Yonsei Med J.  2016 May;57(3):572-579. 10.3349/ymj.2016.57.3.572.

Symptom Interval and Patient Delay Affect Survival Outcomes in Adolescent Cancer Patients

• Jin SL
• Hahn SM
• Kim HS
• Shin YJ
• Kim SH
• Lee YS
• Lyu CJ
• Han JW

• KMID: 2374074
• DOI: http://doi.org/10.3349/ymj.2016.57.3.572

Abstract

PURPOSE
Unique features of adolescent cancer patients include cancer types, developmental stages, and psychosocial issues. In this study, we evaluated the relationship between diagnostic delay and survival to improve adolescent cancer care.
MATERIALS AND METHODS
A total of 592 patients aged 0-18 years with eight common cancers were grouped according to age (adolescents, ≥10 years; children, <10 years). We retrospectively reviewed their symptom intervals (SIs, between first symptom/sign of disease and diagnosis), patient delay (PD, between first symptom/sign of disease and first contact with a physician), patient delay proportion (PDP), and overall survival (OS).
RESULTS
Mean SI was significantly longer in adolescents than in children (66.4 days vs. 28.4 days; p<0.001), and OS rates were higher in patients with longer SIs (p=0.001). In children with long SIs, OS did not differ according to PDP (p=0.753). In adolescents with long SIs, OS was worse when PDP was ≥0.6 (67.2%) than <0.6 (95.5%, p=0.007). In a multivariate analysis, adolescents in the long SI/PDP ≥0.6 group tended to have a higher hazard ratio (HR, 6.483; p=0.069) than those in the long SI/PDP <0.6 group (HR=1, reference).
CONCLUSION
Adolescents with a long SI/PDP ≥0.6 had lower survival rates than those with a short SI/all PDP or a long SI/PDP <0.6. They should be encouraged to seek prompt medical assistance by a physician or oncologist to lessen PDs.

Keyword

Adolescent cancer patients; symptom interval; patient delay

MeSH Terms

Adolescent
Child
*Delayed Diagnosis
Female
Humans
Male
Multivariate Analysis
Neoplasms/classification/*diagnosis/*mortality/psychology
Patient Acceptance of Health Care/*statistics & numerical data
Retrospective Studies
Survival Analysis
Survival Rate
Time Factors

Figure

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  Fig. 1 Symptom interval, patient delay, and physician delay.

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  Fig. 2 Overall survival rate according to the symptom interval (SI) and patient delay proportion (PDP) in all patients (A), adolescents (B), and children (C). No data, patients without patient delay information.

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