M.D. Alert: Young people often face delays in cancer diagnosis
This study highlights the importance of keeping cancer on the differential when a patient in the adolescent/young adult age range presents with symptoms that are persistent, do not fit the usual pattern, or are difficult to diagnose the source of. . . . Providers need to set up regular follow-up and continue to search for an answer in these cases.
By Lorraine L. Janeczko
Adolescents and young adults may have long delays between the onset of cancer symptoms and being diagnosed, according to data from the UK.
"We have identified subgroups at greater risk of prolonged intervals from symptom onset to presentation and diagnosis, in whom further research and early diagnosis interventions might be additionally targeted to maximise their effectiveness," the authors write in The Lancet Child & Adolescent Health, online January 29.
Senior author Dr. Lorna A. Fern of the Cancer Division of University College Hospitals, London, and colleagues conducted a cross-sectional analysis of the BRIGHTLIGHT cohort. That study involved young people ages 12 to 24 who had been recruited, within an average of 6 months after a new primary cancer diagnosis, from 96 National Health Service hospitals throughout England from July 2012 to April 2015.
Participants completed in-person interviews about their diagnostic experiences. The researchers extracted demographic details from case-report forms, and cancer type and diagnosis date from the national cancer registry.
Of 1,114 participants, 830 completed a face-to-face interview. Among participants with available information, 204 of 748 (27%) waited longer than a month to see a general practitioner (GP) or present to an emergency department. Of 701 who consulted a GP, 242 (35%) had three or more consultations before being referred to a specialist.
Among the 803 interviewed patients, the median interval from symptom onset to diagnosis was 62 days. Compared with males, females were significantly more likely to have three or more pre-referral consultations (adjusted odds ratio, 1.6) and they waited a median of 24 days longer from symptom onset to diagnosis.
Patients with lymphoma or bone tumors were most likely, and those with melanoma were least likely, to have three or more pre-referral consultations.
When lymphoma diagnoses were used as the referent, intervals to diagnosis ranged from a median of 51 days longer in patients with bone tumors and a median of 33 days shorter in patients with leukemia.
Three doctors who were not involved in the study shared their comments with Reuters Health.
Dr. Joy M. Fulbright, associate professor of pediatrics at the University of Missouri-Kansas City School of Medicine and director of the Adolescent and Young Adult Program at Children’s Mercy Kansas City, told Reuters Health by email, "This study highlights the importance of keeping cancer on the differential when a patient in the adolescent/young adult age range presents with symptoms that are persistent, do not fit the usual pattern, or are difficult to diagnose the source of. . . . Providers need to set up regular follow-up and continue to search for an answer in these cases."
"These findings support the importance of providing education . . . in school, during doctors' appointments or at other venues regarding the symptoms of cancer - specifically, of the more common cancers in their age group: skin cancer, lymphoma, germ cell tumors, and sarcomas," advised Dr. Fulbright.
"It is also important to encourage . . . regular well visits,” she said. “Many adolescents and young adults do not go to the doctor regularly because they do not perceive the importance of it, or in the United States, they do not have insurance."
Read the full article via M.D. Linx.
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