Open AccessDelay in Diagnosis and Its Effect on Clinical Outcome in High‐grade Sarcoma of Bone: A Referral Oncological Centre Study
Author(s) -
Goedhart Louren M,
Gerbers Jasper G,
Ploegmakers Joris J W,
Jutte Paul C
Publication year - 2016
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12239
Subject(s) - medicine , sarcoma , chondrosarcoma , osteosarcoma , referral , stage (stratigraphy) , retrospective cohort study , surgery , single center , bone sarcoma , pathology , paleontology , family medicine , biology
Objective To investigate delay in diagnosis by both patients and doctors, and to evaluate its effect on outcomes of high‐grade sarcoma of bone in a single‐referral oncological center. Methods Fifty‐four patients with osteosarcoma, 29 with E wing sarcoma and 19 with chondrosarcoma were enrolled in this retrospective study. Delay in diagnosis was defined as the period between initial clinical symptoms and histopathological diagnosis at our center. The delays were categorized as patient‐ or doctor‐related. Short total delays were defined as <4 months; prolonged delays >4 months were assumed to have prognostic relevance. Results Total delay in diagnosis was 688.0 days in patients with chondrosarcoma, which is significantly longer than the 163.3 days for osteosarcoma ( P < 0.01) and 160.2 days for E wing sarcoma ( P < 0.01). Most doctor‐related delays were at the pre‐hospital stage, occurring at the general practitioner ( GP )'s office. However, prolonged total delays (≥4 months) did not result in lower survival rates. Five‐year‐overall survival rates were 67.0% for osteosarcoma, 49.0% for Ewing sarcoma and 60.9% for chondrosarcoma. Survival was significantly lower for patients with metastatic disease for all three types of sarcoma. Conclusion Prolonged delay in diagnosis does not result in lower survival. Metastatic disease has a pronounced effect on survival. Aggressive tumor behavior results in shorter delays. Minimizing GP‐ related delays could be achieved by adopting a lower threshold for obtaining plain radiographs at the pre‐hospital stage.