Timeline of Cancer Diagnosis and Treatment in Malaysia: A Multicentre Cross-sectional Study

Introduction Cancer is the fourth common cause of death in Malaysia and late presentation (Stage III and IV) is one of the primary challenges. This study explores the timeline from symptoms onset to initiation of cancer treatment among breast, cervical, colorectal, and nasopharyngeal cancer patients.     

Methodology This is a multicentre cross-sectional study involving adult patients with primary tumour diagnosed from 2015 to 2020 in eight public hospitals. Data on sociodemographic, time interval from onset to first medical consultation (Patient interval, PI), and from consultation to diagnosis (Diagnostic interval, DI) were collected using self-administered survey; while diagnosis to treatment initiation (Treatment interval, TI) from medical records.    

Results 596 patients were recruited with the distribution of 244 (40.9%), 156 (26.2%), 116 (19.5%) and 80 (13.4%) for breast, colorectal, nasopharyngeal, and cervical cancer, respectively. The overall median PI, DI and TI were 20 days (Interquartile range IQR: 74.0), 39 days (IQR: 71.5) and 37 days (IQR: 41.0), respectively. PI is the shortest median interval across all cancer types ranging from 7.0 days (IQR: 61.0) to 36 days (IQR: 141). DI is the longest median interval across the cancer types ranging from 33 days (IQR: 75) to 49 days (IQR: 81). Breast cancer timelines are closest to the World Health Organization's recommendations of one month target indicator per interval.   

Discussion  Strategies to shorten DI across cancer types is imperative towards improving cancer outcomes. As the interval performances varied between cancer types, it is recommended for early diagnosis interventions to be cancer specific.    

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