PLOS Medicine: The patient, diagnostic, and treatment intervals in adult patients with cancer from high- and lower-income countries: A systematic review

1 November, 2022

An important new paper in PLOS Medicine. Citation, author summary, extract and comments from me below. I look forward to learn from your experience.

CITATION: The patient, diagnostic, and treatment intervals in adult patients with cancer from high- and lower-income countries: A systematic review and meta-analysis

Dafina Petrova ,Zuzana Špacírová,Nicolás Francisco Fernández-Martínez,Ana Ching-López,Dunia Garrido,Miguel Rodríguez-Barranco,Marina Pollán,Daniel Redondo-Sánchez,Carolina Espina,Camila Higueras-Callejón,Maria José Sánchez

Published: October 20, 2022


- Cancer is a leading cause of death globally and timely diagnosis and treatment are considered essential for improving cancer outcomes.

- Three main intervals describe the time patients spend in the pathway to treatment of cancer: the patient interval (from symptom start to first presentation to a healthcare professional), the diagnostic interval (from first presentation to diagnosis), and the treatment interval (from diagnosis to the start of treatment).

- We conducted a systematic review with meta-analysis of the duration of the patient, diagnostic, and treatment intervals in adult patients with diverse types of cancer.

- Patient intervals in studies from lower-income countries were consistently 1.5 to 4 times longer than patient intervals from studies from high-income countries for almost all cancer sites. - Efforts should be made to reduce help-seeking times for cancer symptoms in lower-income countries...

SELECTED EXTRACT: 'The literature on barriers to help-seeking indicates that low cancer symptom recognition and negative beliefs about cancer are likely universal predictors of longer patient intervals. However, there are unique factors in lower-income contexts such as low health literacy, the use of alternative medicine, female-specific barriers (e.g., the need for family permission to seek help), strong negative stigma of cancer treatment, and financial and access barriers that may delay help-seeking].


For me this paper highlights the central importance of basic health knowledge among the general public on how they can identify and self-refer at an early stage of cancer (where the outlook is so much better) rather than delay until the cancer is far advanced. This is one of the key reasons for a long patient interval (delay between symptom start and first presentation). Also critical is the diagnostic interval (from first presentation to diagnosis), which is at least partly dependent on the availability and use of reliable information to guide health professionals. Both are impacted by the availability (and perception) of quality cancer treatment services (WHO/PAHO recently reported that: 'In 2019, more than 90% of high-income countries reported that comprehensive treatment services for cancer were available in the public health system compared to less than 15% of low-income countries'

Best wishes, Neil

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