Age, other factors linked to delays in melanoma diagnosis
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GENEVA — Factors such as age and comorbidities appeared associated with longer time to melanoma diagnosis, according to study results presented at World Cancer Congress.
The diagnostic interval exceeded 1 month for about half of patients analyzed and approached 5 months for 10% of patients.
Rationale and methods
“The diagnostic period is a time of great anxiety for patients and their families, and delays in diagnosis can lead to increased patient anxiety and — in some cases — can lead to disease progression,” Meaghan Mavor, PhD candidate in the department of epidemiology at Queen’s University in Ontario, Canada, said during a presentation. “The purpose of this study was to determine the melanoma diagnostic interval using administrative health data, and to determine factors associated with a longer or shorter diagnostic interval.”
Mavor and colleagues conducted a cross-sectional study that included 33,371 patients in Ontario diagnosed with melanoma between 2007 and 2019.
Researchers used administrative health data to measure the diagnostic interval, defined as the time between a patient’s first cancer-related encounter with the health system and diagnosis. They also measured the primary care subinterval — defined as the time between patients’ first cancer-associated encounter with a general practitioner or non-melanoma specialist and first melanoma-related specialist visit or diagnosis — and the specialist care subinterval, defined as the time between the first cancer-related encounter with a melanoma-related specialist and diagnosis.
Investigators used multivariable quantile regression to assess independent associations between certain variables and the median and 90th percentiles of each interval.
Key findings
Results showed a median diagnostic interval of 36 days (interquartile range [IQR], 8-85), median primary care subinterval of 22 days (IQR, 6-54) and median specialist care subinterval of 6 days (IQR, 1–42).
Half of patients had a diagnostic interval longer than 36 days, and 10% of patients had a diagnostic interval longer than 142 days.
“We did not find significant differences in any interval according to sex, but we did find that older patients had a shorter [diagnostic interval at the 90th percentile] compared with younger patients. This was also evident in the primary care subinterval,” Mavor said.
Patients with more comorbidities experienced longer intervals at the 90th percentile than those with fewer comorbidities.
Those with a prior history of nonmelanoma skin cancer and those previously established with a dermatologist additionally experienced longer intervals at the median and 90th percentiles.
Patients who resided in the most deprived neighborhoods had shorter diagnostic interval and primary care subinterval, and those who lived in rural areas had longer diagnostic intervals than those who lived in major urban areas.
Clinical implications
“More than half of all patients in Ontario are experiencing diagnostic waits that exceed our provincial target of 28 days and the diagnostic interval varies greatly across the province, with differences of up to 16 days across regions,” Mavor said. “This large variation suggests that system-level factors may be partially responsible for longer diagnostic intervals.”
Future studies should examine the differential importance of the diagnostic interval, primary care subinterval and specialist care subinterval on outcomes, researchers concluded.
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Mavor M, et al. Abstract 923. Presented at: World Cancer Congress; Oct. 18-20, 2022; Geneva.
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