Interval from diagnosis to treatment onset for six major cancers in Catalonia, Spain☆
Introduction
Delays in cancer diagnosis and treatment have concerned health organizations for decades [1], [2], [3], [4], [5], [6]. The time interval between onset of cancer symptoms and diagnosis, commonly known as “diagnostic delay”, results from the interplay of cultural norms, patients’ response to symptoms, access to care, and the functioning of the health care system [7], [8], [9]. The interval between diagnosis and onset of treatment, also known as “treatment delay”, is partly due to the characteristics of the cancer at presentation and to the organization of medical services [10], [11]. While many studies have shown that a longer survival is achieved when treatment starts in the early stages of the disease [12], the relationship between stage and the diagnosis to treatment interval (DTI) has often been found to be inverse, particularly when large and unselected populations were studied [12], [13], [14], [15], [16], [17], [18].
Although delays due to the health system are usually a small fraction of the biological lifespan of the tumor, long DTIs may cause psychological distress and decreased quality of life. Furthermore, at present such delays constitute a major cause of medical malpractice claims [19]. Health authorities should base treatment targets for cancer on a realistic assessment of the present intervals [20].
As in other countries, in Spain the local, state and federal governments seldom monitor cancer intervals comprehensively, and research studies have always been conducted in specific hospitals [1], [3], [8], [21], [22], [23]. With some exceptions, such as a systematic survey in England [24], few scientific studies on intervals in major cancers have covered all types of hospitals serving a National Health System. Thus, the aim of the present study was to analyse factors related to the length of the interval from diagnosis to treatment onset for the six most incident cancers in Catalonia, Spain.
Section snippets
Design, setting and patients
This is a cross-sectional study with retrospective collection of data including 22 hospitals of Catalonia, Spain. Catalonia is an autonomous community in the Northeast of Spain with 6,800,000 inhabitants. The National Health Service is based on a public system of primary and hospital care that provides universal free access to the population. Public and private hospitals are integrated in the ‘Public Hospitals Network’ and funded by the National Health Service [25]. Hospitals in this network
Results
At admission half of patients with lung cancer and one fourth of patients with colorectal cancer had disseminated tumors; the proportion of patients with local stage was highest for urinary bladder and breast cancers (Table 1). Most patients were electively admitted to hospital; yet, over one third of lung and colorectal cases had an admission through the ED. Over 80% of breast and endometrial cancer patients were visited by a specialist before hospital admission, and this figure was 65% in
Discussion
The diagnosis to treatment interval was shorter in colorectal, lung, breast and endometrial cancer, and longer in prostate and urinary bladder cancer. This likely reflects, in part, the different natural history of the diseases. While each cancer has its own biological, clinical and social dynamics, comparisons across cancers unveiled similar patterns as well as differences. DTI was often strongly related to level of hospital, stage of disease, and mode of hospital admission.
In this study the
Conflict of interest
None.
Acknowledgements
The authors are grateful to David Almenta, Cristina Asensio, Elisabet Balló, Sara Delgado, Alejandro Ezquerro, Lisandro Fernández, Núria Monfulleda, Núria Prenafeta, Janzet Rodríguez and Maria Dolors Viguera for assistance in field work.
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The study was partly funded by the Catalan Institute of Oncology, Generalitat de Catalunya and by “Thematic network of collaborative centers for epidemiology and public health research” (C03/09), “Thematic network of collaborative centres for cancer research” (C03/10), “Thematic network for cancer research” (RTICC, D06/0020/0089) and “CIBER of Epidemiology and Public Health” (groups lead by C. Borrell and M. Porta), Instituto de Salud Carlos III, Spanish Ministry of Health.
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Other members of the Intercat Study group: Mercè Peris and Josep Maria Borràs, Institut Català d’Oncologia; Manuel Gallen and Xavier Castells, Hospital del Mar (IMAS); Antoni Plasència, Agència de Salut Pública de Barcelona; Montse Bustins, CatSalut; Àlex Guarga, Consorci Sanitari de Barcelona; Anna Ferrer and Monserrat Domènech, Fundació Althaia; Isabel Trías Puig-Sureda, Fundació Plató; Humberto Villavicencio and Lluïsa López, Fundació Puigvert; Jaume Grau and Ferran Caballero, Hospital Comarcal Penedès, Consorci Sanitari Alt Penedès; Anna Belil, Hospital Arnau de Vilanova, Lleida; Artur Conesa, Hospital Clínic i Provincial de Barcelona; Guillem Paluzie and Jordi Valls, Hospital Comarcal de Blanes; Isabel Ginesta, Hospital de la Santa Creu i Sant Pau; Jordi Coderch and Josep Maria Inoriza, Hospital de Palamós; Mercè Josa, Hospital de St. Rafael; David Calvo and Alfredo Garcia, Hospital de Viladecans; Teresa Ros, Hospital Dos de Maig de Barcelona, CSI; Miquel Nogué, Rafael Toribio and Esther Vila, Hospital General de Vic; Patrícia Fernández, Hospital Sagrat Cor de Barcelona; Miquel Carreras, Hospital St. Jaume d’Olot; Albert Anglès Traserra and Núria Serra, Hospital Universitari de la Vall d’Hebron; Montse Guitart, Hospital Universitari Josep Trueta, Girona; Joan Miquel Carbonell, Josep Gumà Padró and Jaume Galceran Padrós, Hospital Universitari St. Joan de Reus; Anton Benet, Jordi Palacín and Albert Pons, Pius Hospital de Valls; and Roger Pla, Pla director general d’oncologia 2001–2004 de Catalunya.