[show abstract][hide abstract] ABSTRACT: Little is known about the patterns of care relating to the diagnosis of chronic lymphocytic leukemia (CLL), including the use of modern diagnostic techniques such as flow cytometry.
The authors used the SEER-Medicare database to identify subjects diagnosed with CLL from 1992 to 2002 and defined diagnostic delay as present when the number of days between the first claim for a CLL-associated sign or symptom and SEER diagnosis date met or exceeded the median for the sample. The authors then used logistic regression to estimate the likelihood of delay and Cox regression to examine survival.
For the 5086 patients analyzed, the median time between sign or symptom and CLL diagnosis was 63 days (interquartile range [IQR] = 0-251). Predictors of delay included age ≥75 (OR 1.45 [1.27-1.65]), female gender (OR 1.22 [1.07-1.39]), urban residence (OR 1.46 [1.19 to 1.79]), ≥1 comorbidities (OR 2.83 [2.45-3.28]) and care in a teaching hospital (OR 1.20 [1.05-1.38]). Delayed diagnosis was not associated with survival (HR 1.11 [0.99-1.25]), but receipt of flow cytometry within thirty days before or after diagnosis was (HR 0.84 [0.76-0.91]).
Sociodemographic characteristics affect diagnostic delay for CLL, although delay does not seem to impact mortality. In contrast, receipt of flow cytometry near the time of diagnosis is associated with improved survival.
Cancer 04/2011; 117(7):1470-7. · 5.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: Increased attention to timely diagnosis motivated us to study 5483 patients diagnosed with multiple myeloma using Medicare claims linked to tumor registries in the Surveillance, Epidemiology and End Results programme. We calculated the time between initial visits for anemia or back pain and for myeloma diagnosis, and used logistic regression to predict the likelihood of diagnostic delay, and also the likelihood of renal or skeletal complications. The median time between sign or symptom and myeloma diagnosis was 99 days. Patients with anemia, back pain and comorbidities were more likely to experience diagnostic delay (OR 1.6, 95% CI 1.3-2.0). Diagnosis while hospitalised (OR 2.5, 95% CI 2.2-2.9) and chemotherapy treatment within 6 months of diagnosis (OR 1.4, 95% CI 1.2-1.6) significantly predicted complications; diagnostic delay did not (OR 0.9, 95% CI 0.8-1.1). Our data suggest that complications are more strongly associated with health status and myeloma severity than with diagnostic delays.
[show abstract][hide abstract] ABSTRACT: To better understand the extent of diagnostic and referral delays from primary care providers (PCPs) for chronic hematologic malignancies, causes of these delays, and their possible effects on cancer outcomes, an extensive review of the literature was performed. Over 50 studies were reviewed, including many that concern delays in referral and diagnosis for solid tumors, as there was only sparse literature on delays specific to the liquid tumors. Delays for some chronic hematologic malignancies have been documented, mainly in centralized health care systems. Possible reasons for delays include PCPs' lack of exposure to hematologic malignancies, limited knowledge of associated signs and symptoms, and a reliance on patient symptoms to prompt referral (as opposed to signs and screening). Patient characteristics such as age, gender and race-ethnicity are also likely to play a role, although it is unclear if these exert their effect primarily via patient or provider mechanisms. Unfortunately, the outcomes associated with such delays are largely unreported, possibly because delay is complex to define and difficult to measure.