4.4 Article

Delay in Diagnosis and Its Effect on Clinical Outcome in High-grade Sarcoma of Bone: A Referral Oncological Centre Study

Journal

ORTHOPAEDIC SURGERY
Volume 8, Issue 2, Pages 122-128

Publisher

WILEY-BLACKWELL
DOI: 10.1111/os.12239

Keywords

Doctor-related delay; Patient-related delay; Sarcoma; Survival

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ObjectiveTo investigate delay in diagnosis by both patients and doctors, and to evaluate its effect on outcomes of high-grade sarcoma of bone in a single-referral oncological center. MethodsFifty-four patients with osteosarcoma, 29 with Ewing sarcoma and 19 with chondrosarcoma were enrolled in this retrospective study. Delay in diagnosis was defined as the period between initial clinical symptoms and histopathological diagnosis at our center. The delays were categorized as patient- or doctor-related. Short total delays were defined as <4months; prolonged delays >4months were assumed to have prognostic relevance. ResultsTotal delay in diagnosis was 688.0days in patients with chondrosarcoma, which is significantly longer than the 163.3days for osteosarcoma (P< 0.01) and 160.2days for Ewing sarcoma (P< 0.01). Most doctor-related delays were at the pre-hospital stage, occurring at the general practitioner (GP)'s office. However, prolonged total delays (4months) did not result in lower survival rates. Five-year-overall survival rates were 67.0% for osteosarcoma, 49.0% for Ewing sarcoma and 60.9% for chondrosarcoma. Survival was significantly lower for patients with metastatic disease for all three types of sarcoma. ConclusionProlonged delay in diagnosis does not result in lower survival. Metastatic disease has a pronounced effect on survival. Aggressive tumor behavior results in shorter delays. Minimizing GP-related delays could be achieved by adopting a lower threshold for obtaining plain radiographs at the pre-hospital stage.

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