TY - JOUR
T1 - Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States
AU - Huepenbecker, Sarah P.
AU - Sun, Charlotte C.
AU - Fu, Shuangshuang
AU - Zhao, Hui
AU - Primm, Kristin
AU - Giordano, Sharon H.
AU - Meyer, Larissa A.
N1 - Funding Information:
This work was supported in part by the MD Anderson Cancer Center Support Grant from the National Cancer Institute of the National Institutes of Health (P30 CA016672, CA217685) and T32 Training Grant CA101642. Larissa A. Meyer is supported by a grant from the National Cancer Institute K07‐CA201013.
Funding Information:
Sarah P. Huepenbecker reports belonging to the Legislative and Regulatory Affairs Subcommittee of the Society of Gynecologic Oncology. Larissa A. Meyer reports research funding from AstraZeneca, consulting for GlaxoSmithKline, and stock in Crispr and Bristol‐Myers Squibb. The other authors made no disclosures.
Publisher Copyright:
© 2021 American Cancer Society
PY - 2021/11/15
Y1 - 2021/11/15
N2 - Background: Patients with ovarian cancer often present with late-stage disease and nonspecific symptoms, but little is known about factors affecting the time to diagnosis (TTD) in the United States. Methods: A retrospective, population-based study of the Surveillance, Epidemiology, and End Results–Medicare database was conducted. It included women 66 years old or older with stage II to IV epithelial ovarian cancer with at least 1 code for abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of the cancer diagnosis. TTD was defined from the first claim with a prespecified symptom to the ovarian cancer diagnosis. Kruskal-Wallis tests were used to assess for differences in TTD by group medians. Univariate and generalized linear models with a log-link function evaluated TTD by covariables. Results: For the 13,872 women analyzed, the mean and median times to diagnosis were 2.9 and 1.1 months, respectively. The median TTD differed significantly by first symptom (P <.001), number of symptoms (P <.001), and first physician specialty seen (P <.001). In a multivariable analysis, TTD differed significantly according to race/ethnicity (P <.001), geographic region (P =.001), urban-rural location (P =.031), emergency room presentation (P <.001), and number of specialties seen (P <.001). A shorter TTD was associated with a diagnosis in 2006-2010 (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) or 2011-2015 (RR, 0.87; 95% CI, 0.81-0.93) in comparison with 1992-1999. Conclusions: The time from a symptomatic presentation to care to a diagnosis of ovarian cancer is influenced by clinical and demographic variables. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to aid in diagnosis. Lay Summary: Ovarian cancer is often diagnosed once disease has spread because the classic symptoms of ovarian cancer—abdominal or pelvic pain, bloating, difficulty eating, and urinary issues—can be mistaken for other problems. This study examined the time between when women with classic ovarian cancer symptoms went to a physician and when they received a cancer diagnosis in a large database population. The authors found that the time to diagnosis differed according to the type and number of symptoms and what type of physician a woman saw as well as factors such as race, geographic location, and year of diagnosis.
AB - Background: Patients with ovarian cancer often present with late-stage disease and nonspecific symptoms, but little is known about factors affecting the time to diagnosis (TTD) in the United States. Methods: A retrospective, population-based study of the Surveillance, Epidemiology, and End Results–Medicare database was conducted. It included women 66 years old or older with stage II to IV epithelial ovarian cancer with at least 1 code for abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of the cancer diagnosis. TTD was defined from the first claim with a prespecified symptom to the ovarian cancer diagnosis. Kruskal-Wallis tests were used to assess for differences in TTD by group medians. Univariate and generalized linear models with a log-link function evaluated TTD by covariables. Results: For the 13,872 women analyzed, the mean and median times to diagnosis were 2.9 and 1.1 months, respectively. The median TTD differed significantly by first symptom (P <.001), number of symptoms (P <.001), and first physician specialty seen (P <.001). In a multivariable analysis, TTD differed significantly according to race/ethnicity (P <.001), geographic region (P =.001), urban-rural location (P =.031), emergency room presentation (P <.001), and number of specialties seen (P <.001). A shorter TTD was associated with a diagnosis in 2006-2010 (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) or 2011-2015 (RR, 0.87; 95% CI, 0.81-0.93) in comparison with 1992-1999. Conclusions: The time from a symptomatic presentation to care to a diagnosis of ovarian cancer is influenced by clinical and demographic variables. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to aid in diagnosis. Lay Summary: Ovarian cancer is often diagnosed once disease has spread because the classic symptoms of ovarian cancer—abdominal or pelvic pain, bloating, difficulty eating, and urinary issues—can be mistaken for other problems. This study examined the time between when women with classic ovarian cancer symptoms went to a physician and when they received a cancer diagnosis in a large database population. The authors found that the time to diagnosis differed according to the type and number of symptoms and what type of physician a woman saw as well as factors such as race, geographic location, and year of diagnosis.
KW - Surveillance, Epidemiology, and End Results (SEER) program
KW - epithelial ovarian cancer
KW - gynecologic neoplasm
KW - late diagnosis
KW - symptom assessment
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U2 - 10.1002/cncr.33829
DO - 10.1002/cncr.33829
M3 - Article
C2 - 34347287
AN - SCOPUS:85111722492
SN - 0008-543X
VL - 127
SP - 4151
EP - 4160
JO - Cancer
JF - Cancer
IS - 22
ER -