title: Predictors of delay in diagnosis and treatment in diffuse large B-cell lymphoma and impact on survival.
abstract: There is a paucity of data on the impact of diagnostic and treatment delays on outcomes in haematological malignancies, particularly in patients with diffuse large B-cell lymphoma (DLBCL). Our database of patients treated for DLBCL between 2002 and 2010 was interrogated. Univariate and multivariate analyses were performed to determine the relationship between sociodemographic or disease-specific variables and delays. Cox Regression analysis was used to discern the impact of delays on survival. Patients (n = 278) waited a median of 4 weeks before seeking medical attention. It took a median of 8 weeks for a non-haematology physician to diagnose DLBCL and refer to a haematologist. A median of 3 weeks elapsed between specialist consultation and chemotherapy initiation. In multivariate logistic regression analysis, bone marrow involvement [odds ratio (OR) = 0·41, P = 0·018], Charlson comorbidity index (OR = 1·42, P = 0·017) and urgent inpatient chemotherapy (OR = 0·40, P = 0·012) were associated with diagnostic delays >6 weeks. Lack of pathological diagnosis at the time of haematology referral was the only factor that independently predicted for treatment delays >4 weeks (OR = 8·25, P < 0·01). Diagnostic or treatment delays did not impact survival or progression-free survival. In conclusion, selected disease and patient-related factors are associated with delays in management of DLBCL, but do not impact outcomes.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON.
authors.forename: Anna
authors.initials: A
authors.lastname: Nikonova
authors.forename: Hany R
authors.initials: HR
authors.lastname: Guirguis
authors.forename: Rena
authors.initials: R
authors.lastname: Buckstein
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Cheung
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D003131:Combined Modality Therapy; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage; D057210:Delayed Diagnosis / Q000009:adverse effects / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011241:Prednisone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: delay; diagnosis; non-Hodgkin lymphoma; targets; treatment