lumps. Thirty-six patients with a bone sarcoma (88%) presented initially with symptoms to prompt further investigation. Nevertheless, significant delays (3.9 months) were seen in reaching specialist care. Only 4 patients (10%) were referred directly to a sarcoma unit at first presentation, with 21 (54%) referred for further investigation elsewhere.CONCLUSIONSIt is evident that awareness and referral of sarcomas remain poor. We suggest specific amendments to current guidelines and clearer referral pathways for patients. Furthermore, the need for robust education strategies is indicated, predominantly among healthcare professionals.