Multiple levels of delay in the management of musculoskeletal tumours in Nigeria

Abstract

Introduction: Musculoskeletal tumours are comparatively rare tumours and rank in the top 10 of all tumours in both sexes at the Ibadan tumour registry. Early diagnosis and multimodality treatments have been shown to improve outcomes. In our environment, patients with these tumours
tend to present late. The aim of the study was to characterise the causes and levels of delay in their management.                                                  Patients and Methods: This was a five year (January 2006-December 2010) review of all orthopaedic patients with diagnosis of musculoskeletal tumour who had surgery at the University College Hospital, Ibadan. From the case notes of these patients, the following specific time frames were extracted: patient delay, doctor delay, referral interval, specialist delay, symptom interval and histopathology wait time.
Results: Fifty-nine patients had biopsies/procedures for tumours over the 5 year study period. The biopsies were for giant cell tumours (24.1%), Osteogenic Sarcoma (10.3%) and Osteochondromas (10.3%). The Median Patient delay was 50 weeks (range 3-11 44weeks) while the Median
Doctor delay was 8 weeks (range 1 108 weeks). The Median Histology interval was 3 weeks (range 1 13 weeks). The Median Referral interval was 4.3 weeks (range 0-56), while the Mean Specialist delay was 12 weeks (range 1-108 weeks). The Median Symptom interval was 61 weeks (range 15-1200 weeks). Nine patients (28.1%) had visited alternative medical practitioners before presenting at the hospital. Eleven patients (34.4%) were lost to follow-up and 10 (31.3%) had documented improvement. Females were found to have a significantly longer symptom interval.
Conclusion: Many patients with musculoskeletal tumours visit alternative medical practitioners. Significant professional delays still exists in the care of patients with musculoskeletal tumours. Incorporating bone setters into the healthcare system and educating primary care doctors
would help to reduce these delays.