INTRODUCTION Lung cancer is one of the leading causes of death worldwide and in Cuba, where its incidence and mortality are on the rise. Diagnostic delay is a variable linked to survival and prognosis. Quantifying this delay and comparing it with data from other national and international sources may lead to planning actions to reduce its impact.
OBJECTIVE Assess diagnostic delay of lung cancer in patients at the Joaquín Albarrán Clinical-Surgical Teaching Hospital, Havana, Cuba, from 2007 to 2010.
METHODS A retrospective descriptive study was conducted based on administrative data from patients diagnosed with lung cancer. The length of overall diagnostic delay was determined, as well delay between symptom onset and the patient’s first contact with the health system, and delay at the primary and secondary levels of the national health system. Descriptive statistics were used to summarize the different time intervals.
RESULTS The study comprised a total of 54 patients; 74.1% were men; the largest age group was 51–60 years. Of the total, 61.1% sought care first at the primary level. Total diagnostic delay for these patients was 67.4 days: 24.3 days due to patient delay (SD 32.8), 16.2 days due to primary care delay (SD 5.2), and 26.9 days due to secondary care delay (SD 20.1). The total delay for patients first seen at the secondary care level was 79.1 days (SD 81.8): 47.8 days due to patient delay (SD 25.6), and 31.3 days due to secondary level delay (SD 14.4).
CONCLUSIONS Diagnostic delay in lung cancer is high. Patients who went directly to hospital did not benefit from shorter delay in diagnosis.
KEYWORDS Lung cancer, diagnostic delay, primary level, risk perception, Cuba
| Introduction Despite advances in diagnostic techniques and treatment, lung cancer is the leading cause of cancer death worldwide and in Cuba. Prompt initiation of cancer therapy depends on rapid diagnostic confirmation; however, most patients are diagnosed at an advanced stage. In the Cuban health system, primary, secondary and tertiary levels of care are interrelated; patients may seek care at any level or may be referred from one to another. Lung cancer diagnoses are confirmed at the tertiary level.
Objective Determine the length of diagnostic delay in patients diagnosed with non-small-cell lung cancer (NSCLC) at a tertiary care facility in Havana, Cuba, as well as mean diagnostic delay attributable to the patient and to the health system by level of care. Methods A descriptive observational study of 96 patients with a cytologically and/or histologically confirmed diagnosis of non-small-cell lung cancer was conducted in 2005–2007. Patients initially sought care for disease symptoms at primary, secondary or tertiary levels in the Cuban public health system, but diagnosis of all patients was confirmed at a specialized tertiary care facility. Total diagnostic delay was calculated as the time elapsed from onset of symptoms to confirmation of NSCLC diagnosis. Variables also included diagnostic delay attributable to the patient and diagnostic delay attributable to the health system by level of care. Data were arranged in tables and analyzed by absolute value, percentage, mean, and standard deviation. Results Of the 96 patients studied, 69% were male, and 54% were aged 50–69 years. Fifty-five percent of patients sought medical care within 15 days of onset of symptoms, 21% within 16–30 days, and 3% waited >90 days. Mean diagnostic delay attributable to the patient was 18.19 ± 3.45 days while mean diagnostic delay attributable to the health system was 61.63 ± 18.50 days, and overall diagnostic delay was 73.13 ± 17.53 days. For the 71% of patients seen in primary care, mean diagnostic delay was 29.51 ± 4.53 days; for the 45% seen exclusively or additionally at the secondary level, mean diagnostic delay was 24.45 ± 7.31 days. Upon admission at the tertiary care level, mean diagnostic confirmation delay was 18.23 ± 3.68 days. Conclusions Diagnostic delay of lung cancer patients in this study was prolonged. Appropriate strategies are needed for reducing this delay. Keywords: Lung cancer, non-small-cell lung carcinoma, diagnosis, delivery of health care |
