Time from Symptom Onset to Diagnosis and Treatment among Haematological Malignancies: Influencing Factors and Associated Negative Outcomes

Abstract

Background and objectives: Diagnostic delay causes unfavorable outcomes among cancer patients. It has been widely analyzed in solid tumors. However, data regarding hematological malignancies diagnostic delay are scarce. We aimed to evaluate diagnostic intervals, their influencing factors, and the negative effect on clinical outcomes among multiple myeloma and lymphoma patients. Materials and methods: One hundred patients diagnosed with multiple myeloma (n = 53) or lymphoma (n = 47) (ICD codes—C90, C81–C84) were asked to participate during their scheduled hematology consultations. Interval durations and the majority of influencing factors were assessed based on a face-to-face questionnaire. Data of disease characteristics were collected from medical records. Results: The median interval from symptom onset to registration for medical consultation was 30 (0–730) days, from registration to consultation 2 (0–30) days, from first consultation to diagnosis 73 (6–1779) days, and from diagnosis to treatment 5 (0–97) days. Overall time to diagnosis median was 151 (23–1800) days. Factors significantly prolonging diagnostic intervals in multivariate linear regression were living in big cities (p = 0.008), anxiety and depression (p = 0.002), self-medication (p = 0.019), and more specialists seen before diagnosis (p = 0.022). Longer diagnostic intervals resulted in higher incidences of multiple myeloma complications (p = 0.024) and more advanced Durie-Salmon stage (p = 0.049), but not ISS stage and Ann-Arbor staging systems for lymphomas. Conclusion: Median overall diagnostic delay was nearly 5 months, indicating that there is room for improvement. The most important factors causing delays were living in big cities, anxiety and depression, self-medication, and more specialists seen before diagnosis. Diagnostic delay may have a negative influence on clinical outcomes for multiple myeloma patients.

What causes delays in diagnosing blood cancers? A rapid review of the evidence

“…demographics) included in the model and delayed/not delayed as the dependent variable. One study used linear regression and therefore continuous measure of delay (Dapkevičiūtė et al, 2019). One study used the interval from symptom onset to presentation at primary care, using a 3-month threshold to define delay (Howell et al, 2015).…”

“…(3) Mild or chronic illness Patients and/or their parents often explained symptoms by relating them to a known mild illness or non-serious condition such as viruses or bad back. Around half of the blood cancer patients assumed that their initial symptoms would resolve on their own (Dapkevičiūtė et al, 2019). One of the key challenges with symptoms of blood cancer is that there were multiple plausible explanations depending on the individual's circumstances (Molassiotis et al, 2010).…”

“…Multiple myeloma may incur longer delays than non-Hodgkin's lymphoma or Hodgkin's lymphomaDapkevičiūtė et al (2019)) Hodgkin's lymphoma can also be a predictor for delay compared to non-Hodgkin's lymphomaAntel et al (2019) Patients with chronic myeloid leukaemia may wait longer than patients with other blood cancer types to visit a doctorHowell et al (2015) Patient characteristics Patients who experienced delayed diagnosis of multiple myeloma were on average 1 year older Friese et al (2009) Black patients are more likely to have delayed diagnosis than white patients in multiple myeloma Friese et al (2009) Women are more likely to have a delayed diagnosis than men in multiple myeloma Friese et al (2009) Patients with co-morbidities are more likely to have a delayed diagnosis than patients without co-morbidities in multiple myeloma Friese et al (2009) Having three or more children is associated with greater diagnostic delay in leukaemia Lins et al (2012) Having a birth order of third or greater is associated with diagnostic delay in leukaemia Lins et al (2012) Health system factors Locum GP visit associated with delay Gibson et al (2013) Patients who are acutely ill are more likely to be referred Gibson et al (2013); Howell et al (2015) Plasma viscosity and erythrocyte sedimentation rate are the most indicative tests for myeloma Koshiaris et al (2018a); Koshiaris et al…”

Haematological malignancies implications during the times of the COVID‑19 pandemic (Review)

“…These methods exhibit high cost and complexity while also being highly time-consuming (41). Furthermore, patients themselves might complicate diagnosis based on their ability to understand their symptoms and react accordingly (42). Therefore, early diagnosis provides numerous challenges for both patients and clinicians.…”

Haematological Malignancies in Nigeria: Challenges in Diagnosis and Management – A Systematic Review.

“…For those who successfully completed the recommended 20 regimen, family income are depleted. The outcomes in hematologic malignancies can vary by time of presentation, stage of the disease at presentation, type of the disease, other co-morbidities, availability and quality of diagnostic facilities, availability of qualified manpower, availability and affordability of drugs, availability and access to palliative and supportive 21,22 medical care. In Nigeria there is a wide gap between cancer burden and a comprehensive cancer control program, with inadequate provision for accurate diagnosis, chemotherapy, radiotherapy and palliative/ supportive care.…”