A systematic review of factors associated with the patient and diagnostic intervals in gastric cancer.

Abstract

Introduction: Many patients with gastric cancer in low-incidence countries are diagnosed at advanced stages, underscoring the need for earlier detection to enable curative treatment. This systematic review aimed to summarize risk factors affecting the patient interval (symptom recognition to first contact with a healthcare professional) and the diagnostic interval (first contact to diagnosis).

Methodology: We reviewed the peer-reviewed literature from 2012 to 2025. The search was conducted across CINAHL, EMBASE, MEDLINE, and PsycINFO, with each title/abstract and full-text article reviewed by two team members. We extracted publication details, study methodology, variables, participant demographics, clinical descriptors, and interval-related information. We followed PRISMA reporting guidelines.

Results: Of 2,848 references screened, 8 studies were included: three on patient intervals and five on diagnostic intervals. Patient-interval studies involved 31 to 187 participants, with median lengths ranging from 9 to 210 days; patient-reported intervals were typically longer than those based on health data alone. Risk factors for longer patient intervals included herbal remedy use, symptom alarm and severity, older age, and multimorbidity. Diagnostic-interval studies included 69 to 2,175 participants, with median intervals of 24 to 84 days; factors associated with longer intervals included lower family-physician density, older age, early-stage disease, female sex, and low diagnostic suspicion.

Conclusion: Long intervals between symptom onset and diagnosis remain a major challenge for people diagnosed with gastric cancer in countries without screening programs. This review identifies significant methodological gaps restricting comparability. Further research with standardized definitions and equity-focused approaches is needed to inform early detection and patient education initiatives.