Can we reduce delays in presentation and thereby improve survival?

Study 1: A retrospective analysis of 3,500 women at Guy's Hospital, London shows that 32% of these women had symptoms for > 3 months before presentation. These patients had a significantly worse survival than those with shorter duration of symptoms. A number of further studies are being undertaken by the Group with the aim to determine optimal approaches to reducing delays between onset of symptoms and presentation to hospital for women with symptomatic breast cancer.

Study 2: An interview-based study of 196 patients with breast cancer has shown that the risk factors for both patient- and general practitioner-mediated delay include nature of initial breast symptom (non-lump versus lump). The expectations and influence of close others have also been shown to be risk factors for patient delay.

Study 3: A systematic review of the world literature on patient and provider mediated delay, has recently been completed. This supports the finding that delay affects survival, with moderate delays of 3-6 months being associated with poorer survival The evidence for factors which increase the risk for delay was of poor quality and firm conclusions can be drawn about the importance of only a few sociodemographic, clinical and psychosocial risk factors.

Three studies are being planned:
Study 4: A multicentre questionnaire-based study to further define the relationship between sociodemographic factors and delay.

Study 5: An interview-based multicentre prospective study to test and refine the hypotheses generated by the initial interview study and the literature review is relation to clinical and psychosocial risk factors for patient delay.

Study 6: A general population based survey of the nature of womens' cancer-related health beliefs and attitudes.

Duration of Study:
1998-2004

Research Team
Caroline Burgess
Alex Westcombe
Mike Richards
Beth Grunfeld

Publications
Richards MA, Westcombe AM, Love S, Littlejohns P, Ramirez AJ. The influence of delay on survival in patients with breast cancer: a systematic review. Lancet 1999;353:1119-1126.

Burgess CC, Ramirez AJ, Smith P, Richards MA. Do adverse life events and mood disorders influence delayed presentation of breast cancer? Journal of Psychosomatic Research 2000; 48: 171-175.

Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD (1999) The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. British Journal of Cancer 1999; 75(5/6): 858-864.

Burgess CC, Ramirez AJ Richards MA & Love SB. Who and what influences delayed diagnosis of breast cancer? British Journal of Cancer 1998; 77(8): 1343-1348.

Ramirez AJ Westcombe AM Burgess CC Sutton S Littlejohns P & Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: A systematic review. Lancet 1999; 353: 1127-1131.