背景:与儿科诊断延迟相关的社会人口统计学和临床因素,青春期,对年轻成人癌症了解甚少。
方法:使用OptumLabsDataWarehouse\对商业健康计划登记者的去识别索赔数据,我们确定了2001年至2017年被诊断患有10种常见癌症之一的儿童(0-14岁)和青少年/年轻人(AYAs)(15-39岁),这些患者在诊断前连续入组6个月.诊断时间计算为第一次医疗遇到可能的癌症症状和癌症诊断日期之间的天数。使用Wilcoxon秩和检验比较从首发症状到诊断的中位时间。多变量非条件逻辑回归确定了与癌症诊断(从症状发作开始)的较长时间(>3个月)相关的社会人口统计学因素。
结果:在47,296名患者中,87%在诊断前出现症状。中枢神经系统(CNS)肿瘤患者最有可能出现症状(93%)。而宫颈癌患者的可能性最小(70%)。症状因恶性肿瘤而异。有症状的患者,甲状腺癌(105天[范围:50-154])和宫颈癌(104天[范围:41-151])的中位诊断时间最长.年龄范围两端的女性和患者更有可能经历超过3个月的诊断延迟。
结论:在有商业保险的人群中,诊断时间因癌症类型而异,年龄,和性爱。需要进一步的工作来了解病人,提供者,以及从症状发作到诊断时间的卫生系统水平因素,特别是在非常年幼的儿童和年轻的成年患者群体中。
BACKGROUND: Sociodemographic and clinical factors associated with diagnostic delays in pediatric, adolescent, and young adult cancers are poorly understood.
METHODS: Using the Optum Labs Data Warehouse\'s de-identified claims data for commercial health plan enrollees, we identified children (0-14 years) and adolescents/young adults (AYAs) (15-39 years) diagnosed with one of 10 common cancers from 2001 to 2017, who were continuously enrolled for 6 months preceding diagnosis. Time to diagnosis was calculated as days between first medical encounter with possible cancer symptoms and cancer diagnosis date. Median times from first symptom to diagnosis were compared using Wilcoxon rank sum test. Multivariable unconditional logistic regression identified sociodemographic factors associated with longer time (>3 months) to cancer diagnosis (from symptom onset).
RESULTS: Of 47,296 patients, 87% presented prior to diagnosis with symptoms. Patients with central nervous system (CNS) tumors were most likely to present with symptoms (93%), whereas patients with cervical cancer were least likely (70%). Symptoms varied by malignancy. Of patients with symptoms, thyroid (105 days [range: 50-154]) and cervical (104 days [range: 41-151]) cancer had the longest median time to diagnosis. Females and patients at either end of the age spectrum were more likely to experience diagnosis delays of more than 3 months.
CONCLUSIONS: In a commercially insured population, time to diagnosis varies by cancer type, age, and sex. Further work is needed to understand the patient, provider, and health system-level factors contributing to time from symptom onset to diagnosis, specifically in the very young children and the young adult patient population going forward.