SYMPTOM DURATION AND DELAY IN REFERRAL FOR PALLIATIVE RADIOTHERAPY INCANCER-PATIENTS - A PILOT-STUDY

Objective: To estimate the frequency of delay in referral for palliati ve radiotherapy (PRT), and to identify factors associated with delay. Design: Prospective survey over three months in 1997. Setting: Radioth erapy department of a cancer centre in Melbourne, Victoria. Participan ts: 158 consecutive patients prescribed PRT in the lung, breast, urolo gy and haematology units. Main outcome measures: Duration of symptoms; incidence of ''unreasonable'' delay in referral; and incidence of neg ative clinical outcome associated with referral delay. Results: The me dian duration of symptoms before prescription of radiotherapy was four weeks. Thirty-eight patients (24%) were considered to have had an unr easonable delay in referral, with median symptom duration of 15 weeks, and median delay in referral of 12 weeks. Causes of delay were classi fied as ''diagnostic uncertainty'' (29%), ''other treatment given'' (1 8%), ''patient related'' (18%), ''language difficulty'' (3%), and ''un explained'' (32%). Twenty-seven of these 38 patients (71%) had negativ e outcomes, including persistent pain, neurological deterioration and persistent respiratory symptoms. Conclusions: These data suggest that delay in referral for PRT is not uncommon, has a variety of causes and can result in negative clinical outcomes. There appears to be a need for greater awareness of patients' symptoms and of the role of PRT amo ng clinicians caring for patients with cancer.