Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

doi:10.1038/bjc.2015.48

Review

. 2015 Mar 31;112 Suppl 1(Suppl 1):S92-107.

doi: 10.1038/bjc.2015.48.

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

R D Neal¹, P Tharmanathan², B France¹, N U Din¹, S Cotton³, J Fallon-Ferguson⁴, W Hamilton⁵, A Hendry¹, M Hendry¹, R Lewis², U Macleod⁶, E D Mitchell⁷, M Pickett³, T Rai⁸, K Shaw⁴, N Stuart⁹, M L Tørring¹⁰, C Wilkinson¹, B Williams⁴, N Williams¹¹, J Emery¹²

Affiliations

¹ North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
² Department of Health Sciences, University of York, York, YO10 5DD, UK.
³ Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK.
⁴ Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
⁵ University of Exeter Medical School, Exeter EX1 2LU, UK.
⁶ Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK.
⁷ Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
⁸ North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK.
⁹ School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK.
¹⁰ Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark.
¹¹ 1] North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK [2] North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK.
¹² 1] Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia [2] General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia.

PMID: 25734382
PMCID: PMC4385982
DOI: 10.1038/bjc.2015.48

Review

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

R D Neal et al. Br J Cancer. 2015.

. 2015 Mar 31;112 Suppl 1(Suppl 1):S92-107.

doi: 10.1038/bjc.2015.48.

Authors

Affiliations

¹ North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
² Department of Health Sciences, University of York, York, YO10 5DD, UK.
³ Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK.
⁴ Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
⁵ University of Exeter Medical School, Exeter EX1 2LU, UK.
⁶ Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK.
⁷ Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
⁸ North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK.
⁹ School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK.
¹⁰ Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark.
¹¹ 1] North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK [2] North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK.
¹² 1] Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia [2] General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia.

PMID: 25734382
PMCID: PMC4385982
DOI: 10.1038/bjc.2015.48

Abstract

Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations.

Methods: Systematic review of the literature and narrative synthesis.

Results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma.

Conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.

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Figures

**Figure 3**
**Flow diagram.** *Of those breast and colorectal cancer records published up to March 2010 (n=706) assessed for retrieval, 330 were retrieved and assessed for inclusion but were not included in the evaluation, as systematic reviews on these cancers had been recently published. The follow-up review, covering the period March 2010 to October 2013, included both breast and colorectal cancers in the qualitative synthesis.

**Figure 4**
Definitions of time interval.

See this image and copyright information in PMC

Comment in

Progress and priorities in reducing the time to cancer diagnosis.
Nicholson BD, Lyratzopoulos G. Nicholson BD, et al. Br J Cancer. 2023 Feb;128(3):468-470. doi: 10.1038/s41416-022-02045-5. Epub 2022 Nov 7. Br J Cancer. 2023. PMID: 36344594 Free PMC article.

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References

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1. Alam M, Goldberg LH, Silapunt S, Gardner ES, Strom SS, Rademaker AW, Margolis DJ. Delayed treatment and continued growth of nonmelanoma skin cancer. J Am Acad Dermatol. 2011;64:839–848. - PubMed
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[1] Akdas A, Kirkali Z, Remzi D. The role of delay in stage Iii testicular tumors. Int Urol Nephrol. 1986;18:181–184. - PubMed

[2] Akdas A, Kirkali Z, Remzi D. The role of delay in stage Iii testicular tumors. Int Urol Nephrol. 1986;18:181–184. - PubMed

[3] Alam M, Goldberg LH, Silapunt S, Gardner ES, Strom SS, Rademaker AW, Margolis DJ. Delayed treatment and continued growth of nonmelanoma skin cancer. J Am Acad Dermatol. 2011;64:839–848. - PubMed

[4] Alam M, Goldberg LH, Silapunt S, Gardner ES, Strom SS, Rademaker AW, Margolis DJ. Delayed treatment and continued growth of nonmelanoma skin cancer. J Am Acad Dermatol. 2011;64:839–848. - PubMed

[5] Alho O, Teppo H, Mantyselka P, Kantola S. Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases. Can Med Assoc J. 2006;174:779–784. - PMC - PubMed

[6] Alho O, Teppo H, Mantyselka P, Kantola S. Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases. Can Med Assoc J. 2006;174:779–784. - PMC - PubMed

[7] Allison P, Franco E, Black M, Feine J. The role of professional diagnostic delays in the prognosis of upper aerodigestive tract carcinoma. Oral Oncol. 1998;34:147–153. - PubMed

[8] Allison P, Franco E, Black M, Feine J. The role of professional diagnostic delays in the prognosis of upper aerodigestive tract carcinoma. Oral Oncol. 1998;34:147–153. - PubMed

[9] Al-Rajhi N, El-Sebaie M, Khafaga Y, Al-Zahrani A, Mohamed G, Al-Amro A. Nasopharyngeal carcinoma in Saudi Arabia: clinical presentation and diagnostic delay. East Mediterr Health J. 2009;15:1301–1307. - PubMed

[10] Al-Rajhi N, El-Sebaie M, Khafaga Y, Al-Zahrani A, Mohamed G, Al-Amro A. Nasopharyngeal carcinoma in Saudi Arabia: clinical presentation and diagnostic delay. East Mediterr Health J. 2009;15:1301–1307. - PubMed

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Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

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Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

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