title: Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review.
abstract: OBJECTIVE
  The aim of this study was to identify the most crucial interval to encourage earlier diagnosis in with gastroesophageal cancer and to identify potential factors effecting this interval.
  
  
  BACKGROUND
  Gastroesophageal malignancy is the eighth most commonly presenting cancer with one of the worst survival rates. Identifying the most crucial period for intervention to inform earlier diagnosis is an important step towards improving survival.
  
  
  METHODS
  Mixed methods literature review.
  
  
  METHODS
  CINAHL, MEDLINE and Academic search primer online databases were searched using keywords and inclusion/exclusion criteria. Empirical evidence published between 2000-2016 with a focus on gastroesophageal cancer presentation and survival was reviewed to inform this study.
  
  
  METHODS
  Twelve studies were extracted for further review. Selected studies were appraised and presented through Olensen's "delay interval" framework to inform the most crucial interval to survival in gastroesophageal cancer.
  
  
  RESULTS
  The findings identify the patient interval as the most critical period for encouraging earlier presentation and reducing advanced stage presentation in gastroesophageal cancer. The article also highlighted some methodological limitations to cancer research, such as a lack of consensus in definitions which prevent statistical meta-analysis of cancer data, survivor bias in gastroesophageal cancer studies and a significant lack of qualitative evidence to reveal patient experience in presenting with this cancer.
  
  
  CONCLUSIONS
  Further research into the patient interval is required to elicit information on how and why patients present with their cancer symptoms.
authors.affiliation: Faculty of Health Sciences, University of Hull, Hull, UK.
authors.forename: Amanda
authors.identifier: http://orcid.org/0000-0003-1378-3123
authors.initials: A
authors.lastname: Lee
authors.affiliation: Queens Centre for Oncology and Haematology, Cottingham, Hull, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Khulusi
authors.affiliation: Faculty of Health Sciences, University of Hull, Hull, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Watson
mesh_terms: D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000473:pathology*; D006801:Humans; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology*; D016019:Survival Analysis
keywords: 
  GOC
  ; advanced presentation; cancer; cancer data; cancer methodology; early presentation; interval delay; late presentation; literature review methodology; oesophagogastric cancer