Time Lag to Diagnosis of Bladder Cancer–Influence of Psychosocial Parameters and Level of Health-Care Provision

Abstract

Delay in diagnosis of carcinoma of the urinary bladder was studied in 343 patients. The median patient's delay (time from first symptom to first consultation) was 15 days, and was longer when the only presenting symptom was urgency of micturition than when it was haematuria (45 vs. 5 days, p < 0.001). In advanced (T2-T4) tumour, patient's delay was 21 days and in Ta-T1 it was 13 days (NS). The median doctor's delay (time from first consultation to diagnosis) was 62 days. It comprised two phases: A from consultation to first referral and B from first referral to diagnosis-respective medians 6 and 47 days. Median doctor's delay (A+B) was longer when the initial consultation was with a general practitioner than with a urologist (78 vs. 21 days, p < 0.001) and longer in patients older than 70 years (69 vs. 54 days, p < 0.01). Doctor's delay correlated with symptoms, being longest in cases with only urgency and shortest in haematuria plus pain (114 vs. 44 days, p < 0.001), and also with number of referrals (33, 63, 230 and 117 days, respectively, for 0, 1, 2 and 3 referrals). More women than men were referred a second or third time (25.6% vs. 8.6%, p < 0.001), and doctor's delay was longer for women (76 vs. 59 days, p < 0.05). A questionnaire completed by 203 of the 229 surviving patients revealed no significant correlation between psychosocioeconomic factors and patient's delay.

Diagnostic delay and prognosis in invasive bladder cancer

“…In a previous study (13), data derived from all 393 cases of bladder cancer in the Southern Swedish Health Care Region notified to the population-based Regional Tumour Register in 1988 were analysed. Fifty patients in whom clinical records revealed non-malignant disease, prostate cancer instead of bladder cancer, recurrent bladder cancer, missing data or a pathologist's report dated 1989 were excluded.…”

Quality of life after radical cystectomy and orthotopic bladder substitution: a comparison between Italian and Swedish men

“…A dichotomous response scale (yes/no) was used for responses to 26 of these questions and a visual analogue scale (VAS) (of 0±10) for seven, with 0 indicating very easy, very good or none/not at all and 10 very dif®cult, very poor/low or very much. Although not formally tested for validity and reliability, use of this questionnaire was guided by experience from previous clinical studies of patients after cystectomy for bladder cancer [7,9,15,16].…”

Gender Differences in Pathologic Outcomes At Primary Bladder Cancer Detection

“…Erkek hastalarda hematüri meydana geldiğin-de hızlıca sistoskopik inceleme ile mesane değerlen-dirilirken, kadın hastalarda idrar yolu infeksiyonuna yorumlanıp sistoskopik inceleme daha sonraki basamaklara ötelenebilmektedir (7,10) . Bir İsveç çalışma-sında ani sıkışma hissi ve hematürisi olan kadın hastaların üroloğa sevkinin geciktiğini ve bundan dolayı ilk tanı anında kadınların daha ileri evre mesane kanseri tanısı aldığını göstermiştir (11) . Başka bir makalede ise, hematüri ile başvuran hastalarda cinsiyet farklılığına bağlı üroloğa sevkinde gecikme olmadığı gösterilmiştir (7) .…”