title: Diagnostic and referral intervals for Manitoba women with epithelial ovarian cancer - the Manitoba Ovarian Cancer Outcomes (MOCO) study group: a retrospective cross-sectional study.
abstract: BACKGROUND
  Epithelial ovarian cancer has the highest mortality of all gynecologic cancers. The poor survival rates are often attributed to the advanced stage at which most of these cancers are detected. We sought to examine the effects of patient demographics, comorbidities and presenting symptoms on diagnostic and referral intervals by location of first presentation (emergency department v. elsewhere) and to identify factors that affect these intervals.
  
  
  METHODS
  We performed a retrospective analysis of chart and medical record data for ovarian cancers, with the exceptions of sex cord and germ cell tumours, diagnosed between 2004 and 2010 in Manitoba, Canada. Data were collected on baseline characteristics, time to diagnosis and referral, number and type of physician visits and emergency department visits.
  
  
  RESULTS
  The final cohort consisted of 601 patients. Sixty-three percent of patients received their diagnosis within 60 days of initial presentation, and 75.2% had their cancer diagnosed within 2 physician encounters. The median diagnostic interval for all stages of patients presenting to the emergency department was 7 days, compared with 55 days for patients presenting elsewhere. Early stage patients not presenting to the emergency department had their diagnosis a median of 34.0 days later than patients with advanced disease (95% confidence interval [CI] 22.22 to 45.69,p< 0.0001). The presence of some symptoms was associated with shortened diagnostic intervals. Patients with serous, clear-cell or endometrioid histotypes were less likely to have first presentation beginning in the emergency department (odds ratio [OR] 0.40, 95% CI 0.24 to 0.64,p= 0.0001; OR 0.28, 95% CI 0.14 to 0.59,p= 0.007) than those with unclassified epithelial histotype.
  
  
  CONCLUSIONS
  For this group of patients, the main factor associated with diagnostic and referral intervals is presentation to the emergency department. These patients likely required more urgent attention for their more symptomatic disease, leading to quicker diagnosis and referral patterns, despite poorer prognosis.
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Love
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lambert
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Donna
authors.initials: D
authors.lastname: Turner
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Robert
authors.initials: R
authors.lastname: Lotocki
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Erin
authors.initials: E
authors.lastname: Dean
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Shaundra
authors.initials: S
authors.lastname: Popowich
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Alon D
authors.initials: AD
authors.lastname: Altman
authors.affiliation: University of Manitoba (Love), Max Rady College of Medicine; Department of Epidemiology (Lambert, Turner), CancerCare Manitoba; Department of Obstetrics Gynecology and Reproductive Sciences (Lotocki, Dean, Popowich, Altman, Nachtigal) University of Manitoba; Division of Gynecologic Oncology (Lotocki, Dean, Popowich, Altman) CancerCare Manitoba; Department of Biochemistry and Medical Genetics (Nachtigal), University of Manitoba; Research Institute in Oncology and Hematology (Nachtigal), CancerCare Manitoba, Winnipeg, Man.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Nachtigal