title: Predictors of the interval between onset of symptoms and first medical visit in patients with digestive tract cancer.
abstract: Lack of effective population screening programmes for digestive tract cancer makes a prompt diagnosis of symptomatic patients the primary option for early detection. The objective of the study was to analyze the characteristics and determinants of the interval between the first medical symptom and the first medical visit (ISV) in a sample of symptomatic patients of mid-low socioeconomic level admitted to hospital for a digestive tract cancer. During two years, 183 patients were personally interviewed with a structured questionnaire designed to elicit initial symptoms of digestive cancer. Fifty-seven percent consulted a physician during the first month after onset of symptoms, and over two-thirds did so within the first 2 months, but it took more than 3 months for 22.4% of the patients. In univariate analyses, the ISV was longer among patients illiterate, unemployed and in the lower social classes. The interval was also significantly longer when the physician-interviewer judged that the patient did not correctly identify the first symptom (p<0.05). In multivariate analyses, the chance of a longer ISV was 2.8 times higher in men; 16 times higher in unemployed patients; 9 times higher in patients with a first symptom of the lower digestive tract; and it increased 8-fold in subjects who attributed no importance to the first manifestation (all p<0.05). In spite of virtually universal health coverage, social factors seemed to act as barriers to seeking medical help in a subgroup of patients. Their procrastination was also related to the nature of the initial symptoms. Achieving an early clinical detection of digestive cancers may be difficult in some segments of the population, and may require substantial improvements in access to and the efficiency of the health system.
authors.affiliation: HOSP MARE DEU ESPERANCA,DEPT ONCOL,BARCELONA,SPAIN. HOSP MARE DEU ESPERANCA,DEPT GASTROENTEROL,BARCELONA,SPAIN.
authors.forename: M
authors.initials: M
authors.lastname: Porta
authors.forename: M
authors.initials: M
authors.lastname: Gallen
authors.forename: J
authors.initials: J
authors.lastname: Belloc
authors.forename: N
authors.initials: N
authors.lastname: Malats