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Delay in Diagnosis and Its Effect on Clinical Outcome in High-grade Sarcoma of Bone: A Referral Oncological Centre
Louren M Goedhart1, Jasper G Gerbers1, Joris J W Ploegmakers1
1Department of Orthopaedics, University Medical Center, University of Groningen, Groningen, The Netherlands.
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 Ewing 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 Ewing 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.
