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      Le délai diagnostique des cancers broncho-pulmonaires vus à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar Translated title: Diagnostic delay in bronchopulmonary cancers at the USFR Befelatanana Pneumology, Antananarivo, Madagascar

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          Abstract

          Le délai entre l'apparition des premiers signes cliniques et le diagnostic du cancer bronchique doit être le plus court possible afin que l'on puisse le prendre en charge de façon précoce et efficace. À Madagascar ce délai diagnostique reste inconnu d'où cette étude qui a pour objectif d'évalué le délai diagnostique des cancers broncho-pulmonaires vu à l'USFR de Pneumologie Befelatanana, Antananarivo, Madagascar. Il s'agit d'une étude rétrospective, descriptive portant sur les cancers broncho-pulmonaires diagnostiqués au sein de l'USFR de Pneumologie Befelatanana pendant la période du 1 er janvier 2011 au 31 décembre 2015 (5 ans). Nous avons inclus dans l'étude tous les patients hospitalisés pendant la période d'étude et ayant un diagnostic de cancer broncho-pulmonaire avec preuve anatomopathologique. Durant la période de notre étude, nous avons colligé 43 patients présentant un cancer broncho-pulmonaire confirmé histologiquement, soit 0,64% des patients hospitalisés. Le délai pré-hospitalier, le délai hospitalier et le délai total étaient respectivement de 171,74 jours, 13,97 jours et 185,71 jours. Le délai entre l'apparition des premiers symptômes et la consultation chez un médecin était moins de trois mois dans 30 cas (69,76%), entre 3 et 6 mois dans 8 cas (18,60%). Notre délai pré-hospitalier chez nos patients était très long par rapport à la recommandation internationale sur le délai diagnostique des cancers broncho-pulmonaire. Un effort doit être fait à ce niveau pour améliorer le délai diagnostique.

          Translated abstract

          The time between clinical symptoms onset and the diagnosis of bronchial cancer should be as short as possible so that it can be managed early and effectively. In Madagascar, this diagnostic delay is unknown. Therefore this study aims to evaluated the diagnostic delay of bronchopulmonary cancers at the the USFR Befelatanana Pneumology, Antananarivo, Madagascar. We conducted a retrospective descriptive study of patients with bronchopulmonary cancers diagnosed at the USFR Befelatanana Pneumology over the period 1 st January 2011 to 31 st December 2015 (5 years). All patients hospitalized during the study period and receiving anatomopathologically-confirmed diagnosis of bronchopulmonary cancer were included in the study. During the study period we collected data from 43 medical records of patients with bronchopulmonary cancer confirmed histologically, reflecting a rate of 0.64% of hospitalized patients. Pre-hospital delay, hospital delay and total delay were 171.74 days, 13.97 days and 185.71 days respectively. The time between symptom onset and consultation with a doctor was less than three months in 30 cases (69.76%), between 3 and 6 months in 8 cases (18.60%). Pre-hospital delay was very long according to the international recommendation for delayed diagnosis of bronchopulmonary cancers. An effort should be made to improve the diagnostic delay.

          Most cited references14

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          Delays in the diagnosis and treatment of lung cancer.

          This study was undertaken to measure delays of diagnosis and to assess the causes for those delays in patients with lung cancer. In addition, the relation of delay times and survival was analyzed. A retrospective study based on patient records. Dates for symptoms, visits to doctors, investigations, treatment, and death were recorded. Patients who were found to have lung cancer at Turku University Hospital, Finland, during 2001. Records of 132 patients were reexamined. The median delay in patient presentation from first symptoms to first appointment with a general practitioner (GP) was 14 days. The median delay by the GP before writing a referral was 16 days, the median referral delay was 8 days, the median delay from the first visit to a specialist until the diagnosis was 15 days, and the median treatment delay was also 15 days. Thirty percent of patients received treatment within 1 month from the first hospital visit, and 61% received treatment within 2 months. The median symptom-to-treatment delay was almost 4 months. The delay in seeing a specialist was shorter in patients with advanced cancer and small cell lung cancer. About half of our patients fulfilled the criteria of the British Thoracic Society recommendations. A longer specialist treatment delay seemed to correlate with better survival in advanced disease, but it was not an independent significant factor for survival. Several reasons for long delays were found, but on many occasions patients underwent numerous consecutive procedures before a diagnosis of cancer was confirmed. Shortening the diagnostic and treatment delay times might be possible with little extra cost by a multidisciplinary team approach and by rapid access to carefully planned investigations, but decreasing the patient delay might be more difficult. This study shows that long specialist treatment delays are not correlated with worse prognosis in patients with advanced disease. In patients with more limited disease, the delay time may be more critical, and if curative treatment is the goal, the diagnostic process should proceed without needless delay to avoid a situation in which curable disease becomes incurable.
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            Effect of delays on prognosis in patients with non-small cell lung cancer.

            The effect of delay on survival in lung cancer remains uncertain. It is suggested that prompt management of non-small cell lung cancer (NSCLC) can influence prognosis. This study was undertaken to examine the relation between delay and prognosis in patients with NSCLC and to investigate the delay time from first symptom and from first hospital visit to start of treatment. Two types of delay (symptom to treatment delay and hospital delay) were investigated in 466 patients treated for NSCLC at two institutions in central Sweden. Delays in relation to clinical characteristics were compared and the effects of delay times and other relevant factors on survival were assessed in multivariate analyses. Thirty five per cent of patients received treatment within 4 weeks of the first hospital visit and 52% within 6 weeks. Median symptom to treatment delay was 4.6 months and median hospital delay 1.6 months. Older age, advanced tumour stage, and non-surgical treatment were independently related to poor survival. Both prolonged hospital delay and symptom to treatment delay provided additional information when considered separately. In a final multivariate model only increased symptom to treatment delay gave significant information of a better prognosis. There was an association between a short delay and a poor prognosis which was most pronounced in patients with advanced disease. When considering the whole study population and all stages of tumour together, shorter delay was associated with a poorer prognosis. This is likely to reflect the fact that patients with severe signs and symptoms receive prompt treatment. These findings indicate that the waiting time for treatment in patients with NSCLC is longer than recommended.
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              Survival of cancer patients in France: a population-based study from The Association of the French Cancer Registries (FRANCIM).

              We present the main results of the first population-based cancers survival study gathering all French registry data. Survival data on 205,562 cancer cases diagnosed between 01/01/1989 and 31/12/1997 were analysed. Relative survival was estimated using an excess rate model. The evolution of the excess mortality rate over the follow-up period was graphed. The analysis emphasised the effect of age at diagnosis and its variation with time after diagnosis. For breast and prostate cancers, the age-standardised five-year relative survivals were 84% and 77%, respectively. The corresponding results in men and women were 56% versus 58% for colorectal cancer and 12% versus 16% for lung cancer. For some cancer sites, the excess mortality rate decreased to low values by five years after diagnosis. For most cancer sites, age at diagnosis was a negative prognostic factor but this effect was often limited to the first year after diagnosis.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                29 July 2019
                2019
                : 33
                : 263
                Affiliations
                [1 ]Service de Pneumologie Centre Hospitalier Universitaire de Fenoarivo, Antananarivo Madagascar
                [2 ]Service de Pneumologie Centre Hospitalier Universitaire de Befeletanana, Antananarivo Madagascar
                [3 ]Service de Pneumologie Centre Hospitalier Universitaire de Fianarantsoa, Fianarantsoa, Madagascar
                Author notes
                [& ]Auteur correspondant: Kiady Ravahatra, Service de Pneumologie Centre Hospitalier Universitaire de Fenoarivo, Antananarivo Madagascar
                Article
                PAMJ-33-263
                10.11604/pamj.2019.33.263.18695
                6814921
                24ae515e-8b0e-411b-b594-c86b1166d949
                © Kiady Ravahatra et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 March 2019
                : 23 June 2019
                Categories
                Case Series

                Medicine
                cancer,pulmonaire,madagascar,délai diagnostique,pulmonary,diagnostic delay
                Medicine
                cancer, pulmonaire, madagascar, délai diagnostique, pulmonary, diagnostic delay

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