Incidence and outcomes of delayed presentation and surgery in peritoneal surface malignancies

Jun Kiat Thaddaeus Tan; Jolene Si Min Wong; Chin Jin Seo; Cindy Lim; Hong-Yuan Zhu; Chin-Ann Johnny Ong; Claramae Shulyn Chia

doi:10.3389/fonc.2023.1137785

Incidence and outcomes of delayed presentation and surgery in peritoneal surface malignancies

Front Oncol. 2023 May 30:13:1137785. doi: 10.3389/fonc.2023.1137785. eCollection 2023.

Authors

Jun Kiat Thaddaeus Tan^{1

2}, Jolene Si Min Wong^{1

2

3

4}, Chin Jin Seo^{1

2

3

4}, Cindy Lim⁵, Hong-Yuan Zhu^{1

2}, Chin-Ann Johnny Ong^{1

2

3

4

6

7}, Claramae Shulyn Chia^{1

2

3

4}

Affiliations

¹ Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, Singapore.
² Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
³ SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
⁴ SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
⁵ Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore.
⁶ Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, Singapore.
⁷ Institute of Molecular and Cell Biology, A*STAR Research Entitie, Singapore, Singapore.

Abstract

Background: Peritoneal surface malignancies (PSM) present insidiously and often pose diagnostic challenges. There is a paucity of literature quantifying the frequency and extent of therapeutic delays in PSM and its impact on oncological outcomes.

Methods: A review of a prospectively maintained registry of PSM patients undergoing Cytoreductive Surgery and Hyperthermic Intra-peritoneal Chemotherapy (CRS-HIPEC) was conducted. Causes for treatment delays were identified. We evaluate the impact of delayed presentation and treatment delays on oncological outcomes using Cox proportional hazards models.

Results: 319 patients underwent CRS-HIPEC over a 6-years duration. 58 patients were eventually included in this study. Mean duration between symptom onset and CRS-HIPEC was 186.0 ± 37.1 days (range 18-1494 days) and mean duration of between patient-reported symptom onset and initial presentation was 56.7 ± 16.8 days. Delayed presentation (> 60 days between symptom onset and presentation) was seen in 20.7% (n=12) of patients and 50.0% (n=29) experienced a significant treatment delay of > 90 days between 1^st presentation and CRS-HIPEC. Common causes for treatment delays were healthcare provider-related i.e. delayed or inappropriate referrals (43.1%) and delayed presentation to care (31.0%). Delayed presentation was a significantly associated with poorer disease free survival (DFS) (HR 4.67, 95% CI 1.11-19.69, p=0.036).

Conclusion: Delayed presentation and treatment delays are common and may have an impact on oncological outcomes. There is an urgent need to improve patient education and streamline healthcare delivery processes in the management of PSM.

Keywords: cytoreductive surgery; delay; hyperthermic intraperitoneal chemotherapy; peritoneal malignancy; survival.

Grants and funding

This study is supported by the NCCS Cancer Fund (Research) and SingHealth Duke-NUS Academic Medicine Centre, facilitated by Joint Office of Academic Medicine (JOAM). JCO is supported by the National Research Council Clinician Scientist-Individual Research Grant (CIRG21jun-0038). All the funding sources had no role in the study design, data interpretation or writing of the manuscript.