DELAYS IN INITIAL REFERRAL, DIAGNOSIS AND TREATMENT IN CHILDREN WITH CANCER

Öz

Objective: Cancer has been one of the most critical health problems during the past decades which requires serious consideration, especially in developing countries. Methods: 80 parents of children with different types of cancers were studied via both questionnaire and person-to-person interviews after declaring their informed consent. Results: The highest delay in patients’ initial referral was due to the following factors: lack of attention or ignoring the first symptoms, delay in referring to the physician, low economic status and even lack of family support for the patient. In addition, visiting several doctors after the initial diagnosis, uncertainty about the first proposed method, and the high cost of treatment can be mentioned as the main causes of delays in the start of treatment. Conclusion: Education plays an important role in identifying the signs of cancer. In addition, proper relationship and cooperation between the health system and physicians as well as provision of adequate information to patients could lead to the long-term cooperation of these patients in continuing their treatment.

Anahtar Kelimeler

• Cancer
• delay in referral
• children
• delay in diagnosis
• delay in treatment

KANSERLİ ÇOCUKLARDA İLK YÖNLENDİRME, TANI VE TEDAVİDE GECİKMELER

Öz

Amaç: Kanser, son yıllarda, özellikle gelişmekte olan ülkelerde, ciddi dikkat gerektiren en kritik sağlık sorunlarından biri olmuştur. Yöntem: Farklı kanser türlerine sahip çocukların 80 ebeveyni aydınlatılmış onamları alındıktan sonra hem anket hem de bire bir görüşme yoluyla incelenmiştir. Bulgular: Hastaların ilk sevkindeki gecikmeler, aşağıdaki faktörlerden kaynaklanmaktadır: dikkat eksikliği veya ilk semptomları görmezden gelme, doktora başvurmada gecikme, düşük ekonomik durum ve hatta hasta için aile desteği eksikliği. Ek olarak, ilk tanıdan sonra farklı doktorlara başvurmak, önerilen ilk yöntem hakkında belirsizlik ve yüksek tedavi maliyeti, tedavinin başlangıcındaki gecikmelerin ana nedenleri olarak gösterilebilir. Sonuç: Eğitim, kanser belirtilerini anlamada önemli bir rol oynamaktadır. Buna ek olarak, sağlık sistemi ve doktorlar arasında ilişki ve işbirliği ile hastalara yeterli bilgi sağlanması, bu hastaların tedavilerini sürdürmede önemli faktörler olarak görünmektedir.

Anahtar Kelimeler

• Kanser
• sevkte gecikme
• çocuk
• tanıda gecikme
• tedavide gecikme

Kaynakça

1. 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30. [CrossRef]
2. 2. Manohar PR, editor. Descriptions and Classification of Cancer in the Classical Ayurvedic Texts. Indian Nat Sci Acad; 2015. [CrossRef]
3. 3. DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252-71. [CrossRef]
4. 4. Girgis A, Lambert S, Johnson C, Waller A, Currow D. Physical, psychosocial, relationship, and economic burden of caring for people with cancer: a review. J Oncol Pract 2012;9:197-202. [CrossRef]
5. 5. Chan CMH, Ahmad W, Azman W, MD Yusof M, Ho GF, Krupat E. Effects of depression and anxiety on mortality in a mixed cancer group: a longitudinal approach using standardised diagnostic interviews. Psychooncology 2015;24:718-25. [CrossRef]
6. 6. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005;353:178492. [CrossRef]
7. 7. Walter F, Webster A, Scott S, Emery J. The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy 2012;17:110-8. [CrossRef]
8. 8. Ermiah E, Abdalla F, Buhmeida A, Larbesh E, Pyrhönen S, Collan Y. Diagnosis delay in Libyan female breast cancer. BMC Res Notes 2012;5:452. [CrossRef]

9. 9. Stefan DC, Siemonsma F. Delay and causes of delay in the diagnosis of childhood cancer in Africa. Pediatr Blood Cancer 2011;56:80-5. [CrossRef]
10. 10. Brown BJ, Adeleye AO, Ibeh JN. A prospective study on the causes of delayed diagnosis of childhood cancer in Ibadan, Nigeria. Pediatr Hematol Oncol 2015;32:365-73. [CrossRef]
11. 11. Murata C, Yamada T, Chen C-C, Ojima T, Hirai H, Kondo K. Barriers to health care among the elderly in Japan. Int J Environ Res Public Health 2010;7:1330-41. [CrossRef]
12. 12. Farmer J, Iversen L, Campbell NC, Guest C, Chesson R, Deans G, et al. Rural/urban differences in accounts of patients’ initial decisions to consult primary care. Health Place 2006;12:210-21. [CrossRef]
13. 13. Harirchi I, Ghaemmaghami F, Karbakhsh M, Moghimi R, Mazaherie H. Patient delay in women presenting with advanced breast cancer: an Iranian study. Public Health 2005;119:885-91. [CrossRef]
14. 14. Meraviglia MG. Prayer in people with cancer. Cancer Nurs 2002;25:326-31. [CrossRef]
15. 15. Rezaei M, Adib-Hajbaghery M, Seyedfatemi N, Hoseini F. Prayer in Iranian cancer patients undergoing chemotherapy. Complement Ther Clin Pract 2008;14:90-7. [CrossRef]
16. 16. Sampson R, Cooper J, Barbour R, Polson R, Wilson P. Patients’ perspectives on the medical primary-secondary care interface: systematic review and synthesis of qualitative research. BMJ Open 2015;5:e008708.