Pathways to ovarian cancer diagnosis: a qualitative study

Lawson-Michod, Katherine A.; Watt, Melissa H.; Grieshober, Laurie; Green, Sarah E.; Karabegovic, Lea; Derzon, Samantha; Owens, Makelle; McCarty, Rachel D.; Doherty, Jennifer A.; Barnard, Mollie E.

doi:10.1186/s12905-022-02016-1

BMC Women's Health

Table 2 Ovarian cancer patient characteristics, key features of patient paths to diagnosis, and duration of MPT intervals

From: Pathways to ovarian cancer diagnosis: a qualitative study

ID	Age^a	Stage^a	Histology	Routine healthcare^b	Referral pathway^c	Symptoms	Providers consulted	Appraisal and help-seeking duration (months)	Diagnostic interval duration (months)	Pre-treatment interval duration (months)	Total MPT interval duration (months)	Time from diagnosis to interview (years)
5	55	IV	SC NOS	Yes	Secondary	FS: urinary frequency RFH: urinary frequency, incontinence, bloating, back pain, palpable mass	1st gastroenterologist, naturopath, 2nd gastroenterologist (×2)	12.17	45	0.13	57.30	2.66
4	64	IV	SC NOS	No	Secondary	FS: abdominal pain, bloating and flatulence, RFH: lump in armpit	PCP, general surgeon, radiologist	12.17	0.63	0.33	13.13	2.82
1	66	IV	HGSC	Yes	Direct	RFH: rapid weight gain	PCP	0.23	NE	0.40	0.63	1.42
12	78	IV	SC NOS	No	Secondary	FS: weight gain RFH: abdominal pain	ED physician, outpatient physician NOS	12	0.33	0.20	12.53	1.33
11	68	IV	HGSC	Yes	Secondary	RFH: difficulty breathing	PCP, ED physician	3	0.23	1.00	4.23	0.71
9	70	IV	C NOS	Yes	Secondary	FS/RFH: neck mass	PCP, ENT	1.37	0.6	0.03	2.00	0.84
10	69	IV	HGSC	Yes	Secondary	RFH: difficulty breathing	Urgent care provider, ED physician, PCP	NA	0.25	0.40	0.65	0.62
13	29	III	Dys	Yes	Direct	FS: tongue sores (“immune reaction”) RFH: abnormal periods, weight gain	PCP	29.43	12	0.20	41.63	0.80
14	72	III	HGSC	Yes	Secondary	RFH: bladder discomfort	Gynecologist, PCP, initial gynecologist	2	0.97	0.13	3.10	1.12
8	48	III	Dys	Yes	Secondary	FS/RFH: cough	Urgent care provider, PCP, pulmonologist	0.5	1.9	0.03	2.43	1.30
15	59	III	HGSC	Yes	Direct	RFH: abdominal pain	PCP	NA	0.75	0.40	1.15	1.13
2	53	II	SC NOS	Yes	Direct	FS: urinary incontinence, back pain RFH: vaginal bleeding	Midwife	0.33	0.17	0.43	0.93	2.21
7	46	I	SC NOS	Yes	ED Direct	FS: urinary incontinence, back pain RFH: back pain, nausea	Massage therapist, ED physician	54	0	0.57	54.57	0.79
6	57	I	EA NOS	No	ED Direct	FS: abdominal pain RFH: worsening of abdominal pain, and dry heaving	ED physician	1.1	0.1	0.03	1.23	3.36

Abbreviations: Unk Unknown, HGSC high grade serous carcinoma, SC serous carcinoma, EA endometrioid adenocarcinoma, Dys dysgerminoma, C carcinoma, NOS not otherwise specified, RFH reason for help-seeking, FS first symptom, PCP primary care provider, ED emergency department, ENT ear nose and throat, NE could not estimate based on transcripts, NA not applicable, Dx diagnosis. ^aAge and stage defined at diagnosis. ^bRoutine healthcare defined by seeing a health care provider for routine care within 12 months of diagnosis. ^cReferral pathways were defined as follows: “direct” patients were seen by an outpatient provider and directly referred by the same provider to gynecologic oncology; “secondary” patients consulted with ≥2 providers prior to receiving a referral to gynecologic oncology; “ED direct” patients first sought help in the emergency department and were directly referred from the ED to gynecologic oncology. Durations of the MPT intervals (Columns 9–13) were estimated from patient narratives. The aggregate appraisal and help-seeking interval was estimated from a patient’s first detection of a symptom to consult with a healthcare provider. The diagnostic interval was defined from first consult with a healthcare provider to receipt of ovarian cancer diagnosis. The pre-treatment interval was defined from the time of ovarian cancer diagnosis to the start of treatment

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ISSN: 1472-6874

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