title: Referral-free health care and delay in diagnosis for lung cancer patients.
abstract: OBJECTIVE
  Lung cancer is not only one of the most prevalent cancers but is also a lethal disease with a very low 5-year survival rate. Delay in diagnosis further reduces the chance of early treatment and worsens patients' survival. The purpose of this study was to understand the delay in the diagnosis of lung cancer under the healthcare system in Taiwan, and to identify the factors associated with it.
  
  
  METHODS
  A total of 840 patients diagnosed with lung cancer who had completed or were undergoing cancer treatments were recruited from a medical center in central Taiwan from July 2007 to January 2011. Structured questionnaires were administered regarding demographic characteristics, factors associated with their time to diagnosis and the length of delay in days.
  
  
  RESULTS
  Mean age was 62.68 years with 52.16 days to diagnosis on average. Number of hospital visits before confirmation of diagnosis differed significantly with the level of healthcare institution initially visited (P < 0.001). Compared with patients who had three or more hospital visits, patients who only visited two and one hospital(s) had a significant 34.91-day (95% confidence interval: 16.29-53.53) and 42.25-day (95% confidence interval: 20.76-63.76) reduction in their time to diagnosis (P < 0.001).
  
  
  CONCLUSIONS
  As the number of hospital visits increased, the delay in diagnosis also increased. It is vital to shorten the time to diagnosis for lung cancer patients by limiting the number of medical visits and educating the public to restrict excessive use of medical resources and strengthen their trust in medical professionals.
authors: Department of Public Health, College of Public Health, China Medical University, No. 91 Hsueh-Shih Rd., Taichung, Taiwan. shshieh@mail.cmu.edu.tw
authors: Vivian Chia-Rong
authors: VC
authors: Hsieh
authors: Trong-Neng
authors: TN
authors: Wu
authors: Shu-Hui
authors: SH
authors: Liu
authors: Shwn-Huey
authors: SH
authors: Shieh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013624:Taiwan; D013997:Time Factors