Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study

Purpose To investigate factors associated with delays in presentation and diagnosis of women with confirmed breast cancer (BC). Methods A cross-sectional study nested in an ongoing prospective cohort study of breast cancer patients at Dr Sardjito Hospital, Yogyakarta, Indonesia, was employed. Participants (n = 150) from the main study were recruited, with secondary information on demographic, clinical, and tumor variables collected from the study database. A questionnaire was used to gather data on other socioeconomic variables, herbal consumption, number of healthcare visits, knowledge-attitude-practice of BC, and open-ended questions relating to initial presentation. Presentation delay (time between initial symptom and first consultation) was defined as ≥3 months. Diagnosis delay was defined as ≥1 month between presentation and diagnosis confirmation. Impact on disease stage and determinants of both delays were examined. A Kruskal-Wallis test was used to assess the length and distribution of delays by disease stage. A multivariable logistic regression analysis was conducted to explore the association between delays, cancer stage and factors. Results Sixty-five (43.3%) patients had a ≥3-month presentation delay and 97 (64.7%) had a diagnosis confirmation by ≥1 month. Both presentation and diagnosis delays increased the risk of being diagnosed with cancer stage III-IV (odds ratio/OR 2.21, 95% CI 0.97–5.01, p = 0.059 and OR 3.03, 95% CI 1.28–7.19, p = 0.012). Visit to providers ≤3 times was significantly attributed to a reduced diagnosis delay (OR 0.15, 95% CI 0.06–0.37, p <0.001), while having a family history of cancer was significantly associated with increased diagnosis delay (OR 2.28, 95% CI 1.03–5.04, p = 0.042). The most frequent reasons for delaying presentation were lack of awareness of the cause of symptoms (41.5%), low perceived severity (27.7%) and fear of surgery intervention (26.2%). Conclusions Almost half of BC patients in our setting had a delay in presentation and 64.7% experienced a delay in diagnosis. These delays increased the likelihood of presentation with a more advanced stage of disease. Future research is required in Indonesia to explore the feasibility of evidence-based approaches to reducing delays at both levels, including educational interventions to increase awareness of BC symptoms and reducing existing complex and convoluted referral pathways for patients suspected of having cancer.

Bone Sarcoma Of The Pelvis: A Multicentric Retrospective Study Of One Hundred-Fourteen Cases

Background: The aim of this study was to assess the oncologic outcome of pelvic bone sarcomas (PBS) and to identify prognosis factors.Methods: We report a multicentric cohort of patients treated for a PBS from 2000 to 2020. Data from 12 hospitals were analysed. Patients treated for primary PBS were included. Alive patients with less than 6 months of follow up were excluded. The primary outcome was survival.Results: One hundred and fourteen patients (67 males and 48 females) were reviewed with a mean follow up of 32±46,5 (1 to 216) months. The mean patient and doctor diagnosis delays were respectively 8,5±10,2 (1 to 60) and 3±4,3 (0 to 24) months. Sixty-eight patients (59,6%) died after a mean time from diagnosis of 15,9±22,8 (1 to 120) months. The overall survival rates at 5 and 10 years were respectively 38,4% and 27,6%. Chondrosarcoma histological type (HR=3,64), metastasis (HR=3,55) and surgery (HR=0,12) were identified as significant survival factors. Surgery was also associated to a decreased risk of metastasis (OR=0,03, 95% CI: 0,01 – 0,1). Among the 76 patients (66,7%) who underwent surgery, local recurrence was observed in 19 patients (25%) with a mean time from surgery to onset of 11,05 (±17,5) months. Conclusions: This nation-wide20-year-cohort study shows that surgery is the most effective treatment option in PBS regardless the histological type of the tumour. Efforts have to be done to decrease the diagnosis delay in order to start treatment when surgery is still feasible.

Total, Patient and System Diagnostic Delays for Pulmonary Bacilliferous Tuberculosis in the Six Diagnostic and Treatment Centers in the Five Health Districts of the Central Region, Burkina Faso, 2018

Introduction Long diagnosis delay contributes significantly to the failure to eradicate tuberculosis. The objective of this study was to evaluate the total, patient and system delays in diagnosis of pulmonary bacilliferous in the six tuberculosis Diagnostic and Treatment Centers in the five health districts of the central region in Burkina Faso. Methods A descriptive cross-sectional study was conducted among 384 microscopy-positive pulmonary tuberculosis patients in 2018 to address this objective. It concerned the socio-demographic, clinical, microbiological characteristics, and referral location/pathway characteristics of the patients. We then calculated the different delays. The “patient” (time from first symptoms to first consultation), “system” (time from first consultation to first diagnosis) and total (time from first symptoms to diagnosis) median diagnostic delay were estimated. Results The median “total”, “patient” and “system” diagnostic times were 37, 21 and 7 days, respectively. Of the 384 patients surveyed, 158 patients or 41.25% of patients had a long total diagnostic delay (> 45 days). The number of patients with a long system diagnostic delay was 125 patients (32.55%; p < 0.001) and those with a long patient diagnostic delay were 105 patients (27.34%; p < 0.001). Conclusion The total diagnosis delay of pulmonary tuberculosis was long for almost half of the patients. Awareness of the signs of tuberculosis among patients and caregivers, and consultation in a health center must be intensified to help considerably reduce these delays.

Cerebro-Meningeal Hemorrhage Revealing a Pheochromocytoma in a Child - Case Report and Systematic Review

Pheochromocytoma is a very rare tumor of the adrenal medulla in children population ,With a very polymorphic symptomatology causing sometimes a diagnosis delay and can be revealed in some cases by a complication We report the case of a child admitted for cerebral-meningeal hemorrhage caused by a pheochromocytoma which confirmed by CT scan and urinary dosage of catecholamines

The Difficult Task of Diagnosing Depression in Elderly People with Cancer: A Systematic Review

Background: Depression is a common psychiatric problem in the elderly and oncology patients. In elderly people with cancer, depression has a peculiar phenomenology. It has a significant impact on the quality of life. Moreover, it is associated with poor adherence to treatments, increased risk of suicide, and mortality. Nevertheless, the topic of depression in elderly people with cancer remains unexplored. Objective: The main goal of this article is to review the literature from the past 20 years on the relationships between depression, cancer, and aging. Methods: The methods followed the Prisma model for eligibility of studies. The articles in which the keywords “depression”, “cancer”, “ elderly, aging, or geriatric” were present, either in the text or in the abstract, were selected. 8.056 articles, by matching the keywords “depression and elderly and cancer,” were identified. Only 532 papers met the eligibility criteria of search limits and selection process. Out of 532 papers, 467 were considered irrelevant, leaving 65 relevant studies. Out of 65 suitable studies, 39 (60.0%) met our quality criteria and were included. Results: The risk factors associated with depression in elderly people with cancer can be divided into 4 groups: 1) tumor-related; 2) anticancer treatment-related; 3) patients-related; 4) number and type of comorbidity. The main obstacles in diagnosing depression in elderly patients with cancer are the overlap of the symptoms of cancer and side effects of treatment with the symptoms of depression but also the different ways of reporting depressive symptoms of elderly people and the different clinical types of depression. There is a lack of data regarding validated scales to assess depression in geriatric patients with cancer. Any mental illness, specifically co-occurring anxiety and depression, increases the risk of diagnosis delay and anticancer treatment adherence. Cancer and the diagnosis of mental disorders prior to cancer diagnosis correlate with an increased risk for suicide. A non-pharmacological therapeutic approach, pharmacological treatment and/or a combination of both can be used to treat elderly patients with cancer, but a detailed analysis of comorbidities and the assessment of polypharmacy is mandatory in order to avoid potential side-effects and interactions between antidepressants and the other drugs taken by the patients. Conclusion: Future research should be conducted with the aim of developing a modified and adapted assessment method for the diagnosis and treatment of depression in elderly people with cancer in order to improve their clinical outcomes and quality of life.

Addressing Challenges in Endometriosis Pain Communication Between Patients and Doctors: The Role of Language

Introduction: In the context of the complex medical, social, and economic factors that contribute to endometriosis diagnosis delay and its consequent impact on quality of life, this report focuses on patient-practitioner pain communication and examines the role of language in doctor-patient communication. Our study explored what patients and doctors consider challenging and effective in endometriosis pain communication. It further examined what commonly used metaphors by patients could be suggestive, or not, of endometriosis to doctors.Method: A United Kingdom-based qualitative (open-ended question) survey with women with endometriosis (n131) and semi-structured telephone interviews with general practitioners (GPs) (n11). Survey and interview data were analyzed thematically.Results: Both women and GPs reported the Numeric Rating Scale (NRS) to be insufficient as a standalone tool for communicating endometriosis related pain. Both also found descriptions of the quality, location, and impact on daily life of pain to more effective means of communicating pain symptoms. When presented with common metaphorical expressions surveyed women used to describe their pain, not all GPs recognized such metaphors as indicative of possible endometriosis. Further, some GPs reported some of the expressions to be indicative of other pathologies.Conclusion: Findings reveal the importance of language in pain communication and the need for additional tools to help women and doctors find the most effective way to communicate the experience and elicit appropriate investigative care. They also show the need for further investigation into how metaphor can be effectively used to improve patient-practitioner communication of endometriosis related pain.

The role of dementia diagnostic delay in the inverse cancer-dementia association

Background Cancer is inversely associated with dementia. Using simulations, we examined whether this inverse association may be explained by dementia diagnosis timing, including death before dementia diagnosis and differential diagnosis patterns by cancer history. Methods We used multistate Markov simulation models to generate cohorts 65 years of age and free of cancer and dementia at baseline; follow-up for incident cancer (all cancers, breast, prostate, and lung cancer), dementia, dementia diagnosis among those with dementia, and death occurred monthly over 30 years. Models specified no true effect of cancer on dementia, and used age-specific transition rates calibrated to US population and cohort data. We varied the average lapse between dementia onset and diagnosis, including non-differential and differential delays by cancer history, and examined observed incidence rate ratios (IRRs) for the effect of cancer on dementia diagnosis. Results Non-differential dementia diagnosis delay introduced minimal bias (IRRs=0.98-1.02) for all cancer, breast, and prostate models and substantial bias (IRR=0.78) in lung cancer models. For the differential dementia diagnosis delay model of all cancer types combined, simulation scenarios with ≥20% lower dementia diagnosis rate (additional 4.5-month delay) in those with cancer history versus without yielded results consistent with literature estimates. Longer dementia diagnosis delays in those with cancer and higher mortality in those with cancer and dementia yielded more bias. Conclusions Delays in dementia diagnosis may play a role in the inverse cancer-dementia relationship, especially for more fatal cancers, but moderate differential delays in those with cancer were needed to fully explain the literature-reported IRRs.

P052 Juvenile dermatomyositis, a multi-faceted disease

Background Dermatomyositis is a rare disease. In children, the incidence is 2–3 per million habitants. It is a serious disease whose mortality is &lt; 5% but whose complications and long-term prognosis remain pejorative for some children. The objective is to report the epidemiological, clinical, therapeutic options and the course of a retrospective series carried out at the CHU pediatric center of Sétif (Algeria) comprising 8 cases of juvenile dermatomyositis. Methods The mean age of onset is 7.7 years (0–15.5 years), The sex ratio was 0.1; The diagnosis delay averaged at 4, 4 months. At disease onset, 100% had rash, 84% a eyelids telangiectasias, 40% Gottron nodules, 90% muscular weakness, 40% arthritis, 13% fever, and 25% dysphagia. The muscular enzymes were increased in 8 cases. The DNA antibodies were present in one patient with myositis overlap, NXP was positive in one child. The electromyogram is myogenic in all patients. Seven patients underwent a histopathological exam, showing interstitial and parenchymal myositis. Treatment regimens were variable depending on the severity of the disease onset. All children were treated with steroids as the first line. Methotrexate was prescribed in 5 cases (62.5%). The immunoglobulin was indicated in 2 cases. The failure to thrive was observed in 2 (25%), and one child died following aspiration pneumonia. Results The dermatomyositis diagnosis is based on the Bohan and Peter criteria. The clinical characteristics of our series are in line with the literature data with a predominance of cutaneous and muscular involvement. However, some specificities are individualized: a case of overlapping myositis with lupus, a case of extensive calcinosis. The treatment was based on corticosteroids and methotrexate. Conclusion Dermatomyositis juvenile is a rare disease with a pejorative prognosis requiring a multidisciplinary management.

P029 Assessment of diagnosis delay during enthesitis related arthritis

Background Enthesitis related arthritis (ERA) is a distinct subgroup of juvenile arthritis characterized by male predominance and adolescent onset. Though, ERA patients still experience long diagnosis delays. This may lead to articular damage and functional disability. The aim of this study was to quantify the lag time between ERA symptoms onset and diagnosis and to evaluate its impact on disease activity, functional disability and structural damage. Methods A retrospective monocentric study was carried out on ERA patients. Diagnosis delay was collected from patients’ medical files. Disease activity was evaluated by: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional disability and structural damage were evaluated by Bath Ankylosing Spondylitis Fonctional Index (BASFI) and Bath Ankylosing Spondylitis Radiology Index (BASRI) respectively. Data were analyzed using the SPSS statistical package. A p-value &lt; 0.05 was considered significant. Results Thirty-four patients with a mean age of 23.8 ± 7.5 years were included. Male to female sex ratio was 3.85. Mean age at disease onset was 12 ± 2.6 years. Median disease duration was 108 months [12–408]. Median ERA diagnosis delay was 10 months [3–108]. Median ESR and CRP were 35 mm/h [8–90] and 20 mg/l [1–70] respectively. Median BASDAI score was 4.7 [1–9.7]. Median BASFI and BASRI scores were 4.6 [1.9–10] and 10 [2–16] respectively. Coxitis was found in 38.2% of cases. On statistical analysis, significant positive correlation was found between ERA diagnosis delay and ESR (P = 0.03, r = 0.69) and CRP (P = 0.05, r = 0.456) respectively. No link was noted between ERA diagnosis delay and these parameters: gender (P = 0.58), age at disease onset (P = 0.68), occurrence of coxitis (P = 0.66), BASFI (P = 0.08), BASDAI (P = 0.45) and BASRI (P = 0.12). Conclusion ERA patient’s journey was long in our study. Longer delays were associated with higher ESR and CRP levels. Further studies are required to confirm our results.

P077 Ultrasound features of a traumatic hip pain in paediatric population

Background Atraumatic hip pain in children is a serious condition that may require urgent investigations. Conventional radiographs are often normal in early stage of the diseases. However, further imaging techniques such as hip ultrasonography (US) are needed. The main objective of this study is to describe Hip ultrasound findings in patients with atraumatic hip pain. Methods We conduct a retrospective monocentric study. Children with atraumatic hip pain and undergoing joint ultrasound were included. Sociodemographic, clinical and biological characteristics were collected. The data were analyzed using the SPSS statistical package. Results: Thirty patients (21 boys and 9 girls) were enrolled. The male to female sex ratio was 2.3. Mean age at disease onset was 9.1 ± 4.6 [1.3–16]. Median diagnosis delay from symptoms onset was 1.2 months [0.2–48]. Chief complaints were as following: 80% of inflammatory hip pain (n = 24), 20% of mechanical hip pain (n = 6) 76.7% of limping (n = 23), 23.3% of functional impotence (n = 7) and 23.3% of fever (n = 7). Physical examination noted a pain on passive joint mobilization and restriction of hip movement in 90% (n = 27) and 54% (n = 18) of cases respectively. A biologic inflammatory syndrome was found in 66.6% of cases (n = 20). Median ESR and CRP were 30 mm/h [2–101] and 4.5 mg/l [1–38] respectively. Hip X-ray was abnormal in 46.6% (n = 14) of cases. All patients had hip ultrasound. US findings were as following: 80% (n = 24) of joint effusion, 50% (n = 15) of synovial thickening, 36.7% (n = 11) of synovitis and 23.3% (n = 7) of positive power Doppler signal. Hip Ultrasound was normal in 13.3% (n = 4) of cases. Causes of hip pain were in decreasing order of frequency: septic arthritis (n = 10), juvenile idiopathic arthritis (n = 10), transient synovitis (n = 7), osteoid osteoma (n = 2) and osteosarcoma (n = 1). Conclusion Hip Ultrasonography is a noninvasive and useful screening technique for the management of atraumatic hip pain in children. Though, imaging features are often various and nonspecific. Radiologists should be more familiar with sonographic anatomy of infant hip.