Assessment of Factors Causing Delay to Surgical Treatment of Patients with Gastrointestinal Malignancies in Patients of Surgery Wards of Cancer Institute and Dr. Shariati Hospital in 2004-6

Abstract

Background: Many patients with gastrointestinal malignancies undergo false treatments and incorrect diagnostic studies before diagnosis. This study considered all possible causes to propose prior solutions.

Materials and Methods: Patients with gastrointestinal malignancies (esophageal, gastric, and colorectal) who were admitted for the first surgery were assessed. The delay of diagnosis and treatment and responsible factors were analyzed from patients' history by interview and reviewing paraclinical data, patient's records, and pathology report.

Results: 109 patients were assessed with esophageal cancer (42 patients), gastric cancer (35 patients), and colorectal cancers (32 patients). Mean duration "from being symptomatic to admission" was 348 days and the mean duration "from being symptomatic to surgery" was 366 days. The most important parts of the delay were: "not being referred by general practitioners" (124 days), "incorrect medical treatment by specialists (100 days), inadequate endoscopy (58 days) and ignoring symptoms by patients (41 days). The mean duration of incorrect medical treatment by general practitioners in gastric cancer was more in compare to esophageal cancers (p-value= 0.01). Inadequate endoscopy resulted in more delay in esophageal and gastric than colorectal cancers (p-value= 0.016). Need to repeat endoscopy in patients with esophagus, gastric and colorectal cancer were 43%, 51%, and 22% respectively (p-value= 0.040).

Conclusion: The most important part of delay in surgical treatment of gastrointestinal malignancies was related to incorrect outpatient treatments by general practitioners and specialists. It seems that the best solution to reduce time of diagnosis in gastrointestinal malignancies is continuing education for physicians, especially general practitioners.