Diagnostic delay, clinical stage, and social class: a hospital based study.

Víneis, Paolo; Fornero, G; Magnino, Assunta; Giacometti, R.; Ciccone, Giovannino

doi:10.1136/jech.47.3.229

Cited by 28 publications

(17 citation statements)

References 14 publications

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“…For stomach cancer, the range is 3-51% (Mikulin and Hardcastle, 1987;Haugstvedt et al, 1991;Wile et al, 1993) (70% in our sample). However, some authors cover all non-elective admissions (Holliday and Hardcastle, 1979;Nilsson et al, 1982;Brown et al, 1983;MacArthur and Smith, 1984;Mikulin and Hardcastle, 1987;Fielding et al, 1989;Ratcliffe et al, 1989;Haugstvedt et al, 1991;Porta et al, 1991;Anderson et al, 1992;Hargarten et al, 1992;Vineis et al, 1993;Wile et al, 1993;Curless et al, 1994;Mountney et al, 1994;Mulcahy et al, 1994;Scott et al, 1995) (as in the present study), while others distinguish urgent from true emergencies (Heys et al, 1994;West and Rosen, 1996).…”

Section: Discussionmentioning

confidence: 94%

“…The proportion of colorectal cancer patients with an emergency presentation has been reported to vary from 11% to 50% (Holliday and Hardcastle, 1979;Nilsson et al, 1982;Fielding et al, 1989;Ratcliffe et al, 1989;Porta et al, 1991;Anderson et al, 1992;Hargarten et al, 1992;Vineis et al, 1993;Curless et al, 1994;Heys et al, 1994;Mulcahy et al, 1994;Mountney et al, 1994;Scott et al, 1995). For stomach cancer, the range is 3-51% (Mikulin and Hardcastle, 1987;Haugstvedt et al, 1991;Wile et al, 1993) (70% in our sample).…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, almost half of all patients with cancer first admitted to our hospital did so via the emergency department (63% of first admissions for lung cancer, 28% for breast cancer, 52% for colorectal cancer, 49% for stomach cancer, 55% for liver cancer and 54% for bladder cancer) (Casamitjana et al, 1996). Lower, but nevertheless significant, figures have been reported from other settings (Holliday and Hardcastle, 1979;Nilsson et al, 1982;Fielding et al, 1989;Ratcliffe et al, 1989;Haugstvedt et al, 1991;Anderson et al, 1992;Hargarten et al, 1992;Vineis et al, 1993;Wile et al, 1993;Curless et al, 1994;Heys et al, 1994;Mountney et al, 1994;Mulcahy et al, 1994;Scott et al, 1995). Factors and processes that contribute to this situation may include: a suboptimal integration among levels of care, the 'waiting iceberg' (e.g.…”

mentioning

confidence: 92%

“…With few exceptions, analyses of diagnostic delay in cancer commonly neglect that patients are often admitted to hospital through an emergency department (Holliday and Hardcastle, 1979;Nilsson et al, 1982;MacArthur and Smith, 1984;Ratcliffe et al, 1989;Haugstvedt et al, 1991;Porta et al, 1991;Vineis et al, 1993).…”

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confidence: 99%

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Emergency admission for cancer: a matter of survival?

Porta

Fernández²,

Belloc³

et al. 1998

Br J Cancer

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Summary The objective of this study was to compare the pre-hospital health care process, clinical characteristics at admission and survival of patients with a digestive tract cancer first admitted to hospital either electively or via the emergency department. The study involved crosssectional analysis of information elicited through personal interview and prospective follow-up. The setting was a 450-bed public teaching hospital primarily serving a low-income area of Barcelona, Catalonia, Spain. Two hundred and forty-eight symptomatic patients were studied, who had cancer of the oesophagus (n = 31), stomach (n = 70), colon (n = 82) and rectum (n = 65). The main outcome measures were stage, type and intention of treatment and time elapsed from admission to surgery; the relative risk of death was calculated using Cox's regression. There were 161 (65%) patients admitted via the emergency department and 87 (35%) electively. The type of physician seen at the first prehospital visit had more often been a general practitioner in the emergency than in the elective group (89% vs 75%, P < 0.01). Emergency patients had seen a lower number of physicians from symptom onset until admission, but two-thirds had made repeated visits to a primary care physician. Emergency patients were less likely to have a localized tumour and a diagnosis of cancer at admission, and surgery as the initial treatment. Median survival was 30 months for elective patients and 8 months for emergency patients (P < 0.001), and the relative risk of death (RR) was 1.83 (95% confidence interval, Cl, 1.32-2.54). After adjustment for strong prognostic factors, emergency patients continued to experience a significant excess risk (RR = 1.58; Cl 1.10-2.27). In conclusion, in digestive tract cancers, admission to hospital via the emergency department is a clinically important marker of a poorer prognosis. Emergency departments can only partly counterbalance deficiencies in the effectiveness of and integration among the different levels of the health system.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 92%

mentioning

confidence: 99%

See 2 more Smart Citations

Emergency admission for cancer: a matter of survival?

Porta

Fernández²,

Belloc³

et al. 1998

Br J Cancer

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show abstract

“…Furthermore, there was no relationship between delay and lower socioeconomic status (Hackett et al, 1973;Worden and Weisman, 1975;MacAdam, 1979;MacArthur and Smith, 1984;Samet et al, 1988;Prohaska et al, 1990;Porta et al, 1996;Langenbach et al, 2003), although some studies suggested that this might be associated with increased delay. Rural residence (Robinson et al, 1986;Bain et al, 2002) and lower levels of education (Marshall and Funch, 1986;Dent et al, 1990;Vineis et al, 1993;Porta et al, 1996;Mariscal et al, 2001;Cockburn et al, 2003;McCaffery et al, 2003) were both found to increase delay.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

et al. 2007

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Colorectal cancer is a major global health problem, with survival varying according to stage at diagnosis. Delayed diagnosis can result from patient, practitioner or hospital delay. This paper reports the results of a review of the factors influencing pre-hospital delay -the time between a patient first noticing a cancer symptom and presenting to primary care or between first presentation and referral to secondary care. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Fifty-four studies were included. Patients' non-recognition of symptom seriousness increased delay, as did symptom denial. Patient delay was greater for rectal than colon cancers and the presence of more serious symptoms, such as pain, reduced delay. There appears to be no relationship between delay and patients' age, sex or socioeconomic status. Initial misdiagnosis, inadequate examination and inaccurate investigations increased practitioner delay. Use of referral guidelines may reduce delay, although evidence is currently limited. No intervention studies were identified. If delayed diagnosis is to be reduced, there must be increased recognition of the significance of symptoms among patients, and development and evaluation of interventions that are designed to ensure appropriate diagnosis and examination by practitioners.

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Cancer mortality by educational level in Italy

Faggiano

Lemma

Costa

et al. 1995

Cancer Causes Control

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Social differences in health concern both ethics and science. From a public health point-of-view, one must assess actual differences and then try to find explanations. This was made possible for the first time for cancer in Italy via nationwide record-linkage between the 1981 census and the national death index. Over the subsequent six months after census, the study-base included 31,000 deaths for cancer and 18 million person-years at risk. Rate ratio (RR) were estimated through a Poisson regression model adjusted by age and geographic area of residence. Educational level was used as social level indicator. Profound social differences were evident for buccal cavity (RR = 3.10 for lowest cf highest educational level), esophagus (RR = 3.00), stomach (RR = 3.43), and larynx (RR = 3.30) among men, and for stomach (RR = 2.25) and uterus (RR = 1.76) among women. Colon (RR = 0.62) and pancreas cancers (RR = 0.65) presented an inverse relationship among men, as did colon (RR = 0.37), breast (RR = 0.56), ovary (RR = 0.45), and melanoma (RR = 0.62) among women. In conclusion, the Italian population at the beginning of the 1980s had large social differences in the risk of dying from cancer, confirming the patterns commonly found in such other countries as Great Britain, France, and New Zealand. Some dissimilarities, useful for hypothesis generation on the mechanisms of inequality, were evident, such as the generally highest social differences found among northern Italian men and among southern Italian women.

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Diagnostic delay, clinical stage, and social class: a hospital based study.

Cited by 28 publications

References 14 publications

Emergency admission for cancer: a matter of survival?

Emergency admission for cancer: a matter of survival?

Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review

Cancer mortality by educational level in Italy

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