Diagnostic delay experienced among gynecological cancer patients: a nationwide survey in Denmark.
OBJECTIVE
To examine diagnostic delay among gynecological cancer patients.


METHODS
Nationwide study.


METHODS
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.


METHODS
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.


METHODS
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.
Robinson
Kirstine M
KM
Department of Health Services Research, Institute of Public Health, Copenhagen University, Copenhagen, Denmark. K.Magtengaard@pubhealth.ku.dk
Ottesen
Bent
B
Christensen
Karl Bang
KB
Krasnik
Allan
A
D000368:Aged; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013997:Time Factors