Delay in cancer diagnosis: the reasons may start in childhood

Author(s)

Bruna Amélia Moreira Sarafim. Silva

• Document type: Doctoral Thesis
• Press: Araçatuba. 2022-04-07.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Odontologia. Araçatuba
• Defense date: 2022-02-15
• Advisor: Daniel Galera Bernabé

Abstract

Delay in the diagnosis of cancer retard the initiation of treatment and has an adverse impact on the patient's prognosis. Although childhood trauma is a common reality in the lives of individuals, the science of its occurrence and consequences are still neglected in patients with chronic diseases. Studies by our team and others have shown evidence of the consequences of childhood trauma on emotional, behavioral and clinicopathological aspects in cancer patients. However, to date, there are no studies that have evaluated the association of childhood trauma with delay in cancer diagnosis. The objective of the present research was to evaluate, for the first time, the relationship between the occurrence of childhood trauma and the delay time for the diagnosis of the disease in a group of patients with head and neck cancer (HNC). In this cross-sectional study, 111 patients with head and neck cancer were evaluated regarding predicting factors for the patient's prolonged time to seek care and their trajectory in the health system until the diagnosis of the disease. The cut-off point for evaluating the delay for diagnosis was 3 months, considering up to 3 months as the shortest delay and more than 3 months as the longest delay. Demographic, clinicopathological and behavioral data were extracted from the patients' records. The Childhood Trauma Questionnaire (CTQ) was used to assess the occurrence of childhood trauma. Multiple regression analyzes were used to assess the association of demographic, behavioral, and clinicopathological variables, as well as the occurrence of childhood trauma with time delay for the diagnosis of cancer. The results showed that the average delay for HNC patients to seek care after noticing the first sign of the disease was 129.50 days, and the average delay time between the patient seeking the first healthcare professional after noticing the tumor and receiving the definitive diagnosis of cancer was 196.43 days. The childhood physical abuse occurrence was an independent variable for the patient's longer delay in seeking first care after having noticed the first symptom of cancer (OR = 3.22, CI = 1.020-10.183, p = 0.046). Patients who had the tumor located in the larynx (OR = 13.5, CI = 2.645-69.355, p = 0.002) and had a history of childhood emotional abuse (OR = 6.7, CI = 1.974-23.293, p = 0.002) were more likely to have a time greater than 3 months between the first consultation at a health service and receiving the diagnosis of cancer. Female patients (OR = 5.6, CI = 1.658-18.934, p = 0.006) and with the tumor located in the larynx (OR = 11.2, CI = 2.204-56.987, p = 0.004), had a longer delay between noticing the first symptom and being diagnosed with the disease. In conjunction with clinicopathological factors, the history of traumatic experiences in childhood may be predictive of a longer delay in the cancer patient seeking health services and receiving the diagnosis. The results of the present study should encourage the reduction of childhood trauma to be considered in the development of strategies for secondary cancer prevention. (AU)

• FAPESP's process: 18/06927-2 - Childhood trauma in head and neck cancer patients: effects on the delay diagnosis, psychological stress, inflammatory mediators and disease prognosis
• Grantee: Bruna Amélia Moreira Sarafim da Silva
• Support Opportunities: Scholarships in Brazil - Doctorate