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What Affects Time to Diagnosis in Children, Adolescents, and Young Adults With Solid Tumors?

Wallace Stephens
Time to diagnosis, the interval that passes from first symptom presentation until diagnosis, varies by cancer type among children, adolescents, and young adults and may be affected by clinical and sociodemogrpahic factors. 
Time to diagnosis among children, adolescents, and young adults (AYAs) varies by cancer type and may be affected by clinical and sociodemographic factors, according to an abstract presented at the 2019 American Society of Clinical Oncology Annual Meeting, held May 31 to June 4, 2019, in Chicago, Illinois.

Researchers used claims data for commercially insured enrollees in a large United States health plan from OptumLabs Data Warehouse. They identified pediatric patients 14 years and younger, as well as AYAs 15 to 39 years old diagnosed with soft tissue sarcomas (STS), bone tumors (BT), and germ cell tumors (GCT) during 2001 to 2017 who were continuously enrolled for 6 months prior to being diagnosed.

Time to diagnosis was calculated as the number of days between a patient’s first medical encounter associated with a potential cancer symptom and their diagnosis date. Researchers compared median times from first symptom to diagnosis using the Wilcoxon Rank Sum test. They used multivariable logistic regression to identify sociodemographic and clinical factors associated with intervals longer than 3 months from appearance of symptoms to diagnosis.

Of 11,395 total patients, 86% presented to medical care with symptoms before they were diagnosed. A total of 2228 patients had STS, 1565 patients had BT, and 5904 had GCT. The most common symptoms reported were pain and swelling.

Researchers found that:
  • STS had the longest median time to diagnosis at 92 days,
  • BT had the second longest median time to diagnosis at 91 days, and
  • GCT had the shortest median time to diagnosis at 49 days.
Researchers determined there was a significant difference in median days to diagnosis by age:
  • For patients with BT, the median time to diagnosis was 69 days for patients 14 years or younger, 77 days for patients 15 to 21 years old, and 105 days for patients 22 to 39 years old, and
  • For patients with GCT, the median time to diagnosis was 96 days for patients 14 years old or younger, 34 days for patients 15 to 21 years old, and 49 days for patients 22 to 39 years old.
There was not a significant difference in median days to diagnosis by age for STS.

Researchers also found that being from a household with a college degree or higher level of education, as well as seeing a specialist besides an oncologist when symptoms first appeared, was associated with a longer delay in diagnosis. Older age and being male were associated with a shorter delays in diagnosis.

“In a commercially insured population, time to diagnosis varies by cancer type and is impacted by clinical and sociodemographic factors,” researchers wrote. “Shorter time to diagnosis may represent delays in presenting to medical care or more acute presentations of symptoms, therefore patient-reported symptoms and barriers to care data should be collected to better define strategies to reduce delays in diagnosis."

Reference

Alvarez EM, Winestone L, McPheeters J, et al. Factors impacting time to diagnosis in pediatric, adolescent and young adult (AYA) patients with solid tumors. Presented at: American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2019; Chicago, Illinois. Abstract e21515.

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