Delay in diagnosis amongst carcinoma lung patients presenting at a tertiary respiratory centre

Objective: To determine time delay from the onset of initial symptoms to diagnosis of primary lung cancer. Materials and Methods: Selected information was captured from 49 consecutive pathologically proven cancer lung patients presenting to a tertiary respiratory centre during 1 ^st January to 30 ^th June 2012 using semi-structured interview schedule. All patients underwent suitable protocol based diagnostic work-up and referral. Results: Background profile of patient was as follows: Male:Female = 7.1:1; mean age was 61.2 (±9.7) years; Nine out of 49 (18.4%) patients were illiterate; Forty-three out of 49 (87.8%) belonged to rural native place; Forty-three out of 49 (87.7%) were smokers with 25 years as median pack-years. Histological profile showed that adenocarcinoma (40.8%) was the predominant form followed by small cell carcinoma (32.7%). Time (median) delay in diagnosis was 3.0 days (home remedies/quack therapy), 60.0 days (primary/secondary level) and 8 days at tertiary level. Twenty seven of 49 patients (55.1%) presented in stage-IV. Higher proportion of patients residing outside the district of study institute had longer delay in diagnosis but did not reach statistical significance (P > 0.05). The most important patient reasons for the delay in diagnosis was procrastinate/did not took symptoms seriously (19/49, 38.7%); no-body to escort (13/49, 26.5%), long distance (5/49, 10.2%), financial constraints (4/49, 8.1%), preferred local practitioner (2/49, 4.0%), family commitment/marriage (2/49, 4.0%), fear of death (1/49, 2.0%) and no reason cited (3/49, 6.1%). Three patients were inadvertently diagnosed as tuberculosis and hence the delay. Conclusion: Patient presented at a higher stage within a short span of time; however, there is scope of increasing health system capacity at primary/secondary level including sensitization training, health communication and appropriate referral to higher center.