title: Intervals between symptom onset and clinical presentation in cancer patients.
abstract: OBJECTIVE
  We aimed to investigate relative values of the intervals between symptom onset and clinical presentation in cancer patients and to correlate them with diagnosis of distant metastasis.
  
  
  METHODS
  Cancer registry and medical records of all cancer patients for over a 10-year period in a medical center of Japan were reviewed. We examined the intervals of symptom onset to clinical presentation and the presence of metastasis at diagnosis.
  
  
  RESULTS
  In 3,893 cancer patients, the mean interval of symptom onset to clinical presentation was 89 days (median, 30 days). The cancer group with a short interval of only days to weeks included hepatobiliary, ovary, brain, and acute leukemia. The group with a long interval of months to years included head and neck, thyroid, and skin cancers. Other types of cancer were included in the middle group with an interval of weeks to months. Among patients with head & neck, skin, and ovarian cancers, the longer interval was significantly associated with a lower likelihood of distant metastasis. A longer interval with an increment of each month was associated with a lower likelihood for distant metastasis with an odds ratio of 0.97 (95% CI, 0.96-0.99).
  
  
  CONCLUSIONS
  Hepatobiliary, ovary, brain, and acute leukemia are among the cancer types with an interval of days to weeks, while head and neck, thyroid, and skin cancers are among the types with an interval of months to years. Among patients with solid tumors, those with metastasis are likely to present to a physician more promptly.
authors.affiliation: Center for Clinical Epidemiology, St Luke's Life Science Institute, Tokyo. tokuyasu@orange.ocn.ne.jp
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Katsuya
authors.initials: K
authors.lastname: Chinen
authors.forename: Haruo
authors.initials: H
authors.lastname: Obara
authors.forename: Suresh K
authors.initials: SK
authors.lastname: Joishy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000628:therapy; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult