title: Delay in diagnosis and treatment of gastric cancer: from the beginning of symptoms to surgery--an Iranian study.
abstract: OBJECTIVE
  In developed countries, diagnosis of gastric cancer is performed in early stages through screening, and the five-year survival rate has risen to 86%. Although patients in developing countries have digestive symptoms for some time, they do not undergo early endoscopy. The patients refer to physicians in developed stages. This research was conducted to determine the median time of delay from the beginning of symptoms to surgery.
  
  
  METHODS
  In this research, 63 patients suffering from gastric cancer were investigated during 2004-2005. A research questionnaire was completed from patient's admission to endoscopy until surgery through patient interview. Mann-Whitney statistical test and SPSS software were used for data analysis.
  
  
  RESULTS
  Out of 63 patients, 48 (76.2%) were male and 43 (68.3%) were rural residents. The most common cancer area was cardia (31 patients) and the most common symptom was abdominal pain (28 patients). The results showed that the median total delay from the beginning of symptoms until surgery was 96 days. Median patient delay [from first symptom to presentation to general practitioner] was determined as 8 days, general practitioner delay (from the first referral to endoscopy) as 57 days, pathologist delay (from endoscopy to pathology confirmation) as 12 days, and surgeon delay (from pathology confirmation to surgery) as 7 days. Factors such as place of residence, education, income and gender had no significant effect on time of delay.
  
  
  CONCLUSIONS
  Delays from referral to endoscopy performance and from performance of endoscopy to pathologic confirmation were higher than expected. A screening plan for timely referral of patients and performance of endoscopy seems essential. To reduce the time of delay, efforts such as physician education, cooperation between hospital units and pathologists and provision of necessary hospital equipment are highly recommended.
authors.affiliation: Department of General Surgeon, Zanjan University of Medical Sciences, Shafiieh Hospital, Zanjan. nejat.hosini@zums.ac.ir
authors.forename: Seyed Nejat
authors.initials: SN
authors.lastname: Hosseini
authors.forename: Seyed Nouraddin
authors.initials: SN
authors.lastname: Mousavinasab
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Moghimi
authors.forename: Ramazan
authors.initials: R
authors.lastname: Fallah
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000855:Anorexia / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D012017:Referral and Consultation; D012424:Rural Population; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014505:Urban Population; D014839:Vomiting / Q000209:etiology