TY - JOUR

T1 - Diagnostic delay experienced among gynecological cancer patients: a nationwide survey in Denmark

AU - Robinson, Kirstine M

AU - Ottesen, Bent

AU - Christensen, Karl Bang

AU - Krasnik, Allan

AU - Robinson, Kirstine Magtengaard

AU - Ottesen, Bent

AU - Christensen, Karl Bang

AU - Krasnik, Allan

N1 - Keywords: Aged; Cohort Studies; Denmark; Female; Genital Neoplasms, Female; Health Care Surveys; Humans; Middle Aged; Questionnaires; Time Factors

PY - 2009/1/1

Y1 - 2009/1/1

N2 - OBJECTIVE: To examine diagnostic delay among gynecological cancer patients. DESIGN: Nationwide study. SETTING: The cohort comprised all women receiving their first treatment for cervical, endometrial, or ovarian cancer between 1 October 2006 and 1 December 2007 in four of the five centers for gynecological cancer surgery in Denmark. SAMPLE: Of the 911 women alive, 648 participated, resulting in a response rate of 71.1%; of these, 30.1% were diagnosed with cervical cancer, 31.0% with endometrial cancer, and 38.9% with ovarian cancer. METHODS: Questionnaire survey. MAIN OUTCOME MEASURES: Diagnostic delay calculated as total delay, patient delay, general practitioner referral delay, gynecologist appointment delay, and secondary care delay. RESULTS: Diagnostic delays were found in all parts of the diagnostic pathway. Total diagnostic delay has remained long with a median delay of 12 weeks from the time patients experience symptoms until the time they receive treatment; the 10% experiencing the longest delay wait for >41 weeks. For all types of delay, distributions were non-normal. This indicates that the greatest potential for optimizing clinical outcomes may be among the minority of patients experiencing very long delays. Ovarian cancer patients experienced significantly shorter delays compared with other gynecological cancer patients in all parts of the health care system. CONCLUSIONS: Delays occur in all parts of the diagnostic process, suggesting that a multifaceted approach should be adopted with special focus on reducing the very long delays experienced by some patients. By reducing the total diagnostic delays, outcomes such as three-year survival rates can potentially be improved.

AB - OBJECTIVE: To examine diagnostic delay among gynecological cancer patients. DESIGN: Nationwide study. SETTING: The cohort comprised all women receiving their first treatment for cervical, endometrial, or ovarian cancer between 1 October 2006 and 1 December 2007 in four of the five centers for gynecological cancer surgery in Denmark. SAMPLE: Of the 911 women alive, 648 participated, resulting in a response rate of 71.1%; of these, 30.1% were diagnosed with cervical cancer, 31.0% with endometrial cancer, and 38.9% with ovarian cancer. METHODS: Questionnaire survey. MAIN OUTCOME MEASURES: Diagnostic delay calculated as total delay, patient delay, general practitioner referral delay, gynecologist appointment delay, and secondary care delay. RESULTS: Diagnostic delays were found in all parts of the diagnostic pathway. Total diagnostic delay has remained long with a median delay of 12 weeks from the time patients experience symptoms until the time they receive treatment; the 10% experiencing the longest delay wait for >41 weeks. For all types of delay, distributions were non-normal. This indicates that the greatest potential for optimizing clinical outcomes may be among the minority of patients experiencing very long delays. Ovarian cancer patients experienced significantly shorter delays compared with other gynecological cancer patients in all parts of the health care system. CONCLUSIONS: Delays occur in all parts of the diagnostic process, suggesting that a multifaceted approach should be adopted with special focus on reducing the very long delays experienced by some patients. By reducing the total diagnostic delays, outcomes such as three-year survival rates can potentially be improved.

U2 - 10.1080/00016340902971482

DO - 10.1080/00016340902971482

M3 - Journal article

C2 - 19455442

VL - 88

SP - 685

EP - 692

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 6

ER -