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Early diagnosis of cancer is one of the main objectives of the current Swedish cancer strategy. The government has thus commissioned the Swedish Council on Technology Assessment in Health Care (SBU) to in a systematic review evaluate if there are any scientifically proven methods, excluding screening, that can be used for the early and accurate diagnosis of cancer.
The objective of this systematic review was to assess the scientific basis for methods that might provide earlier cancer diagnosis in persons with symptoms or signs that might indicate cancer. Screening for cancer was not included in this assessment.
Delay in treatment is often defined as the patient, doctor, or system delay according to the phase in which the delay occurs. Patient delay is usually understood to be the time from the first symptoms to the first contact with the health care system. Such delay usually occurs due to neglect, fear of a serious disease, or not wanting to bother the doctor. Doctor delay is used to describe the delay that occurs due to mistakes, poor understanding of the patient’s symptoms, negligence, etc. System delay occurs due to poor organisation of the health care system or a lack of resources. These delays are usually assumed to occur in sequence one after another. Our understanding, however, is that the different delays overlap and sometimes can be difficult to separate from each other (figure 1). System delay can occur in all phases depending on how the management is organised, how resources are allocated and utilised, etc. For instance, poor accessibility to primary care caused by poor organisation or lack of resources can result in a person with symptoms choosing not to seek care at all. In this report, we focus on interventions that might shorten the time from the first symptom to the diagnosis in ambulatory care. Delays can, of course, also occur later in the course of the patient’s management, but such delays are not discussed in this report.
Figure 1. The components of delay.
A systematic review was undertaken following the standard methods used by the SBU. The review focused on patient’, doctor, and system delay from the first experience of symptoms and signs to the diagnosis of cancer in ambulatory care. We investigated interventions such as education, information, fast-tracks, guidelines, IT systems, structured referrals, telemedicine, etc. Outcomes were different lengths of time for the diagnostic process, the stage distribution at diagnosis, and survival rates. The evaluation included medical, economic, social, and ethical aspects of the different interventions.
In general, we need better knowledge on the psychological and social effects of different methods aiming to speed up cancer diagnosis. Intense information and education of the population as well as the introduction of fast-tracks might lead to reallocation or competition for resources that might actually increase delays for those who are not part of these interventions. This must be avoided.
How to cite this report: SBU. Early diagnosis of symptomatic cancer. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2014. SBU report no 222 (in Swedish).
presents a comprehensive, systematic assessment of available scientific evidence. The certainty of the evidence for each finding is systematically reviewed and graded. Full assessments include economic, social, and ethical impact analyses.
SBU assessments are performed by a team of leading professional practitioners and academics, patient/user representatives and SBU staff. Prior to approval and publication, assessments are reviewed by independent experts, SBU’s Scientific Advisory Committees and Board of Directors.