DELAYED DIAGNOSIS IN ANAL CANCER: DOES IT MATTER?
Katherine Bingmer*, Asya Ofshteyn, Ronald Charles, David Dietz, Sharon L. Stein, Emily Steinhagen
Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
Background:
Recent literature has shown disparities in stage at diagnosis of anal squamous cell carcinoma (ASCC), with women and those with lower household income presenting at later stages. The reasons for this are unknown and include possible delays in reporting symptoms to a physician, or misdiagnosis. The aim of this study is to better characterize those patients who receive a delayed diagnosis.
Methods:
All patients diagnosed with ASCC at a single academic institution from 2005-2017 were retrospectively reviewed. Patients were stratified according to number of physician visits for anorectal complaint prior to diagnosis; more than two visits was considered delayed diagnosis. Patients were also evaluated using days from onset of symptoms to diagnosis; more than 30 days was considered delayed diagnosis. Overall survival was compared via cox regression.
Results:
A total of 136 patients with ASCC were identified; 104 had adequate chart data prior to diagnosis and were included in this study. 66 patients (63%) were diagnosed within two physician visits. When comparing patients who were diagnosed within two visits to those who had a delayed diagnosis (DD), there was no significant difference in age (60.5 vs 58.4) or gender (32% vs 37% male). When comparing ethnicity, DD patients were significantly more likely to be non-white (21% vs 37%, p<0.05). Presenting symptomology was similar: both groups were most likely to complain of bleeding (50% vs 58%). There was no significant difference in initial clinical stage at diagnosis. Both groups experienced similar rates of complete response to chemoradiation (67% vs 63%), and local recurrence (21% vs 21%). On multivariate analysis comparing non-delayed to DD patients, there was no significant difference in overall survival (HR 0.4, CI 0.2-1.4, p=0.17) or disease free survival (HR 1.4, CI 0.5-4.1, p=0.55) between the two groups. Patients were then compared by those diagnosed within 30 days of onset of symptoms (n=57) to those diagnosed later than 30 days (n=23). Patients diagnosed later were more likely to be male (25% vs 52%, p<0.02). There were no significant differences between the two groups in age, race, insurance status, clinical stage at presentation, rates of complete response to chemoradiation, or recurrence. On univariate cox regression there was no difference in overall survival (HR 1.1, CI 0.4-3.1, p=0.89).
Conclusion:
Anal cancer patients are often initially misdiagnosed, which is thought to lead to worse outcomes for patients. Patients requiring three or more visits for diagnosis were more likely to be non-white, and patients diagnosed more than 30 days after onset of symptoms were more likely to be male, but overall there was no difference in rates of response to chemoradiation, risk of recurrence, and overall survival compared to those who are expediently diagnosed.
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