title: Reasons for delays in diagnosis of anal cancer and the effect on patient satisfaction.
abstract: OBJECTIVE
  To quantify the time to diagnosis of anal cancer after onset of symptoms, to identify reasons for delays in diagnosis, and to identify the effect of delays on patient satisfaction.
  
  
  METHODS
  Retrospective questionnaire.
  
  
  METHODS
  Cross Cancer Institute in Edmonton, Alta.
  
  
  METHODS
  Patients newly diagnosed with anal cancer on their first visit to the centre.
  
  
  METHODS
  Timeline from first symptoms to first access to medical care and to diagnosis, and patient satisfaction.
  
  
  RESULTS
  Twenty-six patients completed the survey. Although most sought medical attention promptly, 19% waited for more than 6 months. At first visits after symptom onset, a rectal examination was performed in only 54% of patients, a diagnosis of hemorrhoids was given in 27% of patients, and further investigations were ordered in only 54% of patients. If a misdiagnosis of hemorrhoids was made, substantially more visits were required to diagnose the cancer. An average of 3.2 months after the first visit to a physician and 7.4 months after onset of symptoms was needed to obtain a diagnosis. Overall, 28% of patients believed there were no diagnostic delays and 40% of patients thought they were responsible for the delay. Overall, 72% of patients were satisfied with the care they received. Patients who were dissatisfied perceived the delay in diagnosis to be because no action was taken by a physician or the wait was too long for tests or referrals.
  
  
  CONCLUSIONS
  To reduce delays in diagnosis, it might be important to educate relevant populations about symptoms of anal cancer. In addition, primary care physicians must maintain a high index of suspicion of anal cancer in high-risk populations. Finally, there must be a system-wide increase in access to further investigations through gastroenterologists and general surgeons.
authors.forename: Sharon
authors.initials: S
authors.lastname: Chiu
authors.forename: Kurian
authors.initials: K
authors.lastname: Joseph
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Cornand
authors.forename: Dan
authors.initials: D
authors.lastname: Schiller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D001005:Anus Neoplasms / Q000175:diagnosis* / Q000523:psychology; D057210:Delayed Diagnosis / Q000523:psychology*; D003951:Diagnostic Errors; D055088:Early Detection of Cancer / Q000523:psychology; D005260:Female; D006484:Hemorrhoids / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires