title: Delay in Diagnosis and Its Effect on Clinical Outcome in High-grade Sarcoma of Bone: A Referral Oncological Centre Study.
abstract: OBJECTIVE
  To investigate delay in diagnosis by both patients and doctors, and to evaluate its effect on outcomes of high-grade sarcoma of bone in a single-referral oncological center.
  
  
  METHODS
  Fifty-four patients with osteosarcoma, 29 with Ewing sarcoma and 19 with chondrosarcoma were enrolled in this retrospective study. Delay in diagnosis was defined as the period between initial clinical symptoms and histopathological diagnosis at our center. The delays were categorized as patient- or doctor-related. Short total delays were defined as <4 months; prolonged delays >4 months were assumed to have prognostic relevance.
  
  
  RESULTS
  Total delay in diagnosis was 688.0 days in patients with chondrosarcoma, which is significantly longer than the 163.3 days for osteosarcoma (P < 0.01) and 160.2 days for Ewing sarcoma (P < 0.01). Most doctor-related delays were at the pre-hospital stage, occurring at the general practitioner (GP)'s office. However, prolonged total delays (≥4 months) did not result in lower survival rates. Five-year-overall survival rates were 67.0% for osteosarcoma, 49.0% for Ewing sarcoma and 60.9% for chondrosarcoma. Survival was significantly lower for patients with metastatic disease for all three types of sarcoma.
  
  
  CONCLUSIONS
  Prolonged delay in diagnosis does not result in lower survival. Metastatic disease has a pronounced effect on survival. Aggressive tumor behavior results in shorter delays. Minimizing GP-related delays could be achieved by adopting a lower threshold for obtaining plain radiographs at the pre-hospital stage.
authors.affiliation: Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Louren M
authors.initials: LM
authors.lastname: Goedhart
authors.affiliation: Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Jasper G
authors.initials: JG
authors.lastname: Gerbers
authors.affiliation: Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Joris J W
authors.initials: JJ
authors.lastname: Ploegmakers
authors.affiliation: Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Jutte
mesh_terms: D001859:Bone Neoplasms / Q000175:diagnosis* / Q000401:mortality; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012516:Osteosarcoma / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Doctor-related delay; Patient-related delay; Sarcoma; Survival