Interval from diagnosis to treatment onset for six major cancers in Catalonia, Spain

Abstract

Background: Targets set by health care organizations on time intervals between cancer diagnosis and treatment often go unmet. The objective of the study was to analyse the interval from diagnosis to treatment onset, and related factors, in the six most incident cancers in Catalonia (Spain), a developed European region with universal free access to health care. Methods: Twenty-two hospitals contributed 1023 incident cancer patients (198 lung, 253 colorectal, 95 prostate, 109 urinary bladder, 266 breast, 102 endometrial). Information was gathered from hospital medical records. The dependent variable was the length of the diagnosis to treatment interval (DTI). Independent variables were age, sex, disease stage, hospital level, mode of admission to hospital, and type of physician seen before admission. Multivariate-adjusted odds ratios were calculated by unconditional logistic regression for each cancer site. Results: The median DTI (in days) was 39 for lung cancer, 25 for colorectal, 108 for prostate, 69 for bladder, 35 for breast and 40 for endometrial cancer. In prostate and bladder cancers, over 78% of patients showed a DTI >30 days, while in colorectal the figure was 42%. Disseminated stage (distant metastases) was associated with a lower DTI in all sites. Patients admitted to third-level hospitals and with an elective admission were more likely to have a DTI >30 days. Conclusions: In Catalonia, a substantial proportion of cancer patients experience treatment delays that may impact negatively on psychological well-being, quality of life, and probably survival as well.

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.