Introduction:
Cancer mortality rates are increasing day by day in both developing and developed countries. It is expected to increase at a rate of 13 million deaths annually in 2030. Early diagnosis of cancer, can however decrease the death toll. Delayed diagnosis of cancer can occur due to failure in the patient’s recognition of symptoms, or a delay in primary and secondary care. In cases of atypical cancer symptoms, patients’ failure to recognize the symptoms can also lead to a delayed diagnosis. Poor public awareness has also been a contributing factor to the late diagnosis of cancer, which increases mortality rates. Other barriers to the identification of cancer include patients being hesitant to visit the doctor, fear of diagnosis of chronic disease in hospitals, and patients being too busy to make an appointment with the doctor.
What Are the Factors Contributing to a Delayed Cancer Diagnosis?
Several delays can occur in the diagnostic pathway due to these three main components:
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Patient Delay: Period from symptom recognition to initial consultation with a primary care physician, or a general physician.
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Doctor Delay: Period lasting from the initial consultation with the primary care physician and the initiation of the investigations in case of cancer-related symptoms. The investigations include X-ray, mammography, ultrasound, blood count, hormonal assay, bone scan, CT (computed tomography) scan, MRI (magnetic resonance imaging), FNAC (fine needle aspiration cytology), needle biopsy, etc.
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System Delay: Time from the start of investigations to the start of treatment protocols.
Due to two main components that exist in patients, a delayed diagnosis can also occur:
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Symptom Appraisal: Period from noticing a bodily change and deciding on whether the patient needs to address the symptoms to a physician.
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Help-Seeking: Period from understanding the need to discuss symptoms with a doctor to the initial consultation.
How Does Primary Care Affect Delayed Cancer Diagnosis?
Primary care is the first point of contact for patients using health services. A delay in the recognition of cancer symptoms, and a delay in the referral of the patients who are suspected to be affected can result in a delayed cancer diagnosis. More than 80 % of primary care physicians fail to diagnose cancer at its early stages as many individuals are asymptomatic. There is also an ongoing difficulty faced by primary care doctors to identify patients who need urgent medical care and attention. There can be confusion about cancer in certain self-limiting conditions in the majority of patients. Many cancer-related symptoms that are alarming can also be due to common chronic medical conditions.
Certain patients do not regularly follow up, and they visit foreign countries for further check-ups, which can also contribute to the delay in treatment. This will also lead to a serious lack of continuity in medical care. Continuity of care with a specific doctor has improved the early diagnosis of cancer and swift intervention. This can be promoted by limiting the access of primary care physicians in case of non-urgent conditions. Diagnostic delay can occur as patients have to undergo a number of invasive and non-invasive procedures and investigations to conclude the diagnosis. Delays in treatment can occur due to delayed diagnosis.
What Are the Government Interventions in Delayed Cancer Diagnosis?
In Oman, the Ministry of Health, developed guidelines for the early detection of cancer and screening for breast cancer in 2010. A policy has been adopted by the UK government, which states that patients who are suspected of having cancer symptoms, need to be referred to a cancer specialist within two weeks. In the UK, national screening is made available for certain types of cancer, including colorectal, breast, and cervical cancers. Screening can, however, identify only 10 % of cancer patients. Using the two-week wait system, most of the patients suspected of having cancer symptoms are offered urgent investigation with guaranteed medical specialist inputs.
Guidance from the National Institute for Health and Care Excellence (NICE) is used for the selection of patients for the two-week wait system. Other patients with atypical symptoms or low-risk patients are however seen in routine care and are not recommended for urgent referral. In Pakistan, cancer awareness and population screening programs are available to a limited number of urban populations.
How Does COVID Affect Delayed Cancer Diagnosis?
Due to the pandemic, adult and elderly patients have reduced seeking medical care and this has increased during the lockdown period. The UK National Health Service has also shifted its focus to COVID-affected patients, and therefore, the cancer screening protocol was suspended in 2020. After this pandemic, many patients prefer telephonic consultation, and the two-week referrals have been reduced. In breast cancer, an early diagnosis is possible as the patients can identify a visible lump immediately and report it to the doctor. But in other cancers, patients find it difficult to perceive the symptoms, and thereby there is a delay in reporting it to the doctor. There was another difficulty, being the estimation of COVID infection in patients suspected of having cancer who received hospital investigations.
How to Overcome the Barriers to Delayed Cancer Diagnosis by the People?
Undoubtedly, cancer diagnosis and treatment should be carried out without delay. Early diagnosis can help identify cancer at a treatable stage and thereby prevent further fatal complications. Certain non-governmental organizations across the world, work to increase public awareness through community-based educational programs. It involves educating about the early symptoms of cancer, self-examination of cancer like breast cancer, and the need for timely intervention is made aware of. Using social media like broadcasts on television, newspapers, live lectures, and seminars can help improve awareness among the general public. Implementation of a curriculum in schools that includes education pertaining to cancer prevention and risk factors for cancer can help.
People should be aware of the common symptoms of cancer, like:
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Unexplained bruising or bleeding.
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Fatigue.
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Unexplained lump or thickening of an area.
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Sudden swelling.
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Difficulty swallowing.
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Unhealing sores.
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Unexplained pain.
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Persistent unexplained muscle or joint pain.
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Cough or hoarseness for a chronic period.
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Changes in the appearance of a mole.
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Persistent fevers and unexplained night sweats.
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Unexplained weight changes both weight loss and gain.
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Change in bowel and bladder movements.
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Persistent indigestion and discomfort after eating.
Conclusion:
An early cancer diagnosis has helped improve the lifespan of individuals. In summary, a delayed cancer diagnosis can occur at various levels in the diagnostic pathway. Hence, the public should be made aware of cancer symptoms through social media. Primary care physicians should be notified of the alarming symptoms of cancer. They should also be instructed to promote continuity of care, and an immediate referral to the specialist should be made. These all can help overcome the difficulties of delayed diagnosis and improve the patient’s quality of life.
