A Study on Factors Associated with Primary and Secondary Delays in the Diagnosis of Cancer Patients and Related Models
by
S. N. Dwivedi
Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
Coauthors: Alok Kumar Dwivedi, S.V.S Deo, Arvind Pandey

Objectives: The delay in diagnosis of cancer patients is one of the major public health issues in developing as well as in developed countries. This may consist of primary and secondary delays. The primary delay is mainly attributed with patients related factors and secondary delay with both patients as well as clinicians related factors. Therefore, this presentation aims to find out factors associated with primary and secondary delay separately.

Data and Methodology: This is a cross sectional study. Only new cancer patients were included in the study but recurrence cases were excluded. The data was collected by one of the authors (AKD) in the Department of Surgical Oncology, Institute Rotary Cancer Hospital (IRCH), AIIMS, New Delhi during 2006-2007.The data collection was carried out through semi-structured questionnaire. The Mann Whitney and Kruskal Wallis tests were used to assess the association of individual factors with each delay. Finally, generalized linear regression and quantile regression were used to find out the factors associated with primary and secondary delays respectively.

Results: A total of 360 cancer patients could be included in the analysis. There were 65(18.1%) head and neck, 122(33.9%) breast, 70 (19.4%) gastro-intestinal tract, 38(10.6%) genitor urinary, 32(8.9%) extremity and 33(9.9%) miscellaneous cancer patients. The mean age of the patients at presentation was 48.35(Range 14-85) years. The median and inter quartile range of primary and secondary delays was 30(IQR: 3,90) and 32(IQR: 8,120) days respectively. The factors mainly lack of awareness, economical problem, and type of cancer were associated with both primary and secondary delays. In addition, contacting non-medical person prior to medical person and family related problems were also associated with primary delay whereas long symptomatic treatment and inappropriate diagnosis with secondary delay.

Conclusion: The dissemination of knowledge about in time diagnosis is required for both patients as well as doctors.

Date received: January 12, 2008