Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review

Lee, Amanda J; Khulusi, S.; Watson, Roger

doi:10.1111/jan.13308

Cited by 10 publications

(7 citation statements)

References 48 publications

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“…The study confirms the median age of 64.4 for symptom onset for oesophageal cancer with no oesophageal cancer cases seen below 43 years. This is consistent with the majority of other epidemiological studies 14–17 . In contrast, gastric cancer peaked in the older 70–79 age group, with a median age of 69.6 years, and appears more unpredictable in age onset, with one case occurring in the third decade.…”

Section: Discussionsupporting

confidence: 91%

Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria

Kumar

Kholmurodova

Bull

et al. 2021

ANZ Journal of Surgery

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Background The objective of the study is to identify differences in epidemiology and clinical presentation between oesophageal and gastric cancer and to evaluate the sensitivity of the Australian urgent endoscopy referral guidelines. Methods Design; Observational cohort study from February 2013 to October 2018. Setting: A single tertiary specialist oesophago‐gastric cancer centre: Flinders Medical Centre, South Australia. Participants: Patients with oesophageal and gastric cancer that had surgery with curative intent 61.9% oesophageal cancer, 38.1% gastric cancer. Main outcome measures: Differences between oesophageal and gastric cancer in terms of demographical variables, first presenting symptoms and sensitivity of the Australian urgent endoscopy referral guidelines. Results Oesophageal cancer presented at a median age of 64.4 years old, with a male: female ratio of 6:1, and dysphagia as the first presenting symptom in 61%. Gastric cancer presented at a median age of 69.5, with a 2:1 male: female ratio and predominantly non‐specific symptoms—blood loss (36%), weight loss, nausea, and anorexia (21%) and epigastric pain (13%). The Australia urgent endoscopy referral guidelines had 76% sensitivity for oesophageal cancer detection compared with a 33% sensitivity for gastric cancer in this cohort. Delays from symptom onset to referral occurred for most patients with timeframes over four times the recommended 2‐week timeframe. Conclusion There should be a separate urgent referral guideline for oesophageal and gastric cancer. These should include dysphagia for oesophageal cancer and blood loss (anaemia, haematemesis, melaena) for gastric cancer. Delays from symptom onset to referral indicate the need for further education of the public and general practitioners on symptoms warranting urgent referral.

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Section: Discussionsupporting

confidence: 91%

Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria

Kumar

Kholmurodova

Bull

et al. 2021

ANZ Journal of Surgery

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“…According to the literature, shortening the patient interval is probably most vital to reduce delay in the diagnostic pathway of gastroesophageal cancer. 7,8 In gatekeeper systems like that in the Netherlands, patients have to visit a general practitioner (GP) first and GPs can refer patients to secondary care if needed. Most patients with UGI cancer will therefore initially present with symptoms in primary care.…”

Section: Introductionmentioning

confidence: 99%

Time to diagnosis of symptomatic gastric and oesophageal cancer in the Netherlands: Where is the room for improvement?

et al. 2020

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Background An efficient diagnostic pathway and early stage diagnosis for cancer patients is widely pursued. This study aims to chart the duration of the diagnostic pathway for patients with symptomatic oesophageal and gastric cancer, to identify factors associated with long duration and to assess the association of duration with tumour stage at diagnosis. Methods This was a retrospective cohort study, using electronic health records of six routine primary care databases covering about 640,000 patients, partly linked to the Netherlands Cancer Registry. Symptomatic patients with oesophageal and gastric cancer (2010–2015) that presented in primary care were included. Duration of four diagnostic intervals was determined: patient interval; first symptoms to primary care consultation, primary care interval; consultation to referral, secondary care interval; referral to diagnosis, and the diagnostic interval; consultation to diagnosis. Characteristics associated with ‘long duration’ (≥P75 duration) were assessed using log-binomial regression. Median durations were stratified for tumour stages. Results Among 312 symptomatic patients with upper gastrointestinal cancer, median durations were: patient interval: 29 days (interquartile interval 15–73), primary care interval: 12 days (interquartile interval 1–43), secondary care interval: 13 days (interquartile interval 6–29) and diagnostic interval: 31 days (11–74). Patient interval duration was comparable for patients with and without alarm symptoms. Absence of cancer-specific alarm symptoms was associated with ‘long duration’ of primary care interval and secondary care interval: relative risk 5.0 (95% confidence interval 2.7–9.1) and 2.1 (95% confidence interval 1.3–3.7), respectively. Median diagnostic interval duration for local stage disease was 51 days (interquartile interval 13–135) versus 27 days (interquartile interval 11–71) for advanced stage ( p = 0.07). Conclusion In the diagnostic pathway of upper gastrointestinal cancers, the longest interval is the patient interval. Reducing time to diagnosis may be achieved by improving patients’ awareness of alarm symptoms and by diagnostic strategies which better identify cancer patients despite low suspicion.

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“…In practice, however, patients with oesophageal cancer frequently arrived late in presentation and commonly referred late to the appropriate health facilities. In addition, literature also showed that shortening the time to presentation is an important step in reducing late diagnosis, and improving the prognosis and survival of patients with oesophageal cancer 12 13…”

Section: Introductionmentioning

confidence: 99%

“…In addition, literature also showed that shortening the time to presentation is an important step in reducing late diagnosis, and improving the prognosis and survival of patients with oesophageal cancer. 12 13 …”

Section: Introductionmentioning

confidence: 99%

Time intervals from first symptom recognition to pathological diagnosis among patients with oesophageal cancer in Ethiopia: a cross-sectional study

et al. 2022

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ObjectiveThe aim of this study was to estimate the time intervals from first symptom recognition to pathological diagnosis among patients with oesophageal cancer in Ethiopia.MethodsDesignA cross-sectional study design was employed.Settings and participantsPatients with oesophageal cancer aged ≥18 years were included from Addis Ababa, Ethiopia (n=338) from February 2019 to August 2020. The participants were selected consecutively from six health facilities that provided cancer care nearly for 90% of patients.Main outcomes and measurementsThe Aarhus statement criteria were applied to classify patient intervals (time from first symptom recognition to presentation) and diagnostic intervals (time from first presentation to diagnosis). Patient and diagnostic intervals >60 and >30 days were considered as delays, respectively. For tumour classification, the American Joint Committee on Cancer was used. Data were analysed using SPSS V.24. Descriptive statistics were applied to describe patients’ characteristics. Poisson regression with robust variance was used to compute prevalence ratios. In all statistical tests, significance was declared at a p value of <0.05.ResultsThe mean (SD) age of the participants was 54.30±12.49 years.Approximately 78% of study participants had never heard of oesophageal cancer and thought they had gastritis. Dysphagia was the commonly mentioned symptom. About 76% of the cases were diagnosed at advanced stages (III and IV). Median patient interval was 108.5 (60.5–215) days and median diagnostic interval was 77.5 (39–133) days. After adjusting confounders, being single and unawareness of oesophageal cancer had association with consultation delay; cost of transportation and medical consultation had association with diagnostic delay; and patient delay of >2 months had association with late-stage diagnosis.ConclusionPatients with oesophageal cancer in Ethiopia had prolonged patient and diagnostic intervals. Increasing awareness of symptoms of oesophageal cancer and shortening time to diagnosis will help to improve the outcome of oesophageal cancer care in Ethiopia.

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Which interval is most crucial to presentation and survival in gastroesophageal cancer: A systematic review

Abstract: Further research into the patient interval is required to elicit information on how and why patients present with their cancer symptoms.

Cited by 10 publications

References 48 publications

Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria

Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria

Time to diagnosis of symptomatic gastric and oesophageal cancer in the Netherlands: Where is the room for improvement?

Time intervals from first symptom recognition to pathological diagnosis among patients with oesophageal cancer in Ethiopia: a cross-sectional study

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