Open Access Highly Accessed Research article

Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients

Rikke P Hansen12*, Peter Vedsted12, Ineta Sokolowski3, Jens Søndergaard4 and Frede Olesen3

Author Affiliations

1 Research Unit and Department of General Practice, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark

2 The Danish Cancer Society and the Novo Nordisk Foundation Research Centre for Cancer Diagnosis in Primary Care, Bartholins Allé 2, DK-8000 Aarhus C, Denmark

3 Research Unit for General Practice, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark

4 Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark

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BMC Health Services Research 2011, 11:284  doi:10.1186/1472-6963-11-284

Published: 25 October 2011

Abstract

Background

Delay in diagnosis of cancer may worsen prognosis. The aim of this study is to explore patient-, general practitioner (GP)- and system-related delay in the interval from first cancer symptom to diagnosis and treatment, and to analyse the extent to which delays differ by cancer type.

Methods

Population-based cohort study conducted in 2004-05 in the County of Aarhus, Denmark (640,000 inhabitants). Data were collected from administrative registries and questionnaires completed by GPs on 2,212 cancer patients newly diagnosed during a 1-year period. Median delay (in days) with interquartile interval (IQI) was the main outcome measure.

Results

Median total delay was 98 days (IQI 57-168). Most of the total delay stemmed from patient (median 21 days (7-56)) and system delay (median 55 days (32-93)). Median GP delay was 0 (0-2) days. Total delay was shortest among patients with ovarian (median 60 days (45-112)) and breast cancer (median 65 days (39-106)) and longest among patients with prostate (median 130 days (89-254)) and bladder cancer (median 134 days (93-181)).

Conclusion

System delay accounted for a substantial part of the total delay experienced by cancer patients. This points to a need for shortening clinical pathways if possible. A long patient delay calls for research into patient awareness of cancer. For all delay components, special focus should be given to the 4th quartile of patients with the longest time intervals and we need research into the quality of the diagnostic work-up process. We found large variations in delay for different types of cancer. Improvements should therefore target both the population at large and the specific needs associated with individual cancer types and their symptoms.