The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting

Simple item page
dc.contributor.authorAntel, Katherine
dc.contributor.authorLevetan, Carly
dc.contributor.authorMohamed, Zainab
dc.contributor.authorLouw, Vernon J
dc.contributor.authorOosthuizen, Jenna
dc.contributor.authorMaartens, Gary
dc.contributor.authorVerburgh, Estelle
dc.date.accessioned2019-06-13T06:20:10Z
dc.date.available2019-06-13T06:20:10Z
dc.date.issued2019-04-25
dc.date.updated2019-04-28T03:35:47Z
dc.description.abstractBackground Little is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV. Methods We analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay. Results Patients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1–5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1–8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3–2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival. Conclusions Time-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma.
dc.identifier.apacitationAntel, K., Levetan, C., Mohamed, Z., Louw, V. J., Oosthuizen, J., Maartens, G., & Verburgh, E. (2019). The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting. <i>BMC Cancer</i>, http://hdl.handle.net/11427/30212en_ZA
dc.identifier.chicagocitationAntel, Katherine, Carly Levetan, Zainab Mohamed, Vernon J Louw, Jenna Oosthuizen, Gary Maartens, and Estelle Verburgh "The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting." <i>BMC Cancer</i> (2019) http://hdl.handle.net/11427/30212en_ZA
dc.identifier.citationAntel, K., Levetan, C., Mohamed, Z., Louw, V. J., Oosthuizen, J., Maartens, G., & Verburgh, E. (2019). The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting. BMC cancer, 19(1), 384.
dc.identifier.ris TY - AU - Antel, Katherine AU - Levetan, Carly AU - Mohamed, Zainab AU - Louw, Vernon J AU - Oosthuizen, Jenna AU - Maartens, Gary AU - Verburgh, Estelle AB - Background Little is known about the pathway to diagnosis of lymphoma in Sub-Saharan Africa, despite the increased risk of lymphoma in people living with HIV (PLHIV). The challenges of diagnosis in this setting include diagnostic confusion with extrapulmonary tuberculosis (EPTB), which commonly causes lymphadenopathy in PLHIV. Methods We analysed the time to diagnosis and treatment in patients using predetermined time intervals. Univariate and multivariable analyses were performed to determine the relationship between patient and disease-specific variables with delays to diagnosis. We were particularly interested in the impact of HIV, empiric tuberculosis therapy and fine-needle aspirate for cytology (FNAC) in contributing to delay. Results Patients (n = 163), 29% HIV-infected, waited a median of 4 weeks before seeking medical attention. It took a median of 7 weeks for the diagnosis of lymphoma to be made from the time the patient sought medical attention, termed the healthcare practitioner interval. In multivariable logistic regression analysis, diagnostic delay > 6 weeks was associated with late-stage disease (OR 2.3, 95% CI 1.1–5.2) and Hodgkin lymphoma (HL) (OR 3.0, 95% CI 1.1–8.0). HIV status was not associated with diagnostic delay (OR 0.9, 95% CI 0.3–2.2). The median time to diagnosis was a median of 4 weeks longer for patients on tuberculous (TB) therapy (n = 16, p = 0.28) and patients who underwent an FNAC (n = 63, p = 0.04). Where FNAC was performed, it was diagnostic for lymphoma in only 11%. Diagnostic delay was not associated with overall survival. Conclusions Time-to-diagnosis of lymphoma in South Africa was similar to that reported from high-income countries and shows significant periods of delay between the onset of symptoms to diagnosis and treatment. The longest period of delay was in the health practitioner interval. Education regarding the significance of lymphadenopathy for both patients and health care practitioners and appropriate investigative steps preferably by best-practice algorithms specific to TB-endemic areas are needed to shorten the time-to-diagnosis of lymphoma. DA - 2019-04-25 DB - OpenUCT DP - University of Cape Town J1 - BMC Cancer KW - Lymphoma KW - Diagnosis KW - Tuberculosis KW - HIV KW - FNAC (fine-needle aspiration) LK - https://open.uct.ac.za PY - 2019 T1 - The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting TI - The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting UR - http://hdl.handle.net/11427/30212 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12885-019-5586-4
dc.identifier.urihttp://hdl.handle.net/11427/30212
dc.identifier.vancouvercitationAntel K, Levetan C, Mohamed Z, Louw VJ, Oosthuizen J, Maartens G, et al. The determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting. BMC Cancer. 2019; http://hdl.handle.net/11427/30212.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.sourceBMC Cancer
dc.source.urihttps://bmccancer.biomedcentral.com/
dc.subjectLymphoma
dc.subjectDiagnosis
dc.subjectTuberculosis
dc.subjectHIV
dc.subjectFNAC (fine-needle aspiration)
dc.titleThe determinants and impact of diagnostic delay in lymphoma in a TB and HIV endemic setting
dc.typeJournal Article
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Antel et al._2019_Article.pdf
Size:
1.61 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
0 B
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Journal Articles