The Symptom-to-Treatment Delay And Stage At The Time Of Treatment In Cancer Of Esophagus

Objective:The symptom-to-treatment delay is a highly complex variable that reflects the behavior of the patient and the physician,tumor biology,the function of the health care system,and sociocultural norms.It is a longlasting and general problem in medical practice.The main purpose of this investigation was to measure the delay from the first symptoms to treatment in esophageal cancer and to analyze the relation between the delay and stage at the time of treatment.Patients and Methods:A total of 80 patients who were consecutively found to have esophageal cancer between 1 January 2007 and 30 July 2007 at Qilu Hospital of Shandong University in Jinan(China)were included in the retrospective study.Dates were recorded according to the patients' recollection,written information contained in the doctors' records during the diagnosis process and the patients' hospital files.Two groups of patients were compared,one group with good prognosis(patients in StagesⅠandⅡ)and the other group with poor prognosis(patients in StagesⅢandⅣ).The symptom-to-treatment delay between the two patient-groups was compared using the Mann-Whitney U test.The relationship of symptom-to-treatment delay or delay from the appearance of first symptoms to first contacting the health-care system with anatomical subsites,histological types or histopathological differentiations was also analyzed.Results:The median symptom-to-treatment delay was 2.1 months(range from 0.5 to 24).Twenty nine percent had a delay of more than 3 months,19%more than 4 months,and 11%more than 6 months.The total symptom-to-treatment delay was made up the following components:(a)delay from the first symptoms to first contacting the health-care system(69%);(b)delay from first contacting the health-care system to histological diagnosis of esophageal cancer(20%);(c)delay from histological diagnosis to end point(11%).A significantly shorter median symptom-to-treatment delay was found for patients with StagesⅠandⅡcompared to StagesⅢandⅣ(P=0.0177).No significant difference was found in the comparison of delays in patients with different anatomical subsites,histological types or histopathological differentiations(P＞0.05).Conclusions:Long delays still occur in patients with esophageal cancer.A few months' delay before final treatment of esophageal cancer may have an impact on the stage of the cancer,and thereby on the patients' prognosis.Shortening the delay may result in early detection of esophageal cancer.A series of method may be applied to shorten the delay,including education of the public,improving skills of doctors in diagnosis and treatment and expanding the coverage of medical insurance.