Prognostic Significance of Diagnostic Delay and Deprivation in the Management of Upper Gastrointestinal Cancer

To examine the time taken to diagnose upper gastrointestinal (UGI) cancer, identify sources of delay, and assess its prognostic significance. Methods: Prospective study of 150 consecutive upper GI cancer patients presenting to a UK cancer network. Outcome measures were times from onset of symptoms to histological diagnosis, radiological-staging steps, decision to treatment, and whether potentially curative therapy was possible. Results: Total delay consisted of the following components: patient delay (median 12 weeks, 76%); practitioner delay (median 1 day, 1%) and hospital delay (median 25 days, 23%). Overall median delay from onset of symptoms to diagnosis was 15.5 (1-142) weeks. On multivariate analysis the factors influencing patient delay were; gender (HR 1.463, 95% CI 1.038-2.063, p=0.030) and overall deprivation rank (HR 1.000, 95% CI 1.000-1.001, p=0.005). Urgent Suspected Cancer referrals consisted of 94 patients (63%) and were more likely to receive curative treatment (43%) than the 56 patients (37%) referred via Non Urgent Suspected Cancer pathway (25%, p=0.017). Survival was significantly related to overall delay (R=0.210, p=0.010), patients with the shortest delays survived a median 6 (0.25 to 30) months compared with patients with the longest delays who survived for a median 12.5 (0.5 to 32) months. Conclusions: Patient delay accounted for over three quarters of total delay, and deprivation was an important and independent factor in this regard. Improved public awareness and doctor education, with lower thresholds for referral in deprived geographical areas allied to streamlined diagnostic pathways, are required if earlier diagnosis of UGI cancer is to be achieved.