What factors influence the patient and primary care intervals in the diagnostic pathway of gynaecological cancers?


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Pauline Williams1,Peter Murchie1,Christine Bond1,Chris Burton1
1University of Aberdeen

Abstract

Background

Gynaecological cancers are the second most common female cancer type (1), with lower survival rates than many comparable countries (2). An important factor in the UK’s poorer cancer outcomes is diagnostic delay; gynaecological cancer was identified in 2010 as the cancer type most likely to involve delayed diagnosis (3). The aim of this work was to conduct a systematic review to collate the current evidence on the factors which influence the patient and primary care intervals in the diagnostic pathway of gynaecological cancer.

Method

MEDLINE, EMBASE and Cochrane databases were searched using three terms, their MeSH terms and synonyms: primary care; gynaecological cancer and delay. Citation lists of all identified papers were searched. Two authors (PW and PM) independently screened titles, abstracts and the full texts of publications. Data extraction of factors affecting the diagnostic pathway was performed by PW and duplicated in 8 (22%) of papers by a second reviewer (PM or CB).

Results

1177 references were identified; 35 met the inclusion criteria (one systematic review and 34 observational studies). Using definitions for patient interval and primary care interval as described by the Aarhus statement (4), factors were assigned to one of the two groups. Diagnostic delay was influenced by 1) patient interval factors: patient age and socioeconomic status; delayed presentation to a GP and 2) practitioner interval factors: inadequate examination; lack of suspicion of cancer; non urgent referral and referral to other hospital specialities.

Conclusion

Diagnostic delay is multi-faceted and complicated. Many patients delay presenting to their GP, which is compounded by subsequent inadequate examination and suboptimal onward referral processes pre-diagnosis. This review demonstrates several areas which need further exploration as potential targets for health services interventions with potential to improve cancer outcomes.