Age and Referral Route Impact the Access to Diagnosis for Women with Advanced Ovarian Cancer

Anna Norbeck,1,2 Mihaela Asp,1,2 Tobias Carlsson,3 Päivi Kannisto,1,2 Susanne Malander4,5 1Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden; 2Department of Clinical Sciences, Division of Obstetrics and Gynecology, Lund University, Lund, Sweden; 3Regional Cancer Centre South, Region Skåne, Lund, Sweden; 4Department of Oncology, Skåne University Hospital, Lund, Sweden; 5Department of Clinical Sciences, Division of Oncology, Lund University, Lund, SwedenCorrespondence: Anna Norbeck, Kvinnoklinken Skånes Universitetessjukhus, Klinikgatan 12, Lund, 221 85, Sweden, Tel +4646172106, Email anna.norbeck@med.lu.sePurpose: The majority of women with ovarian cancer are diagnosed in late stages. Most women do have symptoms prior to diagnosis, sometimes several months before the diagnosis. The aim of this study was to evaluate the timeline from the first presentation of symptoms to a physician until there is a reasonable suspicion of cancer, among women diagnosed with advanced stage ovarian cancer. We wanted to investigate which symptoms were the most common and whether there are other factors affecting the time interval before the suspicion of cancer was confirmed.Patients and Methods: This was a retrospective population-based cohort study of women diagnosed with advanced ovarian cancer between January 1, 2017 and December 31, 2019 who were referred to Skane University Hospital Lund, Sweden. Data were collected from electronic medical records at Skane University Hospital. The time interval was recorded as the time from first physician consultation with predefined symptoms to the date when there was a reasonable suspicion of ovarian cancer. Data processing and statistical analysis were performed with the statistical software R.Results: Among the 249 patients included in this study, the median time interval from the first consultation to the reasonable suspicion of cancer was 24 days. The first consultation in specialized care had a 70% decrease in delay compared to primary care. Emergency consultations had a 52.2% decrease in time delay compared to planned consultations. Older age was associated with an increase in the geometric mean by 54.7%, comparing the first to the third quartile. The most common symptom was abdominal pain.Conclusion: The length of time interval from first presentation with symptoms relating to ovarian cancer to reasonable suspicion of cancer was associated with whether the consultation was in primary or specialized care, emergency or planned visit and the patient’s age.Keywords: epithelial ovarian cancer, routes to diagnosis, cancer patient pathway, time to diagnosis