51
|
Hameed Khaliq I, Mahmood HZ, Sarfraz MD, Masood Gondal K, Zaman S. Pathways to care for patients in Pakistan experiencing signs or symptoms of breast cancer. Breast 2019; 46:40-47. [PMID: 31075671 DOI: 10.1016/j.breast.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022] Open
Abstract
Multiple social and financial barriers exist to breast cancer detection in Pakistan, which may cause a delay in seeking care and the final diagnosis. This analytical study documents the pathways and time courses associated with referral to diagnostic centres to evaluate the clinical signs and symptoms of breast cancer. This report also verifies the association between socio-demographic and clinical indicators concerning the length of time spent before reaching diagnostic facilities. A purposive sample of 200 patients was selected from two tertiary care hospitals in Lahore, Pakistan, for the interviews. Descriptive statistics (that is, percentages, frequencies, and measures of central tendencies) and a multiple linear regression model were used to achieve the study objectives. The descriptive model showed 31-128 days interval between a patient's awareness of a clinical sign or symptom and receiving care. The healthcare system, including traditional healers, took from 7 to 194 days, and the time to diagnosis ranged from 15 to 30 days. Pain severity, larger tumour size, lack of clinical improvement, and the desire to obtain better treatment were reasons given for seeking care, but lack of awareness and fear of financial burden related to accessing healthcare facilities were identified as barriers. Moreover, socio-demographic and other predictive clinical factors were potentially associated with and substantially influenced the likelihood of the increased length of breast cancer patients' time to reach diagnostic centres. In conclusion, referrals by multiple healthcare providers, especially traditional healers and general practitioners, was a significant predictor for delay in diagnosis. Therefore, increased awareness and a responsive healthcare system may reduce the time from the recognition of symptoms to the early detection of breast cancer among women, thus improving outcomes in a developing country.
Collapse
Affiliation(s)
- Imran Hameed Khaliq
- Department of Public Health, University of Health Sciences Lahore, Pakistan.
| | - Hafiz Zahid Mahmood
- Department of Economics, COMSATS University Islamabad, Lahore Campus, Pakistan
| | | | - Khalid Masood Gondal
- Vice Chancellor, King Edward Medical University/ Mayo Hospital, Lahore, Pakistan
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences Lahore, Pakistan
| |
Collapse
|
52
|
Zurko JC, Wade RC, Mehta A. The impact of structural factors on diagnostic delay in diffuse large B-cell lymphoma. Cancer Med 2019; 8:1416-1422. [PMID: 30884208 PMCID: PMC6488145 DOI: 10.1002/cam4.2009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/29/2018] [Accepted: 01/15/2019] [Indexed: 11/08/2022] Open
Abstract
Background Reducing diagnostic delays in cancer has been a major interest worldwide; however, the literature on diagnostic delays in lymphoma remains scarce. Diffuse large B‐cell lymphoma (DLBCL) is the most common non‐Hodgkin's lymphoma. We aimed to determine whether certain structural factors predicted diagnostic delays in DLBCL and whether diagnostic delays impacted overall survival (OS). Methods Data were extracted via a retrospective cohort design from a single academic tertiary care referral center. A total of 104 patients were included. Time from first symptoms to diagnosis of <3 months was defined as “early diagnosis” and ≥3 months as “delayed diagnosis”. Analysis was performed with student's t‐test, chi‐square testing, binomial logistic regression, and Kaplan‐Meier log‐rank testing. Results “Delayed diagnosis” was more likely with lower stage, lower international prognostic index (IPI), and further distance from referral center (OR 0.66, CI 0.46‐0.95; OR 0.69, CI 0.51‐0.94; OR 1.008, CI 1.001‐1.015). Patients of “other” ethnicity and without medical insurance were more likely to have significant diagnostic delays and worse overall survival (P = 0.002 and P = 0.007, respectively). Diagnostic delays of ≥3 months did not predict worse OS. However, delays of >6 months did predict worse OS. Conclusion Our data suggest that excessive diagnostic delays of more than 6 months, ethnic minority status, and uninsured status in DLBCL may lead to worse outcomes. Efforts should be undertaken to reduce excessive diagnostic delays. More investigation needs to be done on the impacts of diagnostic delays in both DLBCL and other aggressive lymphomas.
Collapse
Affiliation(s)
- Joanna C Zurko
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Raymond C Wade
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
53
|
Cabral ALLV, Giatti L, Casale C, Cherchiglia ML. Social vulnerability and breast cancer: differentials in the interval between diagnosis and treatment of women with different sociodemographic profiles. CIENCIA & SAUDE COLETIVA 2019; 24:613-622. [PMID: 30726393 DOI: 10.1590/1413-81232018242.31672016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/18/2017] [Indexed: 11/21/2022] Open
Abstract
This study aimed to identify the sociodemographic profiles of women diagnosed as breast cancer in the city of Belo Horizonte and to investigate its association with interval between diagnosis and treatment. A cross-sectional study from hospital records of 715 patients undergoing treatment between 2010 and 2013. Cluster analysis was used to delineate the profiles from the variables: age, color of the skin, education and cost of treatment. The association between profiles and intervals was investigated using multinomial logistic regression. Five profiles were identified: A (white skin color, years of schooling >15 and treatment through private healthcare systems); B (white skin color, years of schooling = 11 and treatment through the Unified National Health System (SUS); C and D (brown skin color, years of schooling = 11 and < 8 respectively, and SUS); E (black skin color, years of schooling < 8, and SUS). Profiles B, C, D and E were associated with increased diagnosis-to-treatment intervals regardless of cancer staging upon diagnosis; and profile E had 37- fold higher chances of interval > 91 days (OR: 37.26; 95% CI:11.91-116.56). Breast cancer patients with social vulnerability profiles wait longer for treatment even after overcoming barriers to access oncology units.
Collapse
Affiliation(s)
- Ana Lúcia Lobo Vianna Cabral
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais (UFMG). Av. Prof. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Luana Giatti
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG. Belo Horizonte MG Brasil
| | - Claudina Casale
- Programa de Avaliação e Vigilância do Câncer, Secretaria de Estado de Saúde de Minas Gerais. Belo Horizonte MG Brasil
| | | |
Collapse
|
54
|
Baig M, Sohail I, Altaf HN, Altaf OS. Factors influencing delayed presentation of breast cancer at a tertiary care hospital in Pakistan. Cancer Rep (Hoboken) 2019; 2:e1141. [PMID: 32721102 DOI: 10.1002/cnr2.1141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Breast cancer is the leading cause of death despite the continuous development of newer and more effective modalities of treatment for breast cancer. In Asia, Pakistan has the highest rate of breast cancer. Breast cancer treatment shows better prognosis when it is diagnosed at an early stage, but mortality increases significantly with delayed diagnosis and advanced stage of disease. Delay in diagnosis and nonavailability of treatment are the major factors responsible for advanced stage and low survival. AIMS The objective of our study was to identify the factors responsible for delayed presentation of patients with breast carcinoma. METHODS AND RESULTS A cross-sectional study using a questionnaire method was conducted at the Foundation University Medical College from January 2015 to December 2016. A total of 89 patients gave consent and were interviewed using a prestructured questionnaire during the study. Age ranged from 25 to 64 years. Majority of patients were in stage T3N1M0 (31.5%). Second most common stage was T4N0M0 (14.6%). Thirteen patients (12.4%) were in stage T3N0M0, and 10 patients (11.2%) were in T3N2M0. Delay ranged from 3 months to more than 1 year; 43.8% presented with delay of 3 to 6 months. The reasons for delay were lack of knowledge about breast cancer (41%), lack of availability of health care services (32.6%), purdah and religious reasons (6.7%), and fear of being diagnosed with cancer (10.1%). CONCLUSION The main reasons for delay identified in our study were lack of knowledge and availability of appropriate health care facilities. In order to improve outcome of breast cancer, more focus is needed on spreading awareness and improving health care services in rural areas.
Collapse
Affiliation(s)
- Mehreen Baig
- MRCS General Surgery, Department of surgery, Surgical Unit I, Foundation University Medical College, Rawalpindi, Pakistan
| | - Iram Sohail
- FRCS Histopathology, Department of Pathology, Foundation University Medical College, Rawalpindi, Pakistan
| | - Humera Naz Altaf
- FCPS General Surgery, Department of Surgery, Shifa College of Medicine, Shifa Tameer e' Millat University, Islamabad, Pakistan
| | - Omar Shahzad Altaf
- Tehsil Head Quarter Hospital Hazro Khebar Pakhtoonkhawa, Hazro, Pakistan
| |
Collapse
|
55
|
Pinto JA, Pinillos L, Villarreal-Garza C, Morante Z, Villarán MV, Mejía G, Caglevic C, Aguilar A, Fajardo W, Usuga F, Carrasco M, Rebaza P, Posada AM, Tirado-Hurtado I, Flores C, Vallejos CS. Barriers in Latin America for the management of locally advanced breast cancer. Ecancermedicalscience 2019; 13:897. [PMID: 30792814 PMCID: PMC6372299 DOI: 10.3332/ecancer.2019.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 01/21/2023] Open
Abstract
Breast cancer (BC) is a highly prevalent malignancy in Latin American women, most cases being diagnosed at locally advanced or metastatic stages when options for cancer care are limited. Despite its label as a public health problem in the region, Latin American BC patients face several barriers in accessing standard of care treatment when compared with patients from developed countries. In this review, we analyse the landscape of the four main identified barriers in the region: i) high burden of locally advanced/advanced BC; ii) inadequate access to medical resources; iii) deficient access to specialised cancer care and iv) insufficient BC research in Latin America. Unfortunately, these barriers represent the main factors associated with the BC poor outcomes seen in the region. Targeted actions should be conducted independently by each country and as a region to overcome these limitations and create an enhanced model of BC care.
Collapse
Affiliation(s)
- Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Luis Pinillos
- Departamento de Radioterapia, Oncosalud-AUNA, Lima 15036, Peru
| | - Cynthia Villarreal-Garza
- Departamento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Zaida Morante
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru.,Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Manuel V Villarán
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Gerson Mejía
- Departamento de Oncología Médica, Hospital Clínico Viedma, Cochabamba 00725, Bolivia
| | - Christian Caglevic
- Medical Oncology Department, Clinica Alemana, Santiago 5951, Chile.,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 700, Chile
| | - Alfredo Aguilar
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru
| | - Williams Fajardo
- Departamento de Medicina Especializada, Hospital Nacional Dos de Mayo, Lima 15003, Peru
| | - Franz Usuga
- Grupo de Radioterapia Oncológica, Instituto Nacional de Cancerología, Bogotá 9-85, Colombia
| | - Marcia Carrasco
- Departamento de Oncología, Hospital Santa Rosa, Lima 95405, Peru.,Unidad de la Mama, Oncosalud-AUNA, Lima 15036, Peru
| | | | - Ana M Posada
- Unidad de la Mama, Oncosalud-AUNA, Lima 15036, Peru
| | | | - Claudio Flores
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Carlos S Vallejos
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru
| |
Collapse
|
56
|
Nouws S, Brandão M, Fontes F, Pereira S, Dias T, Ribeiro AI, Lunet N, Peleteiro B. Factors associated with time to breast cancer diagnosis and treatment in unscreened women in Portugal. Women Health 2018; 59:601-614. [PMID: 30462571 DOI: 10.1080/03630242.2018.1539430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Delays in detection, diagnosis and treatment may lead to poorer prognosis in women with breast cancer. We quantified time intervals from first detection (FD) to diagnosis (D) and first treatment (FT) and identified associated factors. We studied 282 patients diagnosed with breast cancer during 2012 at the Breast Clinic of the Portuguese Institute of Oncology in Porto, Portugal using face-to-face interview and medical records. Associations of sociodemographic and clinical characteristics with time intervals was computed using adjusted percentage differences (adjPD) after logarithmic transformation, odds ratios (adjOR) for comparing the highest and lowest thirds of the distribution and 95 percent confidence intervals (CI) for both measures, using linear and logistic regression, respectively. The median times between FD and D and FT were 31 and 44 days, respectively. Significantly longer periods between FD and D were found in symptomatic women (adjPD = 99.5, 95 percent CI: 37.1, 190.0; adjOR = 3.16, 95 percent CI: 1.57, 6.33). More advanced stage was associated with shorter intervals between D and FT (adjPD = -33.8, 95 percent CI: -44.2, -21.5; adjOR = 0.14, 95 percent CI: 0.05, 0.34). Although some differences according to clinical characteristics were observed, they did not seem to translate into inequities in access to public healthcare in this group of women.
Collapse
Affiliation(s)
- Sónia Nouws
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
| | - Mariana Brandão
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Filipa Fontes
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
| | - Susana Pereira
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Teresa Dias
- b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Ana Isabel Ribeiro
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Nuno Lunet
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,c Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina , Universidade do Porto , Porto , Portugal
| | - Bárbara Peleteiro
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,c Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina , Universidade do Porto , Porto , Portugal
| |
Collapse
|
57
|
Fouladi N, Pourfarzi F, Daneshian A, Alimohammadi S. Mediating Factors in Early Diagnosis of Breast Cancer: from Initial Changes in Health to Breast Cancer Detection. Asian Pac J Cancer Prev 2018; 19:2751-2755. [PMID: 30360602 PMCID: PMC6291050 DOI: 10.22034/apjcp.2018.19.10.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Breast cancer is one of the most frequently occurring cancers in women throughout the world. In Iran, according to available reports, 70% of patients with breast cancer are detected at the advanced stages of the disease. Materials and Methods: This study is of descriptive-analytic cross-sectional type.160 female patients was selected. The data in this study was collected via face to face interview using a questionnaire based on the Anderson’s delay model. Data were analyzed using SPSS 22 and the significance level was considered to be 0.05. Results: The results showed that presence of mass was the first symptom in many of women, i.e., 76 cases (47.5%). not only the presence of mass in the breast, but also any other symptom, hadn’t been taken as a serious problem initially by women. Non-improvement of the symptoms and exacerbation of the symptoms was considered as a symptom of illness by patients. After considering the changes as the symptoms of illness, patients had tried to treat the disease through different methods of self-treatment. The failure of the self-treatment in controlling the symptoms, had directed the patients toward seeking for medical services. Out of 160 patients, 49 patients (39.6%) changed the time of their appointment with doctor. 110 cases (68%) out of 160 patients, rather than initiating relevant diagnostic procedure related to the disease, had received non-specific and non-related therapeutic measures. Conclusion: Pondering on the results yields that patient-related delays, resulting from their lack of awareness of the disease, cultural factors, and fear, can only play an important role in postponement of visiting a physician, but in the diagnosis of disease it is the inability of general practitioners in performing differential diagnoses, and making request for related diagnostic measures which can significantly increase the lag time until the onset of the main treatment.
Collapse
Affiliation(s)
- Nasrin Fouladi
- Community Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.,Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | | | | | | |
Collapse
|
58
|
Abstract
BACKGROUND Even small delays in the treatment of breast cancer are a frequently expressed concern of patients. Knowledge about this subject is important for clinicians to counsel patients appropriately and realistically, while also optimizing care. Although data and quality measures regarding time to chemotherapy and radiotherapy have been present for some time, data regarding surgical care are more recent and no standard exists. This review was written to discuss our current knowledge about the relationship of treatment times to outcomes. METHODS The published medical literature addressing delays and optimal times to treatment was reviewed in the context of our current time-dependent standards for chemotherapy and radiotherapy. The surgical literature and the lack of a time-dependent surgical standard also were discussed, suggesting a possible standard. RESULTS Risk factors for delay are numerous, and tumor doubling times are both difficult to determine and unhelpful to assess the impact of longer treatment times on outcomes. Evaluation components also have a time cost and are inextricable from the patient's workup. Although the published literature has lack of uniformity, optimal times to each modality are strongly suggested by emerging data, supporting the current quality measures. Times to surgery, chemotherapy, and radiotherapy all have a measurable impact on outcomes, including disease-free survival, disease-specific survival, and overall survival. CONCLUSIONS Delays have less of an impact than often thought but have a measurable impact on outcomes. Optimal times from diagnosis are < 90 days for surgery, < 120 days for chemotherapy, and, where chemotherapy is administered, < 365 days for radiotherapy.
Collapse
Affiliation(s)
- Richard J Bleicher
- Department of Surgical Oncology, Room C-308, Fox Chase Cancer Center, Philadelphia, PA, USA.
| |
Collapse
|
59
|
Chukmaitov AS, Kaidarova DR, Talaeyva ST, Sheppard VB, Xu H, Siangphoe U, Ettner SL. Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan. Asian Pac J Cancer Prev 2018; 19:2519-2525. [PMID: 30256046 PMCID: PMC6249466 DOI: 10.22034/apjcp.2018.19.9.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective: Although Kazakhstan has made significant investments to improve health and life expectancy of its population, high cancer rates persist, with breast cancer being the most prevalent type. Factors contributing to delays in treatment and late staging for breast cancer patients were assessed. Methods: A retrospective follow-up study with registry data identified 4,248 breast cancer patients in sixteen regions of Kazakhstan in 2014. We used logistic regressions to estimate (i) associations of treatment delays with patient demographics and cancer center regions; and (ii) associations of late-stage (III and IV) cancer diagnosis with patient demographics and cancer center regions, with and without controlling for treatment delays. Results: Breast cancer patients treated in regions located further away from Almaty City had higher risks of treatment delays. However, the risks of late-stage cancer diagnosis were greater for patients treated in Almaty City and those with treatment delays. Conclusion: The main driver of delayed treatment is cancer center region. Residents of Almaty City, a major urban area of Kazakhstan, may have a better access to a tertiary cancer center, resulting in less treatment delays. Referrals of sicker patients from neighboring regions to Almaty City for cancer treatment is likely to increase risks of late-stage diagnosis. New or upgraded cancer centers may reduce treatment delays, but their case-mix is likely to increase.
Collapse
Affiliation(s)
- Askar S Chukmaitov
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, VCU Massey Cancer Center, USA.
| | | | | | | | | | | | | |
Collapse
|
60
|
Weller D. In our March 2017 issue of EJCC…. Eur J Cancer Care (Engl) 2018; 26. [PMID: 28244270 DOI: 10.1111/ecc.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
61
|
Al-Azri M, Al-Saidi M, AL-Mutair E, Panchatcharam SM. Awareness of Risk Factors, Symptoms and Time to Seek Medical Help of Ovarian Cancer amongst Omani Women Attending Teaching Hospital in Muscat Governorate, Oman. Asian Pac J Cancer Prev 2018; 19:1833-1843. [PMID: 30049195 PMCID: PMC6165654 DOI: 10.22034/apjcp.2018.19.7.1833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Ovarian cancer has been regarded as most deadly gynaecological cancer in the world. In Oman, ovarian cancer is the third most prevalent gynaecological cancer affecting Omani women. The awareness of risk factors, symptoms and seeking early medical care play a role in the improvement of survival rates. The aim of this study is to explore knowledge, risk factors, symptoms and the time taken to seek early medical help for ovarian cancer among Omani women attended Sultan Qaboos University Hospital. Methods The ovarian Cancer Awareness and Measure (CAM) questionnaire (translated into Arabic) was used to collect data. Results A total of 499 women participated. The most recognised risk factors were having ovarian cysts (71.3%), smoking (67.5%) and having close relative with ovarian cancer (63.5%); the least recognised were having in vitro fertilization (25.5%), having children (26.3%) and using talcum powder in the genital area (31.5%). The most recognised symptoms were persistent pain in the pelvis (67.7%), persistent pain in the abdomen (60.3%) and extreme fatigue (56.5%); the least recognised were feeling full persistently (22.8%), passing more urine than usual (31.1%) and changes in bowel habits (32.1%). Multinomial logistic regression showed recognition of risk factors and symptoms were associated with a higher level of education, a higher income, increased age, higher number of pregnancies, a longer duration of marriage and having a family history of ovarian cancer. Most of the barriers to seeking medical help were for several emotional, practical and healthcare service reasons. Conclusion The overall level of recognition of risk factors and symptoms of ovarian cancer among Omani women were low with several emotional, practical and service barriers preventing them from seeking early medical help. More measures to raise national cancer awareness levels are needed, and support for women to overcome these barriers to minimized delays in the presentation.
Collapse
Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | | | | |
Collapse
|
62
|
Byrne J, Campbell H, Gilchrist M, Summersby E, Hennessy B. Barriers to care for breast cancer: A qualitative study in Ireland. Eur J Cancer Care (Engl) 2018; 27:e12876. [DOI: 10.1111/ecc.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 05/21/2018] [Accepted: 05/31/2018] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Marie Gilchrist
- Oncology Unit; Our Lady of Lourdes Hospital; Drogheda Ireland
| | | | - Bryan Hennessy
- Oncology Unit; Our Lady of Lourdes Hospital; Drogheda Ireland
| |
Collapse
|
63
|
Elapsed Time Between the First Symptoms of Breast Cancer and Medical Help-Seeking Behavior and the Affecting Factors. Cancer Nurs 2018; 41:E21-E29. [DOI: 10.1097/ncc.0000000000000498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
64
|
Steiness HS, Villegas-Gold M, Parveen H, Ferdousy T, Ginsburg O. Barriers to care for women with breast cancer symptoms in rural Bangladesh. Health Care Women Int 2018; 39:536-554. [PMID: 29505392 DOI: 10.1080/07399332.2018.1446958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Breast cancer survival rates in lower-income countries like Bangladesh are approximately 50%, versus over 80% in high income countries. Anecdotal reports suggest that, beyond economic and health system barriers, sociocultural factors may influence a woman's care-seeking behavior and resultant early stage diagnoses. To understand these barriers, we conducted 63 interviews (43 women with breast cancer symptoms and 20 men) in Khulna, Bangladesh. We identified socio-cultural barriers like neglect and indifference toward women, women's lack of power to use resources, and reduced support from family due to stigma. Interventions must address these barriers and improve the status of women in Bangladesh.
Collapse
Affiliation(s)
- Heather Story Steiness
- a Human Evolution and Social Change, Arizona State University College of Liberal Arts and Sciences , St. Phoenix, Arizona , USA
| | - Michelle Villegas-Gold
- a Human Evolution and Social Change, Arizona State University College of Liberal Arts and Sciences , St. Phoenix, Arizona , USA
| | - Homaira Parveen
- a Human Evolution and Social Change, Arizona State University College of Liberal Arts and Sciences , St. Phoenix, Arizona , USA
| | | | - Ophira Ginsburg
- c Perlmutter Cancer Center, Section for Global Health , Department of Population Health, NYU Langone Health, New York , New York , USA
| |
Collapse
|
65
|
Unger-Saldaña K, Ventosa-Santaulària D, Miranda A, Verduzco-Bustos G. Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico. Oncologist 2018; 23:440-453. [PMID: 29284758 PMCID: PMC5896704 DOI: 10.1634/theoncologist.2017-0431] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most breast cancer patients in low- and middle-income settings are diagnosed at advanced stages due to lengthy intervals of care. This study aimed to understand the mechanisms through which delays occur in the patient interval and diagnosis interval of care. MATERIALS AND METHODS We conducted a cross-sectional survey including 886 patients referred to four major public cancer hospitals in Mexico City. Based in a conceptual model of help-seeking behavior, a path analysis strategy was used to identify the relationships between explanatory factors of patient delay and diagnosis delay. RESULTS The patient and the diagnosis intervals were greater than 3 months in 20% and 65% of participants, respectively. We present explanatory models for each interval and the interrelationship between the associated factors. The patient interval was longer among women who were single, interpreted their symptoms as not worrisome, concealed symptoms, and perceived a lack of financial resources and the difficulty of missing a day of work as barriers to seek care. These barriers were more commonly perceived among patients who were younger, had lower socioeconomic status, and lived outside of Mexico City. The diagnosis interval was longer among those who used several different health services prior to the cancer hospital and perceived medical errors in these services. More health services were used among those who perceived errors and long waiting times for appointments, and who first consulted private services. CONCLUSION Our findings support the relevance of strengthening early cancer diagnosis strategies, especially the improvement of quality of primary care and expedited referral routes to cancer services. IMPLICATIONS FOR PRACTICE This study's findings suggest that policy in low- and middle-income countries (LMICs) should be directed toward reducing delays in diagnosis, before the implementation of mammography screening programs. The results suggest several factors susceptible to early diagnosis interventions. To reduce patient delays, the usually proposed intervention of awareness promotion could better work in LMIC contexts if the message goes beyond the advertising of screening mammography to encourage the recognition of potential cancer symptoms and sharing of symptoms with significant others. To reduce diagnosis delay, efforts should focus on strengthening the quality of public primary care services and improving referral routes to cancer care centers.
Collapse
Affiliation(s)
- Karla Unger-Saldaña
- National Council of Science and Technology (CONACYT) - Mexican National Cancer Institute, Epidemiology Unit, Mexico City, Mexico
| | | | | | | |
Collapse
|
66
|
Moodley J, Cairncross L, Naiker T, Constant D. From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study. BMC Cancer 2018; 18:312. [PMID: 29562894 PMCID: PMC5863383 DOI: 10.1186/s12885-018-4219-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/13/2018] [Indexed: 01/07/2023] Open
Abstract
Background Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey. Methods A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI. Results The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40–0.86), initial symptom denial (HR 0.43, 95% CI 0.19–0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33–0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47–0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80–11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15–2.76). Conclusion The Model of Pathways to Treatment provides a useful framework to explore patient’s journeys to care and identified opportunities for targeted interventions. Electronic supplementary material The online version of this article (10.1186/s12885-018-4219-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa. .,Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa. .,SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa.
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa
| | - Thurandrie Naiker
- Department of Radiation Oncology, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa
| | - Deborah Constant
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa
| |
Collapse
|
67
|
Mensah KB, Oosthuizen F, Bonsu AB. Cancer awareness among community pharmacist: a systematic review. BMC Cancer 2018; 18:299. [PMID: 29548307 PMCID: PMC5857088 DOI: 10.1186/s12885-018-4195-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background The WHO recognises that community pharmacists are the most accessible healthcare professionals to the general public. Most patients regularly visit community pharmacies for health information and also seek advice from pharmacists with respect to signs and symptoms of cancer. As readily accessible health care professionals, community pharmacists are also in the best position to include cancer-screening initiatives into their practice. Pharmacists are therefore in a good position to raise awareness when they counsel people who buy over-the-counter medication for the control of possible cancer-related symptoms. The aim of this review was to critically appraise evidence gathered from studies that; (1) explore or assess knowledge of community pharmacist on signs and symptoms of cancer, (2) explore or assess knowledge of community pharmacist on cancer screening. Methods EMBASE (ovid), CINAHL (EBSCOhost) and MEDLINE (EBSCOhost) were systematically searched for studies conducted between 2005 to July 2017. Studies that focused on knowledge of community pharmacist in cancer screening, signs and symptoms were included. Results A total of 1538 articles were identified from the search, of which 4 out of the 28 potentially relevant abstracts were included in the review. Findings of the selected studies revealed lack of sufficient knowledge on breast cancer screening, signs and symptoms. Both studies attributed knowledge limitation as the cause of reason for the key findings of their studies. Conclusion The selected studies focused largely on breast cancer, which hinder the generalizability and transferability of the findings. Hence there is a need for more studies to be conducted in this area to draw a better conclusion.
Collapse
Affiliation(s)
- Kofi Boamah Mensah
- National Center for Radiotherapy & Nuclear Medicine, Directorate of Oncology, Komfo Anokye Teaching Hospital, Box 1934, Kumasi, Ghana. .,University of KwaZulu-Natal, Discipline of Pharmaceutical Sciences, College of Health Sciences, Westville Campus, University Road, Durban, South Africa.
| | - Frasia Oosthuizen
- University of KwaZulu-Natal, Discipline of Pharmaceutical Sciences, College of Health Sciences, Westville Campus, University Road, Durban, South Africa
| | - Adwoa Bemah Bonsu
- Kwame Nkrumah University of Science & Technology, Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| |
Collapse
|
68
|
Özmen V. A Patient Advocacy Group Summit, Cancer Care in Turkey and The Society of Breast Health. Eur J Breast Health 2018; 14:1-4. [PMID: 29322111 DOI: 10.5152/ejbh.2017.1213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Vahit Özmen
- Department of Surgery, Istanbul University, Istanbul School of Medicine, İstanbul, Turkey
| |
Collapse
|
69
|
Romanoff A, Constant TH, Johnson KM, Guadiamos MC, Vega AMB, Zunt J, Anderson BO. Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru. JAMA Oncol 2017; 3:1563-1567. [PMID: 28542677 DOI: 10.1001/jamaoncol.2017.1023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women's awareness of breast health concerns. Objective To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. Design, Setting, and Participants In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. Main Outcomes and Measures Method of breast cancer detection and factors that influence time to and stage at diagnosis. Results Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more likely to be diagnosed with early-stage disease (AJCC stage 0, I, or II) than those with longer patient delay (31 [58.5%] vs 11 [30.6%], P = .01). Women who underwent a previous clinical breast examination were more likely to be diagnosed with early-stage disease compared with women who had never undergone previous clinical breast examination; this relationship remained significant after controlling for insurance and household income (odds ratio, 2.44; 95% CI, 1.01-5.95; P = .048). Conclusions and Relevance In a population in which most breast cancers are self-detected, previous clinical breast examination was associated with shorter patient delay and earlier stage at breast cancer diagnosis. In regions of the world that lack mammographic screening, the routine use of clinical breast examination may provide a resource-appropriate strategy for improving breast cancer early diagnosis.
Collapse
Affiliation(s)
- Anya Romanoff
- Department of Global Health, University of Washington, Seattle.,Department of Surgery, Mount Sinai Hospital, New York, New York
| | | | - Kay M Johnson
- Department of Medicine, University of Washington, Seattle.,Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Manuel Cedano Guadiamos
- Department of Surgery, Instituto Regional de Enfermedades Neoplásicas del Norte, Trujillo, Peru
| | - Ana María Burga Vega
- Department of Epidemiology and Statistics, Instituto Regional de Enfermedades Neoplásicas del Norte, Trujillo, Peru
| | - Joseph Zunt
- Department of Global Health, University of Washington, Seattle
| | - Benjamin O Anderson
- Department of Global Health, University of Washington, Seattle.,Department of Surgery, University of Washington, Seattle.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
70
|
Stamatovic L, Vasovic S, Trifunovic J, Boskov N, Gajic Z, Parezanovic A, Icevic M, Cirkovic A, Milic N. Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia. Psychooncology 2017; 27:576-582. [PMID: 28857314 DOI: 10.1002/pon.4551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.
Collapse
Affiliation(s)
- L Stamatovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - S Vasovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - J Trifunovic
- Oncology Institute of Vojvodina, Novi Sad, Serbia
| | - N Boskov
- General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Z Gajic
- General Hospital Kruševac, Kruševac, Serbia
| | | | | | - A Cirkovic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.,Department for Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
71
|
Elmi M, Hussein H, Nofech-Mozes S, Curpen B, Leahey A, Look Hong N. Budget impact analysis of a breast rapid diagnostic unit. Curr Oncol 2017; 24:e214-e219. [PMID: 28680289 DOI: 10.3747/co.24.3381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Odette Cancer Centre's recent implementation of a rapid diagnostic unit (rdu) for breast lesions has significantly decreased wait times to diagnosis. However, the economic impact of the unit remains unknown. This project defined the development and implementation costs and the operational costs of a breast rdu in a tertiary care facility. METHODS From an institutional perspective, a budget impact analysis identified the direct costs associated with the breast rdu. A base-case model was also used to calculate the cost per patient to achieve a diagnosis. Sensitivity analyses computed costs based on variations in key components. Costs are adjusted to 2015 valuations using health care-specific consumer price indices and are reported in Canadian dollars. RESULTS Initiation cost for the rdu was $366,243. The annual operational cost for support staff was $111,803. The average per-patient clinical cost for achieving a diagnosis was $770. Sensitivity analyses revealed that, if running at maximal institutional capacity, the total annual clinical cost for achieving a diagnosis could range between $136,080 and $702,675. CONCLUSIONS Establishment and maintenance of a breast rdu requires significant investment to achieve reductions in time to diagnosis. Expenditures ought to be interpreted in the context of institutional patient volumes and trade-offs in patient-centred outcomes, including lessened patient anxiety and possibly shorter times to definitive treatment. Our study can be used as a resource-planning tool for future rdus in health care systems wishing to improve diagnostic efficiency.
Collapse
Affiliation(s)
- M Elmi
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre.,Department of Surgery, University of Toronto
| | - H Hussein
- Division of Breast Imaging, Sunnybrook Health Sciences Centre; and.,Department of Medical Imaging, University of Toronto, Toronto, ON; and.,Department of Medical Imaging, Cairo University, Cairo, Egypt
| | - S Nofech-Mozes
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre
| | - B Curpen
- Division of Breast Imaging, Sunnybrook Health Sciences Centre; and.,Department of Medical Imaging, University of Toronto, Toronto, ON; and
| | - A Leahey
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre
| | - N Look Hong
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre.,Department of Surgery, University of Toronto
| |
Collapse
|
72
|
Montagna G, Schneeberger AR, Rossi L, Bianchi Micheli G, Meani F, Imperiali M, Spitale A, Pagani O. Can we make a portrait of women with inoperable locally advanced breast cancer? Breast 2017; 33:83-90. [PMID: 28288387 DOI: 10.1016/j.breast.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Delay between clinical presentation and treatment of breast cancer (BC) can significantly impact mortality. We aimed at drawing a picture of women with locally advanced breast cancer (LABC) treated at our Breast Unit and at investigating factors associated with treatment delay. MATERIAL AND METHODS A retrospective descriptive analysis, using a specific 28-item semi-structured questionnaire, was conducted in 67 patients diagnosed with T4 BC. RESULTS Nearly a third of our patients had at least one known predisposing factor for LABC. 42% of patients did not perform routine medical breast checks, 49% reported indifference as the first feeling and 47% waited at least 3 months before seeking medical attention. The reasons for diagnostic delay were different in the various age groups. Doctor's delay in making the right diagnosis occurred in 60% of younger patients (≤40 years, n = 5), whereas among women aged 41-69years (n = 34) 50% suffered from psychiatric comorbidities. In patients ≥70 years (n = 28) social factors such as isolation, being widowed and living in a retirement home were present in most of the cases. Delay in seeking medical care was also associated with increasing age. Across all age groups, coping factors such as denial and indifference were also associated with an increase in the odds of delayed presentation, as opposed to fear. CONCLUSIONS Factors possibly explaining late medical consultation seem to differ according to age. Psychological factors are crucial in patients' delay whereas age and social factors are relevant in doctors' and system's delay.
Collapse
Affiliation(s)
- Giacomo Montagna
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland.
| | - Andres R Schneeberger
- Psychiatric University Hospital (UPK), University Basel, Basel, Switzerland; Psychiatric Services Grisons (PDGR), Chur, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences (AECOM), New York, NY, USA
| | - Lorenzo Rossi
- Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | - Francesco Meani
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland
| | - Mauro Imperiali
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Olivia Pagani
- Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| |
Collapse
|
73
|
Morris M, Woods LM, Bhaskaran K, Rachet B. Do pre-diagnosis primary care consultation patterns explain deprivation-specific differences in net survival among women with breast cancer? An examination of individually-linked data from the UK West Midlands cancer registry, national screening programme and Clinical Practice Research Datalink. BMC Cancer 2017; 17:155. [PMID: 28231774 PMCID: PMC5324281 DOI: 10.1186/s12885-017-3129-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 02/08/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In England and Wales breast cancer survival is higher among more affluent women. Our aim was to investigate the potential of pre-diagnostic factors for explaining deprivation-related differences in survival. METHODS Individually-linked data from women aged 50-70 in the West Midlands region of England, diagnosed with breast cancer 1989-2006 and continuously eligible for screening, was retrieved from the cancer registry, screening service and Clinical Practice Research Datalink. Follow-up was to the end of July 2012. Deprivation was measured at small area level, based on the quintiles of the income domain of the English indices of deprivation. Consultation rates per woman per week, time from last breast-related GP consultation to diagnosis, and from diagnosis to first surgery were calculated. We estimated net survival using the non-parametric Pohar-Perme estimator. RESULTS The rate of primary care consultations was similar during the 18 months prior to diagnosis in each deprivation group for breast and non-breast symptoms. Survival was lower for more deprived women from 4 years after diagnosis. Lower net survival was associated with more advanced extent of disease and being non-screen-detected. There was a persistent trend of lower net survival for more deprived women, irrespective of the woman's obesity, alcohol, smoking or comorbidity status. There was no significant variation in time from last breast symptom to diagnosis by deprivation. However, women in more deprived categories experienced significantly longer periods between cancer diagnosis and first surgery (mean = 21.5 vs. 28.4 days, p = 0.03). Those whose surgery occurred more than 12 weeks following their cancer diagnosis had substantially lower net survival. CONCLUSIONS Our data suggest that although more deprived women with breast cancer display lifestyle factors associated with poorer outcomes, their consultation frequency, comorbidities and the breast cancer symptoms they present with are similar. We found weak evidence of extended times to surgical treatment among most deprived women who were not screen-detected but who presented with symptoms in primary care, which suggests that treatment delay may play a role. Further investigation of interrelationships between these variables within a larger dataset is warranted.
Collapse
Affiliation(s)
- M. Morris
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - L. M. Woods
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - K. Bhaskaran
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - B. Rachet
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| |
Collapse
|
74
|
Jiang Y, Sereika SM, Bender CM, Brufsky AM, Rosenzweig MQ. Beliefs in Chemotherapy and Knowledge of Cancer and Treatment Among African American Women With Newly Diagnosed Breast Cancer. Oncol Nurs Forum 2017; 43:180-9. [PMID: 26906129 DOI: 10.1188/16.onf.180-189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine beliefs regarding the necessity of chemotherapy and knowledge of breast cancer and its treatment in African American women with newly diagnosed breast cancer, and to explore factors associated with women's beliefs and knowledge.
. DESIGN Descriptive, cross-sectional study.
. SETTING Six urban cancer centers in Western Pennsylvania and Eastern Ohio.
. SAMPLE 101 African American women with newly diagnosed breast cancer.
. METHODS Secondary analysis using baseline data collected from participants in a randomized, controlled trial at their first medical oncology visit before the first cycle of chemotherapy.
. MAIN RESEARCH VARIABLES Belief in chemotherapy, knowledge of cancer and recommended treatment, self-efficacy, healthcare system distrust, interpersonal processes of care, symptom distress, and quality of life.
. FINDINGS African American women endorsed the necessity of chemotherapy. Most women did not know their tumor size, hormone receptors, specific therapy, or why chemotherapy was recommended to them. Women who perceived better interpersonal communication with physicians, less self-efficacy, or were less involved in their own treatment decision making held stronger beliefs about the necessity of chemotherapy. Women without financial difficulty or having stronger social functioning had more knowledge of their cancer and recommended chemotherapy.
. CONCLUSIONS African American women with newly diagnosed breast cancer generally agreed with the necessity of chemotherapy. Knowledge of breast cancer, treatment, and risk reduction through adjuvant therapy was limited.
. IMPLICATIONS FOR NURSING Oncology nurses could help advocate for tailored educational programs to support informed decision making regarding chemotherapy acceptance for African American women.
Collapse
Affiliation(s)
- Yun Jiang
- University of Michigan School of Nursing in Ann Arbor
| | - Susan M Sereika
- Associate professors School of Nursing, University of Pittsburgh, Pennsylvania
| | | | | | | |
Collapse
|
75
|
Soylar P, Genç MF. The Treatment Approach and Social Support Needs for Patients with Breast Cancer. THE JOURNAL OF BREAST HEALTH 2016; 12:56-62. [PMID: 28331734 PMCID: PMC5351501 DOI: 10.5152/tjbh.2016.2753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Breast cancer is the most common type of cancer in women both in developed and developing countries. It has a higher mortality rate in low and middle income countries due to the late-stage diagnosis. The principal aim of this study was to investigate what patients with breast cancer did before presenting to Turgut Özal Medical Center and its relationship with late stage diagnosis. The study also aimed to identify the level of patients' perceived social support. MATERIALS AND METHODS The study included 200 patients with breast cancer who were treated at the chemotherapy unit during 2013 and 2014. RESULTS The mean age of the patients was 51.16±1.10 years and 60% of the women were graduates of elemantary school. The majority of patients (69.5%) noticed breast mass as the first symptom and 56.5% were diagnosed at later stages. Thirty-four percent of the patients delayed their visit to a health care centers after realizing the first symptom. No statistically significant relationship was determined between women's education level, residential area, age, the first symptom noticed, stages of tumor, and patients and system-related delay (p>0.05). In terms of family history of breast cancer, there was a significant difference between patient-related and system-related delays (p<0.05). The family support score (24.8±4.6) was higher than those of friends and husbands (23.8±5.5, 21.3±6.4, respectively). The husband support score was statistically different in terms of intimacy between women and their husbands after disease (p<0.001). CONCLUSION It can be concluded that overcoming barriers related to patients and the system will lead to early-stage diagnosis, which in turn will result in higher survival rates of patients with breast cancer. As awareness and knowledge level of women about cancer increases, they will visit health care centers earlier where they can receive more comprehensive treatment.
Collapse
Affiliation(s)
- Pınar Soylar
- Department of Public Health, İnönü University School of Medicine, Malatya, Turkey
| | - Metin F. Genç
- Department of Public Health, İnönü University School of Medicine, Malatya, Turkey
| |
Collapse
|
76
|
Al-Azri M, Al-Hamedi I, Al-Awisi H, Al-Hinai M, Davidson R. Public awareness of warning signs and symptoms of cancer in oman: a community-based survey of adults. Asian Pac J Cancer Prev 2016; 16:2731-7. [PMID: 25854355 DOI: 10.7314/apjcp.2015.16.7.2731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of deaths from cancer occur in low and middle income countries, partly due to poor public awareness of the signs and symptoms of cancer. MATERIALS AND METHODS A community based survey using the Cancer Awareness Measure (CAM) questionnaire was conducted in three different communities in Oman. Omani adults aged 18 years and above were invited to participate in the study. RESULTS A total of 345 responded from 450 invited participants (response rate=76.7%). The majority of respondents were unable to identify the common signs and symptoms of cancer identified in the CAM (average awareness was 40.6%). The most emotional barrier to seeking help was worry about what the doctor might find (223, 64.6%); a practical barrier was too busy to make an appointment (259, 75.1%) and a service barrier was difficulty talking to the doctor (159, 46.1%). The majority of respondents (more than 60% for seven out of ten symptoms) would seek medical help in two weeks for most signs or symptoms of cancer. Females were significantly more likely than males to be embarrassed (p<0.001), scared (p=0.001), and lack confidence talking about their symptoms (p=0.022). CONCLUSIONS Urgent strategies are needed to improve public awareness of the signs and symptoms of cancer in Oman. This might leads to earlier diagnosis, improved prognosis and reduced mortality from cancer.
Collapse
Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman E-mail :
| | | | | | | | | |
Collapse
|
77
|
Chen SJ, Kung PT, Huang KH, Wang YH, Tsai WC. Characteristics of the Delayed or Refusal Therapy in Breast Cancer Patients: A Longitudinal Population-Based Study in Taiwan. PLoS One 2015; 10:e0131305. [PMID: 26114875 PMCID: PMC4482743 DOI: 10.1371/journal.pone.0131305] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 06/01/2015] [Indexed: 11/25/2022] Open
Abstract
Background The evidence indicated breast cancer was a cancer with high survival rate. However, there were still some breast cancer patients delaying or refusing therapy. So we conducted a cohort study to explore the relationship between characteristics of breast cancer patients and delay or refusal of therapy within four months after cancer diagnosed. Methods This was a retrospective national population-based study from 2004 to 2010 in Taiwan. This study included 35,095 patients with new diagnosis breast cancer from Taiwan Cancer Registry Database. Several analysis methods, including t test, Chi-square test, generalized estimating equations of logistic regression analysis, and Cox proportional hazards model, were performed to explore the characteristics of these patients and the relative risk of mortality with delay or refusal of therapy. Results Our study showed that the overall survival rates were significantly different (p <0.05) between the breast cancer patients who delayed or refused therapy and those with treatment. The patients who delayed or refused therapy had lower 5-year overall survival rate compared with the treated group. The related factors included age, Charlson comorbidity index, cancer staging (OR = 1.30–19.69; p <0.05), other catastrophic illnesses or injuries and the level of diagnostic hospitals. However, the patients with different income levels and degree of urbanization in living area were not statistically significant factors. Conclusion Our results demonstrated that age and cancer staging were the main patient characteristics affecting whether the patients delayed or refused therapy. The delay or refusal of treatment was associated with the level of diagnosing hospital.
Collapse
Affiliation(s)
- Su Jing Chen
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Kuang Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
78
|
Pace LE, Mpunga T, Hategekimana V, Dusengimana JMV, Habineza H, Bigirimana JB, Mutumbira C, Mpanumusingo E, Ngiruwera JP, Tapela N, Amoroso C, Shulman LN, Keating NL. Delays in Breast Cancer Presentation and Diagnosis at Two Rural Cancer Referral Centers in Rwanda. Oncologist 2015; 20:780-8. [PMID: 26032138 DOI: 10.1634/theoncologist.2014-0493] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/27/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Breast cancer incidence is increasing in low- and middle-income countries (LMICs). Mortality/incidence ratios in LMICs are higher than in high-income countries, likely at least in part because of delayed diagnoses leading to advanced-stage presentations. In the present study, we investigated the magnitude, impact of, and risk factors for, patient and system delays in breast cancer diagnosis in Rwanda. MATERIALS AND METHODS We interviewed patients with breast complaints at two rural Rwandan hospitals providing cancer care and reviewed their medical records to determine the diagnosis, diagnosis date, and breast cancer stage. RESULTS A total of 144 patients were included in our analysis. Median total delay was 15 months, and median patient and system delays were both 5 months. In multivariate analyses, patient and system delays of ≥6 months were significantly associated with more advanced-stage disease. Adjusting for other social, demographic, and clinical characteristics, a low level of education and seeing a traditional healer first were significantly associated with a longer patient delay. Having made ≥5 health facility visits before the diagnosis was significantly associated with a longer system delay. However, being from the same district as one of the two hospitals was associated with a decreased likelihood of system delay. CONCLUSION Patients with breast cancer in Rwanda experience long patient and system delays before diagnosis; these delays increase the likelihood of more advanced-stage presentations. Educating communities and healthcare providers about breast cancer and facilitating expedited referrals could potentially reduce delays and hence mortality from breast cancer in Rwanda and similar settings. IMPLICATIONS FOR PRACTICE Breast cancer rates are increasing in low- and middle-income countries, and case fatality rates are high, in part because of delayed diagnosis and treatment. This study examined the delays experienced by patients with breast cancer at two rural Rwandan cancer facilities. Both patient delays (the interval between symptom development and the patient's first presentation to a healthcare provider) and system delays (the interval between the first presentation and diagnosis) were long. The total delays were the longest reported in published studies. Longer delays were associated with more advanced-stage disease. These findings suggest that an opportunity exists to reduce breast cancer mortality in Rwanda by addressing barriers in the community and healthcare system to promote earlier detection.
Collapse
Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tharcisse Mpunga
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Vedaste Hategekimana
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean-Marie Vianney Dusengimana
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Hamissy Habineza
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean Bosco Bigirimana
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cadet Mutumbira
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Egide Mpanumusingo
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean Paul Ngiruwera
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Neo Tapela
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cheryl Amoroso
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy L Keating
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
79
|
Pakseresht S, Ingle GK, Garg S, Sarafraz N. Stage at diagnosis and delay in seeking medical care among women with breast cancer, delhi, India. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14490. [PMID: 25763229 PMCID: PMC4341328 DOI: 10.5812/ircmj.14490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 09/06/2014] [Accepted: 10/18/2014] [Indexed: 11/30/2022]
Abstract
Background: Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease. Objectives: The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India. Patients and Methods: This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer “detected in surgery Out Patient Department (OPD) from January 2007 to December 2009” at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X2, Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P < 0.05). Results: the mean age of women was 46.99 years. 38.4% of women were ≤ 40 years. 61% of women were in stage IV of cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P < 005). Conclusions: A significant association was found between ages of women with their delays in consultation. Delay is still prevalent amongst women with breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.
Collapse
Affiliation(s)
- Sedigheh Pakseresht
- Reproductive Health Research Center, Department of Obstetrics, Guilan University of Medical Sciences, Rasht, IR Iran
| | - Gopal Krishna Ingle
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nahid Sarafraz
- Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Nahid Sarafraz, Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9132614866, Fax: +98-3615556633, E-mail:
| |
Collapse
|
80
|
Lee HB, Han W. Unique features of young age breast cancer and its management. J Breast Cancer 2014; 17:301-7. [PMID: 25548576 PMCID: PMC4278047 DOI: 10.4048/jbc.2014.17.4.301] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/05/2014] [Indexed: 12/16/2022] Open
Abstract
Young age breast cancer (YABC) has unique clinical and biological features that are not seen in older patients. Breast tumor biology is more aggressive and is associated with an unfavorable prognosis in younger women. The diagnosis of breast cancer is often delayed, resulting in their initial presentation with more advanced disease. Together, these characteristics lead to a poorer prognosis in younger women than in older women. Young women who receive breast-conserving therapy have a higher rate of local recurrence. Therefore, it is important to secure sufficient resection margins and consider boost radiotherapy to prevent local treatment failure. Based on age alone, patients with YABC should be regarded as high-risk cases, and they should be treated with adjuvant chemotherapy. Special considerations regarding psychosocial factors and fertility should be taken into account for young patients. This review discusses the major considerations and principles concerning the management of patients with YABC.
Collapse
Affiliation(s)
- Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| |
Collapse
|
81
|
Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol 2014; 5:465-477. [PMID: 25114860 PMCID: PMC4127616 DOI: 10.5306/wjco.v5.i3.465] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/23/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.
Collapse
|