Diagnostic delay, quality of life and patient satisfaction among women diagnosed with endometrial or ovarian cancer: a nationwide Danish study.

BACKGROUND: This study investigates the association between diagnostic delay (total delay), quality of life (QoL) and patient satisfaction, and the associations between QoL and patient satisfaction scores and survival for women diagnosed with ovarian or endometrial cancer. METHODS: A questionnaire survey was conducted among 723 women diagnosed with ovarian or endometrial cancer from 2006 to 2007; 453 women were chosen to participate in the study. Data on total delay (number of weeks between first cancer symptom and initiation of treatment) were available from 353 women. RESULTS: Experiencing longer total delay was associated with reduced overall QoL and appetite loss among ovarian cancer patients, while longer total delay was associated with reduced overall QoL, reduced role and social functioning, and increased fatigue, insomnia and constipation among endometrial cancer patients. Likewise, longer total delay was associated with decreased patient satisfaction for both cancer types. For survival and QoL scores, worse scores for pain were statistically significantly associated with reduced survival for women diagnosed with ovarian cancer, while reduced overall QoL, physical, role and emotional functioning as well as increased nausea and vomiting, pain, dyspnoea and appetite loss were associated with reduced survival for women diagnosed with endometrial cancer. For survival and patient satisfaction, associations were not significant when adjusted for diagnosis, age, cancer stage and radicality of operation. CONCLUSIONS: We found that few QoL measures were associated with total delay and survival for ovarian cancer, while a number of associations were found between QoL, total delay and survival for endometrial cancer patients. This supports the hypothesis that long total delay may influence QoL and survival for some cancer patients. Reduced patient satisfaction with the diagnostic phase was also statistically significantly associated with long total delay, highlighting that total delay is an important component in patients' evaluation of the care they receive.

Diagnostic delay experienced among gynecological cancer patients: a nationwide survey in Denmark.

OBJECTIVE: To examine diagnostic delay among gynecological cancer patients. DESIGN: Nationwide study. SETTING: The cohort comprised all women receiving their first treatment for cervical, endometrial, or ovarian cancer between 1 October 2006 and 1 December 2007 in four of the five centers for gynecological cancer surgery in Denmark. SAMPLE: Of the 911 women alive, 648 participated, resulting in a response rate of 71.1%; of these, 30.1% were diagnosed with cervical cancer, 31.0% with endometrial cancer, and 38.9% with ovarian cancer. METHODS: Questionnaire survey. MAIN OUTCOME MEASURES: Diagnostic delay calculated as total delay, patient delay, general practitioner referral delay, gynecologist appointment delay, and secondary care delay. RESULTS: Diagnostic delays were found in all parts of the diagnostic pathway. Total diagnostic delay has remained long with a median delay of 12 weeks from the time patients experience symptoms until the time they receive treatment; the 10% experiencing the longest delay wait for >41 weeks. For all types of delay, distributions were non-normal. This indicates that the greatest potential for optimizing clinical outcomes may be among the minority of patients experiencing very long delays. Ovarian cancer patients experienced significantly shorter delays compared with other gynecological cancer patients in all parts of the health care system. CONCLUSIONS: Delays occur in all parts of the diagnostic process, suggesting that a multifaceted approach should be adopted with special focus on reducing the very long delays experienced by some patients. By reducing the total diagnostic delays, outcomes such as three-year survival rates can potentially be improved.