Objective: Diagnostic and treatment delays can be reduced to improve the prognoses of the cancer patients. A limited number of studies have carried out regarding delays in diagnosis and treatment of cancer patients in developing countries. We performed a deep study from 2016 to 2017 for evaluating multiple components of delay time at different stages experienced by the cancer patients. This study aims at exploring treatment delay among the cancer patients in Lahore and nearby areas of Lahore (Pakistan) using Qualitative and Quantitative strategies and an effort has been made to develop a practical approach to facilitate the clinicians to reduce the delay in diagnosis and treatment of cancer.
Patients and Methods: In this study, we prepared a particular questionnaire and interviews were made from 673 patients to determine which factors were responsible for the total delay in treatment of cancer. We considered six time intervals which include: Patient delay interval (the time from first noticing the symptoms to visit a hospital): Referral delay interval (the time between referring the patients to different hospitals and doctors): Oncologist delay interval (the time from the assessment by an oncologist to diagnosis of the cancer): Treatment delay interval (the time from diagnosis of the disease to treatment started): System delay interval (the time from first medical contact to the start of the treatment): Total delay interval (the time from noticing symptoms to the start of the cancer treatment). We calculated the means, medians, 25th and 75th percentiles of the delays in days among different groups of patients by using SPSS version 20.0 and obtained the Ethical approval from all the participating centers.
Results: Mean age of the patients at the time of diagnosis was 37.6 years. Males to females ratio was 0.65 where 39.4% were male patients and 60.6% were female patients. It was found that the breast cancer was the most commonly occurring disease in 36.7% of the total patients. The highest total delay, with mean 258 days, was in the breast cancer patients and the lowest, with mean 94 days, was found to be in the blood cancer patients. The median of total delay was 363 days along with (219, 547) 25^th and 75^th percentiles, the median patient delay was 270 days along with (180, 390) 25^th and 75^th percentiles, the median referral delay was 20 days along with (11, 34) 25^th and 75^th percentiles, the median oncologist delay was 9 days along with (4, 14) 25^th and 75^th percentiles, the median physician delay was 25 days along with (13, 48) 25^th and 75^th percentiles, the median treatment delay was 28 days along with (12, 45) 25^th and 75^th percentiles, the median system delay was 40 days along with (14, 64) 25^th and 75^th percentiles.
Conclusions: We concluded that the patient delay in our population is associated with lack of awareness, low household income and difficulties in approaching the healthcare facilities. The referral and system delays increased due to lack of cancer hospitals and facilities available in the hospitals for cancer diagnosis and treatment. The delay in scheduling diagnostic tests and waiting time for radiation therapy were found to be quite long that consequently increased the system delay. As the cancer incidence rate has been increasing in our country, therefore it is suggested that the government should take measures to improve primary health care system so the diagnosis of cancer in patients could be possible at the early stage and should also build new cancer hospitals across the country.