567P_PR - Diagnostic delay in oncology: Is there a need for increasing cancer awareness among primary care physicians of developing countries?

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Bioethics, Legal, and Economic Issues
Presenter Raviteja Miriyala
Citation Annals of Oncology (2016) 27 (suppl_9): ix184-ix189. 10.1093/annonc/mdw603
Authors R. Miriyala, A. Bansal, C. Dracham, P. Thakur, S. Ghoshal
  • Radiotherapy And Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), 160012 - Chandigarh/IN



Advanced stage at diagnosis is associated with poor outcomes for most cancers. Diagnostic delay often leads to progression of disease, especially in developing countries with limited resources. Purpose of this study is to analyze the factors contributing to delay in diagnosis and initiation of cancer treatment in developing countries, and evaluate the influence of such delay on treatment intent.


All cancer patients referred to our department through primary care physicians in January 2015 were included in this audit. Details regarding date of first cancer related symptom noticed by the patient, date of first consultation with primary physician and date of first oncology consultation were collected. They were prospectively followed up and date of initiation of first cancer directed therapy and intent of treatment (curative vs palliative) were recorded. Delay intervals on behalf of patient, primary care physician and treating oncologist were analyzed and correlated with treatment intent using multivariate analysis.


Median total delay before initiation of cancer treatment, was 6 months. Maximum contribution to the delay was by patients (median, 4 months). Median delay in referral by primary physicians was 3 weeks, but it ranged from less than a week to up to 5 years in some cases. Oncologists contributed to a median delay of 10 days. Patient delay and physicians delay were significant factors contributing to overall delay (p = 0.04). Shorter delays were observed for brain and lung cancers, while longest for head and neck cancers. Significant correlations were observed between patient delay and education status (p = 0.03), physician delay and rural habitat (p = 0.02), oncologist delay and cancer site (p = 0.01). Overall delay was a significant factor determining the intent of treatment (p = 0.001).


Diagnostic delay has a significant impact on the intent of treatment eventually received by patients. Delays on behalf of patient and primary care physician have significant contribution to overall delay. Apart from educating the population regarding cancer symptoms, increasing cancer awareness among primary care physicians might improve overall diagnostic delay.

Clinical trial indentification

Legal entity responsible for the study

Department of Radiotherapy, PGIMER, Chandigarh


No funding received. Academic support from Department of Radiotherapy, PGIMER, Chandigarh


All authors have declared no conflicts of interest.