Socioeconomic and administrative factors associated with treatment delay of esophageal and gastric carcinoma: Prospective study from a tertiary care centre in a developing country. (August 2020)

• Record Type: Journal Article
• Authors: Lokanatha, D.; Hassan, Syed Adil; Jacob, Linu Abraham; Suresh Babu, M.C.; Lokesh, K.N.; Rudresha, A.H.; Rajeev, L.K.; Saldanha, Smitha; Thottian, Antony G.F.
• Is Part Of: Cancer epidemiology. Volume 67(2020:Aug.)
• Publication Date: 2020-08
• Subjects: Esophageal cancers -- Gastric cancer -- Delay in treatment -- Administrative delay -- Socioeconomic status; Cancer -- Epidemiology -- Periodicals; Cancer -- Prevention -- Periodicals; Cancer -- Diagnosis -- Periodicals; Carcinogenesis -- Periodicals; 616.994005
• DOI: 10.1016/j.canep.2020.101770
• Languages: English
• ISSNs: 1877-7821

Abstract

Highlights: Median time interval from onset of first symptoms to start of treatment in our study population was 15 weeks. Per capita income and educational level of the patient significantly influence the Prehospital delay. Community oriented approaches and administrative changes are required to reduce delay. Abstract: This study was aimed to analyze the spectrum of time intervals, from the onset of symptoms to the commencement of treatment in esophagogastric cancers. Factors influencing these time delays and correlation between these time points with variables including socioeconomic strata, educational level, histopathology, location of tumor and the initial modality of treatment were assessed. Study setting and methods: A prospective analysis of patients with esophagogastric cancer presenting to a single tertiary care unit over a period of 12 months was performed. Histopathology other than adenocarcinoma and squamous cell were excluded. Results: 202 patients were enrolled in the study. Most patients presented with advanced disease, i.e. 91.5 % of esophageal and 90 % of gastric malignancies belonged to either stage 3 or stage 4 as per American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The median delay from the appearance of the first symptoms to initiation of treatment was 15 weeks (range 4–64). Patient related factors contributed to a significant delay [median of 5 weeks (range 1−24)]. Administrative factors were responsible for median delay of 3 weeks (range 0.5−20). Curative multimodality treatment was administered in 62.5 % of patients. Significant longer delay was influenced by socioeconomic strata, educational level, evaluation by non-specialist (p < 0.05). No relationship was noted between histopathology, location of tumor or initial modality of treatment. Conclusions: Delays in our setting is much more than that is seen in Western and even some Asian countries. An important component of delay is administrative related factors. These may be intervened at the hospital level compared to other factors which may need long term community oriented approaches.