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A retrospective audit of diagnostic delay in lymphoma patients in West Bengal, India

Author: 
Bidyut Mandal, Anish Bandyopadhyay, Pratyusha Mukherjee, Abhishek Basu, Avik Maji and Prof S.K.Sikdar
Subject Area: 
Health Sciences
Abstract: 

Introduction: Prior to diagnosis lymphoma patients often have multiple primary care consultations, resulting in diagnostic delay. They are less likely to be referred urgently to hospital and often present in advanced stage or land up in emergency. This is a dismal picture for an otherwise curable disease. There is a paucity of studies in Indian context examining this diagnostic delay. We retrospectively examined this diagnostic delay and clarify its impact on clinical stage and outcome in our institution. Objectives: To estimate mean diagnostic delay of presentation and to find impact of diagnostic delay on stage of disease presentation, treatment outcome & Progression free survival. Material and Methods: We have analysed histopathlogically confirmed 250 lymphoma patients, excluding extra nodal presentations, in a retrospective single institutional epidemiological study. Follow up time is Date of treatment completion to date of last contact, local recurrence, distant metastasis or death. Statistical analysis was done by bivariate analysis using IBM SPSS software v.23 Results: Mean diagnostic delay is 302 days, including delay in tertiary care of 60days.56%patients had CR,6%PR ,28% SD. Simple correlation between PFS & Range of diagnostic delay(R=.488). The lesser the primary care delay, better is the treatment response (p 0.00). Beyond a delay of 300 days, patients presented with advanced stage. Conclusions: In developing country like India delayed presentation due to diagnostic delay is taking a toll on treatment outcome. More evidence is needed as well as interventions to reduce time to diagnosis such as public education campaign and GP decision making aids.

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