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Symptom duration and delay in referral for palliative radiotherapy in cancer patients: a pilot study
1Peter MacCallum Cancer Institute, Melbourne, VIC. awirth@petermac.unimelb.edu.au
Objective:
To estimate the frequency of delay in referral for palliative radiotherapy (PRT), and to identify factors associated with delay.
Design:
Prospective survey over three months in 1997.
Setting:
Radiotherapy department of a cancer centre in Melbourne, Victoria.
Participants:
158 consecutive patients prescribed PRT in the lung, breast, urology and haematology units.
Main Outcome Measures:
Duration of symptoms; incidence of "unreasonable" delay in referral; and incidence of negative clinical outcome associated with referral delay.
Results:
The median duration of symptoms before prescription of radiotherapy was four weeks. Thirty-eight patients (24%) were considered to have had an unreasonable delay in referral, with median symptom duration of 15 weeks, and median delay in referral of 12 weeks. Causes of delay were classified as "diagnostic uncertainty" (29%), "other treatment given" (18%), "patient related" (18%), "language difficulty" (3%), and "unexplained" (32%). Twenty-seven of these 38 patients (71%) had negative outcomes, including persistent pain, neurological deterioration and persistent respiratory symptoms.
Conclusions:
These data suggest that delay in referral for PRT is not uncommon, has a variety of causes and can result in negative clinical outcomes. There appears to be a need for greater awareness of patients' symptoms and of the role of PRT among clinicians caring for patients with cancer.