"Systematic review of patient-mediated delay in presentation of cancer and provider-mediated delay and variation in onward referral for treatment"

Project aims and objectives

Patient delay in responding to symptoms of cancer may be associated with later stage of disease at presentation and shorter overall survival. Equally, delays and variations in onward referral by health professionals for treatment may prejudice survival. It is now timely to undertake a systematic critical review of the literature in this area. Data will be sought on the extent of patient-mediated delay in initial presentation and provider-mediated delay and variation in onward referral for treatment. Evidence for the influence of socio-demographic factors on delay and survival will be collated. Similarly information on why patient delays occur in terms of the influence of psychosocial factors and nature of symptoms, will be evaluated. Reasons for provider-mediated delays and variations in onward referral for treatment will be reviewed. Evidence regarding the effectiveness and cost-effectiveness of strategies to reduce patient and provider-mediated delays and provider-mediated variations in onward referral will be evaluated. It is expected that the review will result in recommendations for further research and development initiatives to reduce mortality and morbidity from cancer in patients presenting with symptomatic disease by reducing both patient delays in the instigation of treatment and provider delays and variation in onward referral. 


Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 1999;353:1119-1126

Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA.  Factors predicting delayed presentation of symptomatic breast cancer: a systematic review.  Lancet 1999;353:1127-1131

Further information may be obtained from:

Professor Amanda Ramirez                                                                     Department of Liaison Psychiatry                                                                    Adamson Centre for Mental Health 
St.Thomas' Hospital
Lambeth Palace Road                                                                                       London                      SE1 9RT

Phone:  0171 960 5734
Fax: 0171 960 5719
e-mail: amanda-jane.ramirez@kcl.ac.uk

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Last updated 22 November 2004
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