Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States. Issue 22 (4th August 2021)

• Record Type: Journal Article
• Authors: Huepenbecker, Sarah P.; Sun, Charlotte C.; Fu, Shuangshuang; Zhao, Hui; Primm, Kristin; Giordano, Sharon H.; Meyer, Larissa A.
• Is Part Of: Cancer. Volume 127:Issue 22(2021)
• Page Start: 4151
• Page End: 4160
• Publication Date: 2021-08-04
• Subjects: epithelial ovarian cancer -- gynecologic neoplasm -- late diagnosis -- Surveillance, Epidemiology, and End Results (SEER) program -- symptom assessment; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33829
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Patients with ovarian cancer often present with late‐stage disease and nonspecific symptoms, but little is known about factors affecting the time to diagnosis (TTD) in the United States. Methods: A retrospective, population‐based study of the Surveillance, Epidemiology, and End Results–Medicare database was conducted. It included women 66 years old or older with stage II to IV epithelial ovarian cancer with at least 1 code for abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of the cancer diagnosis. TTD was defined from the first claim with a prespecified symptom to the ovarian cancer diagnosis. Kruskal‐Wallis tests were used to assess for differences in TTD by group medians. Univariate and generalized linear models with a log‐link function evaluated TTD by covariables. Results: For the 13, 872 women analyzed, the mean and median times to diagnosis were 2.9 and 1.1 months, respectively. The median TTD differed significantly by first symptom ( P < .001), number of symptoms ( P < .001), and first physician specialty seen ( P < .001). In a multivariable analysis, TTD differed significantly according to race/ethnicity ( P < .001), geographic region ( P = .001), urban‐rural location ( P = .031), emergency room presentation ( P < .001), and number of specialties seen ( P < .001). A shorter TTD was associated with a diagnosis in 2006‐2010 (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87‐0.98) or 2011‐2015 (RR, 0.87; 95% CI, 0.81‐0.93) in comparison with 1992‐1999. Conclusions: The time from a symptomatic presentation to care to a diagnosis of ovarian cancer is influenced by clinical and demographic variables. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to aid in diagnosis. Lay Summary: Ovarian cancer is often diagnosed once disease has spread because the classic symptoms of ovarian cancer—abdominal or pelvic pain, bloating, difficulty eating, and urinary issues—can be mistaken for other problems. This study examined the time between when women with classic ovarian cancer symptoms went to a physician and when they received a cancer diagnosis in a large database population. The authors found that the time to diagnosis differed according to the type and number of symptoms and what type of physician a woman saw as well as factors such as race, geographic location, and year of diagnosis. Abstract : In this retrospective, population‐based cancer registry database study of 13, 872 women with ovarian cancer, the time between a symptomatic presentation to medical care and a cancer diagnosis differs significantly with the presenting symptom, number of symptoms, physician specialty, and clinical and demographic variables, including significant racial disparities. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to facilitate timely workup and referrals.