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Yang JH, Huynh V, Leonard LD, Kovar A, Bronsert M, Ludwigson A, Wolverton D, Hampanda K, Christian N, Kim SP, Ahrendt G, Mathes DW, Tevis SE. Are Diagnostic Delays Associated with Distress in Breast Cancer Patients? Breast Care (Basel) 2023; 18:240-248. [PMID: 37900555 PMCID: PMC10601706 DOI: 10.1159/000529586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Receiving a new breast cancer diagnosis can cause anxiety and distress, which can lead to psychologic morbidity, decreased treatment adherence, and worse clinical outcomes. Understanding sources of distress is crucial in providing comprehensive care. This study aims to evaluate the relationship between delays in breast cancer diagnosis and patient-reported distress. Secondary outcomes include assessing patient characteristics associated with delay. Methods Newly diagnosed breast cancer patients who completed a distress screening tool at their initial evaluation at an academic institution between 2014 and 2019 were retrospectively evaluated. The tool captured distress levels in the emotional, social, health, and practical domains with scores of "high distress" defined by current clinical practice guidelines. Delay from mammogram to biopsy, whether diagnostic or screening mammogram, was defined as >30 days. Result 745 newly diagnosed breast cancer patients met inclusion criteria. Median time from abnormal mammogram to core biopsy was 12 days, and 11% of patients experienced a delay in diagnosis. The non-delayed group had higher emotional (p = 0.04) and health (p = 0.03) distress than the delayed group. No statistically significant differences in social distress were found between groups. Additionally, patients with higher practical distress had longer time interval between mammogram and surgical intervention compared to those with lower practical distress. Older age, diagnoses of invasive lobular carcinoma or ductal carcinoma in situ, and clinical anatomic stages 0-I were associated with diagnostic delay. Conclusion Patients with higher emotional or health-related distress were more likely to have timely diagnoses of breast cancer, suggesting that patients with higher distress may seek healthcare interventions more promptly. Improved understanding of sources of distress will permit early intervention regarding the devastating impact of breast cancer diagnosis.
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Affiliation(s)
- Jerry H. Yang
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura D. Leonard
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra Kovar
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | | | - Dulcy Wolverton
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Christian
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Simon P. Kim
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David W. Mathes
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah E. Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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2
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Afaya A, Ramazanu S, Bolarinwa OA, Yakong VN, Afaya RA, Aboagye RG, Daniels-Donkor SS, Yahaya AR, Shin J, Dzomeku VM, Ayanore MA, Alhassan RK. Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review. BMC Health Serv Res 2022; 22:1601. [PMID: 36587198 PMCID: PMC9805268 DOI: 10.1186/s12913-022-08927-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.
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Affiliation(s)
- Agani Afaya
- grid.15444.300000 0004 0470 5454Mo-Im Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.449729.50000 0004 7707 5975Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sheena Ramazanu
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Obasanjo Afolabi Bolarinwa
- grid.127050.10000 0001 0249 951XDepartment of Global Public Health, Canterbury Christ Church University, Canterbury, UK
| | - Vida Nyagre Yakong
- grid.442305.40000 0004 0441 5393Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- grid.442305.40000 0004 0441 5393Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Gyan Aboagye
- grid.449729.50000 0004 7707 5975Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Silas Selorm Daniels-Donkor
- grid.8241.f0000 0004 0397 2876Department of Nursing, School of Health Sciences, University of Dundee, Scotland Dundee, UK
| | - Ahmed-Rufai Yahaya
- Hariri School of Nursing, American University of Beruit, Beirut, Lebanon ,grid.460777.50000 0004 0374 4427Department of Internal Medicine, Tamale Teaching Hospital, Tamale, Ghana
| | - Jinhee Shin
- grid.412965.d0000 0000 9153 9511Woosuk University, College of Nursing, Wanju, Republic of Korea
| | - Veronica Millicent Dzomeku
- grid.9829.a0000000109466120Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Amogre Ayanore
- grid.449729.50000 0004 7707 5975Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- grid.449729.50000 0004 7707 5975Centre for Health Policy and Implementation Research. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Momenimovahed Z, Momenimovahed S, Allahqoli L, Salehiniya H. Factors Related to the Delay in Diagnosis of Breast Cancer in the Word: A Systematic Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Mohd Mujar NM, Dahlui M, Emran NA, Hadi IA, Yan YW, Arulanantham S, Chea CH, Mohd Taib NA. Breast Cancer Care Timeliness Framework: A Quality Framework for Cancer Control. JCO Glob Oncol 2022; 8:e2100250. [PMID: 35286134 PMCID: PMC8932493 DOI: 10.1200/go.21.00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A retrospective cohort study was conducted at six tertiary centers in Malaysia. All women with newly diagnosed breast cancer were interviewed, and a medical records review was conducted using a structured questionnaire. The BCC timeliness framework showed that the total time between a woman discovering their first breast changes and the date of initial treatment was divided into three distinct intervals: presentation interval, diagnostic interval, and treatment interval. Four diagnosis subintervals, referral, biopsy, report, and diagnosis resolution intervals, were also looked into. RESULTS The BCC timeliness framework was used to capture important time points. The median total time, presentation interval, diagnostic interval, and treatment interval were 4.9 months (range, 1 month to 10 years), 2.4 months (range, 7 days to 10 years), 26 days (range, 4 days to 9.3 months), and 21 days (range, 1 day to 7.2 months), respectively. Meanwhile, the median time for the diagnosis subinterval of referral, biopsy, report, and diagnosis resolution was 8 days (range, 0 day to 8 months), 0 day (range, 0 day to 20 days), 7 days (range, 3 days to 3.5 months), and 4 days (range, 1 day to 1.8 months), respectively. CONCLUSION The BCC timeliness framework is based on the current sequenced trajectory of the BCC journey. Clarity in the measurement of timeliness provides a standardized language for monitoring and outcome research. It can serve as a quality indicator for community and hospital-based breast cancer programs.
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Affiliation(s)
- Noor Mastura Mohd Mujar
- Lifestyle Science Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, UM Cancer Research Institute, Universiti Malaya, Kuala Lumpur, Malaysia
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Shamsi U, Khan S, Azam I, Usman S, Maqbool A, Gill T, Iqbal R, Callen D. Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed. JCO Glob Oncol 2021; 6:873-883. [PMID: 32579484 PMCID: PMC7328101 DOI: 10.1200/go.20.00034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them. METHODS Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review. RESULTS The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months. CONCLUSION Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.
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Affiliation(s)
- Uzma Shamsi
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Shaista Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shaheryar Usman
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Amir Maqbool
- Department of Oncology, Karachi Institute of Radiation and Nuclear Medicine Hospital, Karachi, Pakistan
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - David Callen
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Knowledge and Health Seeking Behaviour of Breast Cancer Patients in Ghana. Int J Breast Cancer 2019; 2019:5239840. [PMID: 31057972 PMCID: PMC6463645 DOI: 10.1155/2019/5239840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/17/2019] [Indexed: 10/27/2022] Open
Abstract
Background Breast cancer is a major contributor to cancer-related deaths among women worldwide, despite the numerous measures employed to prevent and manage the disease. This study explored the knowledge and health seeking behaviour of breast cancer patients at the Komfo Anokye Teaching Hospital. Methods A descriptive cross-sectional study was conducted at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from June 2014 to July 2014. Thirty-five participants were purposively selected. The responses to questions about their experiences with breast cancer were determined using indepth interviews. Transcripts were coded and analysed using NVIVO version 10.0. Results Participants' knowledge about signs and symptoms of breast cancer after their diagnosis was high but low for risk factors. Screening for breast cancer through self-breast examination was infrequently performed prior to their diagnosis. The patients' first point of care was generally health facilities. Some patients reported late due to misinterpretation of signs and symptoms, cultural influences and fear of losing their breast to surgery, physician delay, health providers' laxity, and disinterest in breast cancer. Men, for example, husbands, decide on where and when breast cancer patients go for treatment. Conclusion There is poor knowledge of the risk factors for developing breast cancer. Patients resorted to the hospital as first options for cure but were generally delayed in doing so. There is the need to create awareness about breast cancer among the general population.
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7
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Alba LH, Díaz S, Gamboa O, Poveda C, Henao A, Perry F, Duggan C, Gil F, Murillo R. Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia. Prev Med 2018; 115:19-25. [PMID: 30092313 DOI: 10.1016/j.ypmed.2018.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 08/04/2018] [Indexed: 10/28/2022]
Abstract
Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50-69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3-99.3) and 99.4% (95%CI 99.2-99.6). CBE sensitivity was 39.1% (95%CI 37.9-40.3) and specificity 83.4% (95%CI 82.6-84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.
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Affiliation(s)
- Luz Helena Alba
- Department of Preventive and Social Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sandra Díaz
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Oscar Gamboa
- Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - César Poveda
- Servicio de Imaginología, Instituto Nacional de Cancerología, Bogotá, Colombia; Facultad de Medicina, Universidad Nacional, Bogotá, Colombia
| | - Andrés Henao
- Radiología, Centro de Enfermedades Mamarias, Bogotá, Colombia
| | - Fernando Perry
- Clínica de seno, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fabián Gil
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Raúl Murillo
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France; Subdirección de Investigaciones y Salud Pública, Instituto Nacional de Cancerología, Bogotá, Colombia.
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8
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Jiang L, Gilbert J, Langley H, Moineddin R, Groome PA. Is being diagnosed at a dedicated breast assessment unit associated with a reduction in the time to diagnosis for symptomatic breast cancer patients? Eur J Cancer Care (Engl) 2018; 27:e12864. [PMID: 29873137 DOI: 10.1111/ecc.12864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/27/2022]
Abstract
The length of the cancer diagnostic interval can affect a patient's survival and psychosocial well-being. Ontario Diagnostic Assessment Units (DAUs) were designed to expedite the diagnostic process through coordinated care. We examined the effect of DAUs on the diagnostic interval among female patients with symptomatic breast cancer in Ontario using the Ontario Cancer Registry linked to administrative healthcare data. The diagnostic interval was defined as the time from patients' first referral or test to the cancer diagnosis. DAU use was determined based on the hospital where the breast biopsy/surgery was performed. Multivariable quantile regression and logistic regression analyses adjusted for possible confounders. Forty-seven per cent of patients were diagnosed in a DAU and 53% in usual care (UC). DAUs achieved the Canadian timeliness targets more often than UC (71.7% vs. 58.1%, respectively). DAU use was associated with a 10-day (95% CI: 7.8-11.9) reduction in the median diagnostic interval. This effect increased to 19 days for patients at the 75th percentile and 22 days for those at the 90th percentile of the diagnostic interval distribution. Use of an Ontario DAU is associated with a shorter time to diagnosis in patients with symptomatic breast cancer, especially for those who would otherwise wait the longest.
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Affiliation(s)
- Li Jiang
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | | | - Hugh Langley
- South East Regional Cancer Program, Kingston General Hospital, Kingston, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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9
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Khanna S, Kim KN, Qureshi MM, Agarwal A, Parikh D, Ko NY, Rand AE, Hirsch AE. Impact of patient demographics, tumor characteristics, and treatment type on treatment delay throughout breast cancer care at a diverse academic medical center. Int J Womens Health 2017; 9:887-896. [PMID: 29255374 PMCID: PMC5723124 DOI: 10.2147/ijwh.s150064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose and objective The aim of this study was to examine the impact of patient demographics, tumor characteristics, and treatment type on time to treatment (TTT) in patients with breast cancer treated at a safety net medical center with a diverse patient population. Patients and methods A total of 1,130 patients were diagnosed and treated for breast cancer between 2004 and 2014 at our institution. We retrospectively collected data on patient age at diagnosis, race/ethnicity, primary language spoken, marital status, insurance coverage, American Joint Committee on Cancer (AJCC) stage, hormone receptor status, and treatment dates. TTT was determined from the date of breast cancer biopsy to treatment start date. Nonparametric Mann-Whitney U-test (or Kruskal-Wallis test when appropriate) and multivariable quantile regression models were employed to assess for significant differences in TTT associated with each factor. Results Longer median TTT was noted for Black (P=0.002) and single (P=0.002) patients. AJCC stage IV patients had shorter TTT (27.5 days) compared to earlier AJCC patients (36, 35, 37, 37 days for stage 0, I, II, III, respectively), P=0.028. Age, primary language spoken, insurance coverage, and hormone receptor status had no significant impact on TTT. On multivariate analysis, race/ethnicity remained the only significant factor with Black reporting longer TTT, P=0.025. However, race was not a significant factor for time from first to second treatment. More Black patients were noted to be single (P<0.0001) and received chemotherapy as first treatment (P=0.008) compared to White, Hispanic, or other race/ethnicity patients. Conclusion In this retrospective analysis, Black patients had longer TTT, were more likely to receive chemotherapy as first treatment, and have a single marital status. These patient factors will help identify vulnerable patients and guide further research to understand the barriers to care and the impact of treatment delays on outcomes.
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Affiliation(s)
- Shivani Khanna
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Kristine N Kim
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Ankit Agarwal
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Divya Parikh
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Naomi Y Ko
- Department of Hematology Oncology, Boston Medical Center, Boston MA, USA
| | - Alexander E Rand
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine
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10
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Chiarelli AM, Muradali D, Blackmore KM, Smith CR, Mirea L, Majpruz V, O'Malley FP, Quan ML, Holloway CM. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care. Br J Cancer 2017; 116:1254-1263. [PMID: 28359079 PMCID: PMC5482732 DOI: 10.1038/bjc.2017.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/27/2017] [Accepted: 02/25/2017] [Indexed: 11/12/2022] Open
Abstract
Background: Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation. This study aims to evaluate factors associated with diagnostic wait times for women undergoing assessment through BAC and UC. Methods: Of the 2 147 257 women aged 50–69 years screened in the OBSP between 1 January 2002 and 31 December 2009, 155 866 (7.3%) had an abnormal mammogram. A retrospective design identified two concurrent cohorts of women diagnosed with screen-detected breast cancer at a BAC (n=4217; 47%) and UC (n=4827; 53%). Multivariable logistic regression analyses examined associations between wait times and assessment and prognostic characteristics by pathway. A two-sided 5% significance level was used. Results: Screened women with breast cancer were two times more likely to be diagnosed within 7 weeks when assessed through a BAC vs UC (OR=1.91, 95% CI=1.73–2.10). In addition, compared with UC, women assessed through a BAC were significantly more likely to have their first assessment procedure within 3 weeks of their abnormal mammogram (OR=1.25, 95% CI=1.12–1.39), ⩽3 assessment procedures (OR=1.54, 95% CI=1.41–1.69), ⩽2 assessment visits (OR=1.86, 95% CI=1.70–2.05), and ⩾2 procedures per visit (OR=1.41, 95% CI=1.28–1.55). Women diagnosed through a BAC were also more likely than those in UC to have imaging (OR=1.99, 95% CI=1.44–2.75) or a biopsy (OR=3.69, 95% CI=2.64–5.15) vs consultation only at their first assessment visit, and two times more likely to have a core or FNA biopsy than a surgical biopsy (OR=2.08, 95% CI=1.81–2.40). Having ⩽2 assessment visits was more likely to reduce time to diagnosis for women assessed through a BAC compared with UC (BAC OR=10.58, 95% CI=8.96–12.50; UC OR=4.47, 95% CI=3.94–5.07), as was having ⩽3 assessment procedures (BAC OR=4.97, 95% CI=4.26–5.79; UC OR=2.95, 95% CI=2.61–3.33). Income quintile affected wait times only in women diagnosed in UC, with those in the two highest quintiles more likely to receive a diagnosis in 7 weeks. Conclusions: Women with screen-detected breast cancer in OBSP were more likely to have shorter wait times if they were diagnosed through organised assessment. This might be as a result of women diagnosed through a BAC having more procedures per visit, procedures scheduled in shorter intervals, and imaging or biopsy on their first visit. Given the significant improvement in timeliness to diagnosis, women with abnormal mammograms should be managed through organised assessment.
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Affiliation(s)
- Anna M Chiarelli
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario M5T 3M7, Canada
| | - Derek Muradali
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada.,St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.,Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, Ontario M5T 1W7, Canada
| | - Kristina M Blackmore
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada
| | - Courtney R Smith
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada
| | - Lucia Mirea
- Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, Arizona 85016, USA
| | - Vicky Majpruz
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada
| | - Frances P O'Malley
- Department of Laboratory Medicine, St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - May Lynn Quan
- Calgary Breast Health Program, Foothills Medical Centre, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada.,Department of Surgery and Surgical Oncology, University of Calgary, 1331-29 Street NW, Calgary, Alberta T2N 4N2, Canada
| | - Claire Mb Holloway
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.,Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto, Ontario M5T 1P5, Canada
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11
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Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, Boateng D. Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PLoS One 2017; 12:e0171024. [PMID: 28192444 PMCID: PMC5305236 DOI: 10.1371/journal.pone.0171024] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Breast cancer (BC) has been described as the leading cause of cancer deaths among women especially in the developing world including sub Saharan Africa (SSA). Delayed presentation and late diagnosis at health facilities are parts of the contributing factors of high BC mortality in Africa. This review aimed to appraise the contributing factors to delayed breast cancer presentation and diagnosis among SSA women. METHODS Five databases encompassing medical and social sciences were systematically searched using predefined search terms linked with breast cancer presentation and diagnosis and sub Saharan Africa. Reference lists of relevant papers were also hand searched. Quality of quantitative and qualitative articles were assessed using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Critical Appraisal Skills Programme (CASP) quality appraisal checklist. Thematic analysis was used to synthesize the qualitative studies to integrate findings. RESULTS Fourteen (14) quantitative studies, two (2) qualitative studies and one (1) mixed method study merited inclusion for analysis. This review identified low knowledge of breast cancer among SSA women. This review also found lack of awareness of early detection treatment, poor perception of BC, socio-cultural factors such as belief, traditions and fear as factors impacting African women's health seeking behavior in relation to breast cancer. CONCLUSION Improving African women's knowledge and understanding will improve behaviors related to breast cancer and facilitate early presentation and detection and enhance proper management and treatment of breast cancer.
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Affiliation(s)
| | | | | | - Dan Yedu Quansah
- Graduate School of Public health, Seoul National University, Seoul, South Korea
| | | | - Daniel Boateng
- Julius Global Health, University Medical Center, Utrecht University, the Netherlands
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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12
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Youl PH, Aitken JF, Turrell G, Chambers SK, Dunn J, Pyke C, Baade PD. The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1156. [PMID: 27869758 PMCID: PMC5129366 DOI: 10.3390/ijerph13111156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 01/07/2023]
Abstract
Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a "non-lump" symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.
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Affiliation(s)
- Philippa H Youl
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
- School of Population Health, University of Queensland, Brisbane, QLD 4072, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Gavin Turrell
- Institute of Health and Ageing, Australian Catholic University, Fitzroy, VIC 3115, Australia.
| | - Suzanne K Chambers
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Jeffrey Dunn
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
- School of Social Science, University of Queensland, Brisbane, QLD4072, Australia.
| | - Christopher Pyke
- Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia.
| | - Peter D Baade
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
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13
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Ayrault-Piault S, Grosclaude P, Daubisse-Marliac L, Pascal J, Leux C, Fournier E, Tagri AD, Métais M, Lombrail P, Woronoff AS, Molinié F. Are disparities of waiting times for breast cancer care related to socio-economic factors? A regional population-based study (France). Int J Cancer 2016; 139:1983-93. [PMID: 27405647 DOI: 10.1002/ijc.30266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/30/2016] [Indexed: 01/27/2023]
Abstract
The increasing number of breast cancer cases may induce longer waiting times (WT), which can be a source of anxiety for patients and may play a role in survival. The aim of this study was to examine the factors, in particular socio-economic factors, related to treatment delays. Using French Cancer Registry databases and self-administered questionnaires, we included 1,152 women with invasive non-metastatic breast cancer diagnosed in 2007. Poisson regression analysis was used to identify WTs' influencing factors. For 973 women who had a malignant tissue sampling, the median of overall WT between the first imaging procedure and the first treatment was 44 days (9 days for pathological diagnostic WT and 31 days for treatment WT). The medical factors mostly explained inequalities in WTs. Socio-economic and behavioral factors had a limited impact on WTs except for social support which appeared to be a key point. Better identifying the factors associated with increase in WTs will make it possible to develop further interventional or prospective studies to confirm their causal role in delay and at last reduce disparities in breast cancer management.
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Affiliation(s)
| | - Pascale Grosclaude
- Registre Des Cancers Du Tarn, Institut Claudius Regaud, IUCT-O, LEASP-UMR 1027 Inserm-Université De Toulouse, Toulouse, France
| | - Laetitia Daubisse-Marliac
- Registre Des Cancers Du Tarn, Institut Claudius Regaud, IUCT-O, LEASP-UMR 1027 Inserm-Université De Toulouse, Toulouse, France
| | - Jean Pascal
- Département D'Information Médicale, Cellule d'Identito-Vigilance, CHU Toulouse, Toulouse, France
| | | | - Evelyne Fournier
- Registre Des Tumeurs Du Doubs Et Du Territoire De Belfort, CHRU Besançon, EA3181, Université De Franche-Comté, Besançon, France
| | | | - Magali Métais
- Registre Des Cancers De Loire-Atlantique-Vendée, Nantes, France
| | - Pierre Lombrail
- Laboratoire « Éducations Et Pratiques De Santé » EA3412, Université Paris 13-Sorbonne Paris Cité, Bobigny, France
| | - Anne-Sophie Woronoff
- Registre Des Tumeurs Du Doubs Et Du Territoire De Belfort, CHRU Besançon, EA3181, Université De Franche-Comté, Besançon, France
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14
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Racz JM, Holloway CMB, Huang W, Hong NJL. Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit. ACTA ACUST UNITED AC 2016; 23:e260-5. [PMID: 27330363 DOI: 10.3747/co.23.3017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (rdu) on wait times to clinical investigations and definitive treatment. METHODS A retrospective before-after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the rdu. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test. RESULTS The non-rdu group included 287 patients with 164 invasive breast carcinomas. The rdu group included 260 patients with 154 invasive carcinomas. The rdu patients had more single visits for biopsy (92% rdu vs. 78% non-rdu, p < 0.0001). The rdu group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the rdu vs. 50 days without the rdu, p = 0.3806). CONCLUSIONS Introduction of a rdu appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.
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Affiliation(s)
- J M Racz
- University of Toronto, Department of Surgical Oncology, Toronto, ON
| | - C M B Holloway
- Division of Surgical Oncology, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto, ON;; Department of Surgery, University of Toronto, Toronto, ON
| | - W Huang
- University of Toronto, Department of Surgical Oncology, Toronto, ON
| | - N J Look Hong
- Division of Surgical Oncology, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto, ON;; Department of Surgery, University of Toronto, Toronto, ON
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15
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Limam M, Ajmi T, Zedini C, Khelifi A, Mellouli M, El Ghardallou M, Sahli J, Khairi H, Mtiraoui A. Étude des délais de traitement du cancer du sein à Sousse, Tunisie. SANTÉ PUBLIQUE 2016. [DOI: 10.3917/spub.163.0331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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16
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Webber C, Jiang L, Grunfeld E, Groome PA. Identifying predictors of delayed diagnoses in symptomatic breast cancer: a scoping review. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26950652 DOI: 10.1111/ecc.12483] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
Delayed diagnosis of breast cancer can adversely impact patient outcomes. To better understand this issue, we conducted a scoping review of literature from 1996 to 2015 that examined predictors of delayed presentation and diagnosis among women with breast cancer symptoms. We performed searches to identify studies of predictors of the time from symptom onset to first presentation (the patient interval), first presentation to diagnosis (the diagnostic interval) and symptom onset to diagnosis (the total interval) among women with breast cancer symptoms. Two reviewers independently reviewed and abstracted the findings of these studies. Of the 22 studies included in this review, 16 examined predictors of the patient interval, six examined predictors of the diagnostic interval and four examined predictors of the total interval. A total of 116 predictors were examined; three had evidence of an association with a less timely diagnosis: not disclosing symptoms to others, non-lump breast symptoms and African American ethnicity. Improving awareness of atypical breast cancer symptoms and encouraging disclosure could improve the timeliness of a breast cancer diagnosis. Access concerns for vulnerable groups need to be addressed. Future research should be more purposeful in its choice of predictors, possibly through the use of established conceptual frameworks.
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Affiliation(s)
- Colleen Webber
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Li Jiang
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Eva Grunfeld
- Health Services Research Program, Ontario Institute for Cancer Research, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
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17
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Effect of specialized diagnostic assessment units on the time to diagnosis in screen-detected breast cancer patients. Br J Cancer 2015; 112:1744-50. [PMID: 25942395 PMCID: PMC4647239 DOI: 10.1038/bjc.2015.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 01/07/2023] Open
Abstract
Background: The duration of the cancer diagnostic process has considerable influence on patients' psychosocial well-being. Breast diagnostic assessment units (DAUs) in Ontario, Canada are designed to improve the quality and timeliness of care during a breast cancer diagnosis. We compared the diagnostic duration of patients diagnosed through a DAU vs usual care (UC). Methods: Retrospective population-based cohort study of 2499 screen-detected breast cancers (2011) using administrative health-care databases linked to the Ontario Cancer Registry. The diagnostic interval was measured from the initial screen to cancer diagnosis. Diagnostic assessment unit use was based on the biopsy and/or surgery hospital. We compared the length of the diagnostic interval between the DAU groups using multivariable quantile regression. Results: Diagnostic assessment units had a higher proportion of patients diagnosed within the 7-week target compared with UC (79.1% vs 70.2%, P<0.001). The median time to diagnosis at DAUs was 26 days, which was 9 days shorter compared with UC (95% CI: 6.4–11.6). This effect was reduced to 8.3 days after adjusting for all study covariates. Adjusted DAU differences were similar at the 75th and 90th percentiles of the diagnostic interval distribution. Conclusions: Diagnosis through an Ontario DAU was associated with a reduced time to diagnosis for screen-detected breast cancer patients, which likely reduces the anxiety and distress associated with waiting for a diagnosis.
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18
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Nessim C, Winocour J, Holloway DPM, Saskin R, Holloway CMB. Wait times for breast cancer surgery: effect of magnetic resonance imaging and preoperative investigations on the diagnostic pathway. J Oncol Pract 2015; 11:e131-8. [PMID: 25670200 DOI: 10.1200/jop.2014.002105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Women with breast cancer often require an extensive diagnostic work-up. We sought to determine the overall wait time, from the patient's perspective, from identification of an imaging abnormality to definitive treatment. The objective was to identify which factors contribute to overall wait time in women with breast cancer. METHODS A retrospective chart review in a tertiary care center was performed to identify all women who had breast surgery for invasive carcinoma and ductal carcinoma in situ. We recorded the dates of first imaging abnormality, first biopsy, subsequent imaging and biopsy, first consultation with any physician at the cancer center, first surgical consultation, and date of surgery. Clinical data that might influence these dates were then extracted. Wait times were calculated and factors associated with wait times were described. RESULTS Eligible consecutive women with a cancer diagnosis (n = 264) were identified. The median time between first imaging abnormality and definitive surgery was 79 days. The median time from first surgical consultation to surgery was significantly longer in women who underwent magnetic resonance imaging and in women who underwent initial imaging outside of our tertiary care center (P < .05). On multivariable analysis, the modifiable factors associated with prolonged wait times included number of preoperative clinic visits, number of visits to radiology, and initial imaging outside of our center (P < .05). CONCLUSION Extensive diagnostic work-up is an important factor that affects the time to definitive surgery. A more integrated approach using a rapid diagnostic clinic for tissue diagnosis initially, followed by facilitated preoperative evaluation, may potentially decrease wait times in breast evaluation.
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Affiliation(s)
- Carolyn Nessim
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Julian Winocour
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Diana P M Holloway
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Refik Saskin
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Odette Cancer Centre and Sunnybrook Health Sciences Centre; University of Toronto; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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19
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Rahaei Z, Ghofranipour F, Morowatisharifabad MA, Mohammadi E. Determinants of Cancer Early Detection Behaviors:Application of Protection Motivation Theory. Health Promot Perspect 2015; 5:138-46. [PMID: 26290829 PMCID: PMC4539052 DOI: 10.15171/hpp.2015.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/10/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer is account for 13% of all deaths around the world and is the third cause of mortality in Iran. More than one third of these cases are pre-ventable and about 33% are curable with early detection. The aim of this study was to determine the predictors of cancer early detection (CED) behaviors applying Protection Motivation Theory (PMT). METHODS In this cross-sectional study, cluster sampling method was employed to recruit 260 individuals of above 20 years old in Yazd, Iran and a researcher designed questionnaire was completed through interviews for each of the respondents. PMT theoretical variables and CED behaviors were the basis of data collection procedure. RESULTS Participants acquired 64.47% of the protection motivation, 30.97% of the passive and 45.64% of the active behaviors‟ possible scores. Theory constructs predicted 19.8%, 15.6% and 9.6% of the variations for protection motivation, passive and active behavior respectively. Protection motivation was responsible for 3.6% of passive and 8% of active behaviors‟ variations. CONCLUSION Considering the scarceness of CED behaviors and the applicability of PMT in predicting these behaviors, utilization of the PMT‟s constructs in any interventional programs to accelerate CED behaviors could be an alternate methodological choice in the cancer control initiatives.
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Affiliation(s)
- Zohreh Rahaei
- Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ghofranipour
- Department of Health Education, Tarbiat Modares University, Tehran, Iran
- Corresponding Author: Ghofranipour Fazlollah Tel: +98 21 82883869;
| | | | - Eesa Mohammadi
- Department of Nursing, Tarbiat Modares University, Tehran, Iran
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20
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Yuan Y, Li M, Yang J, Winget M. Using administrative data to estimate time to breast cancer diagnosis and percent of screen-detected breast cancers - a validation study in Alberta, Canada. Eur J Cancer Care (Engl) 2014; 24:367-75. [DOI: 10.1111/ecc.12277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Yuan
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - M. Li
- School of Public Health; University of Alberta; Edmonton Alberta Canada
| | - J. Yang
- Cancer Control Alberta; Alberta Health Services; Edmonton Alberta Canada
| | - M. Winget
- Department of Medicine; Stanford University School of Medicine; Palo Alto California USA
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21
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Gyenwali D, Khanal G, Paudel R, Amatya A, Pariyar J, Onta SR. Estimates of delays in diagnosis of cervical cancer in Nepal. BMC WOMENS HEALTH 2014; 14:29. [PMID: 24533670 PMCID: PMC3932513 DOI: 10.1186/1472-6874-14-29] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/13/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer related deaths among women in Nepal. The long symptom to diagnosis interval means that women have advanced disease at presentation. The aim of this study was to identify, estimate and describe the extent of different delays in diagnosis of cervical cancer in Nepal. METHODS A cross-sectional descriptive study was conducted in two tertiary cancer hospitals of Nepal. Face to face interview and medical records review were carried out among 110 cervical cancer patients. Total diagnostic delay was categorized into component delays: patient delay, health care providers delay, referral delay and diagnostic waiting time. RESULTS Total 110 patients recruited in the study represented 40 districts from all three ecological regions of the country. Median total diagnostic delay was 157 days with more than three fourth (77.3%) of the patients having longer total diagnostic delay of >90 days. Out of the total diagnostic delay, median patient delay, median health care provider delay, median referral delay and median diagnostic waiting time were 68.5 days, 40 days, 5 days and 9 days respectively. Majority of the patients had experienced longer delay of each type except referral delay. Fifty seven percent of the patients had experienced longer patient delay of >60 days, 90% had suffered longer health care provider delay of >1 week, 31.8% had longer referral delay of >1 week and 66.2% had waited >1 week at diagnostic center for final diagnosis. Variation in each type of delay was observed among women with different attributes and in context of health care service delivery. CONCLUSIONS Longer delays were observed in all the diagnostic pathways except for referral delay and diagnostic waiting time. Among the delays, patient delay is of crucial importance because of its longer span, although health care provider delay is equally important. In the context of limited screening services in Nepal, the efforts should be to reduce the diagnostic delay especially patient and health care provider delay for early detection and reduction of mortality rate of cervical cancer.
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Affiliation(s)
- Deepak Gyenwali
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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22
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Molinié F, Leux C, Delafosse P, Ayrault-Piault S, Arveux P, Woronoff AS, Guizard AV, Velten M, Ganry O, Bara S, Daubisse-Marliac L, Tretarre B. Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France. Breast 2013; 22:810-6. [PMID: 23473773 DOI: 10.1016/j.breast.2013.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/25/2013] [Accepted: 02/11/2013] [Indexed: 02/07/2023] Open
Abstract
Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France.
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Affiliation(s)
- F Molinié
- Registre des cancers de Loire-Atlantique-Vendée, Nantes, France; Réseau Francim, Toulouse, France.
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23
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Murchie P, Campbell NC, Delaney EK, Dinant GJ, Hannaford PC, Johansson L, Lee AJ, Rollano P, Spigt M. Comparing diagnostic delay in cancer: a cross-sectional study in three European countries with primary care-led health care systems. Fam Pract 2012; 29:69-78. [PMID: 21828375 DOI: 10.1093/fampra/cmr044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The principal aim of this study was to determine the feasibility of a large-scale comparative study, between the UK, the Netherlands and Sweden, to investigate whether delays in the diagnostic pathway of cancer might explain differences in cancer survival between countries. METHODS Following a planning meeting to agree the format of a data collection instrument, data on delays in the cancer diagnostic pathway were abstracted from primary care-held medical records. Data were collected on 50 cases each (total of 150) from practices in each of Grampian, Northeast Scotland; Maastricht, the Netherlands and Skane, Sweden. Data were entered into SPSS 18.0 for analysis. RESULTS Data on delays in the cancer diagnostic pathway were readily available from primary care-held case records. However, data on demographic variables, cancer stage at diagnosis and treatment were less well recorded. There was no significant difference between countries in the way in which cases were referred from primary to secondary care. There was no significant difference between countries in the time delay between a patient presenting in primary care and being referred to secondary care. Median delay between referral and first appointment in secondary care [19 (8.0-47.5) days] was significantly longer in Scotland that in Sweden [1.0 (0-31.5) days] and the Netherlands [5.5 (0-31.5) days] (P < 0.001). Secondary care delay (between first appointment in secondary care and diagnosis) in Scotland [22.5 (0-39.5) days] was also significantly longer than in Sweden [14.0 (4.5-31.5) days] and the Netherlands [3.5 (0-16.5) days] (P = 0.003). Finally, overall delay in Scotland [53.5 (30.3-96.3) days] was also significantly longer than in Sweden [32.0 (14.0-71.0) days] and the Netherlands [22.0 (7.0-60.3) days] (P = 0.003). CONCLUSIONS A large-scale study comparing cancer delays in European countries and based on primary care-held records is feasible but would require supplementary sources of data in order to maximize information on demographic variables, the cancer stage at diagnosis and treatment details. Such a large-scale study is timely and desirable since our findings suggest systematic differences in the way cancer is managed in the three countries.
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Affiliation(s)
- Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Johnson TV, Hsiao W, Jani A, Master VA. Increased mortality among Hispanic testis cancer patients independent of neighborhood socioeconomic status: a SEER study. J Immigr Minor Health 2011; 13:818-24. [PMID: 21140218 DOI: 10.1007/s10903-010-9419-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Testis cancer-specific survival (CSS) varies by Hispanic ethnicity. Our goal was to assess whether neighborhood socioeconomic status (SES) accounts for elevated testis CSS among Hispanic patients. We queried the Surveillance, Epidemiology, and End Results (SEER) database for Hispanic (HW) and Non-Hispanic white (NHW) patients. Multivariate Cox regression analyses evaluated Hispanic ethnicity's impact on tCSS while adjusting for neighborhood socioeconomic status (education and income levels). HWs constituted 14.3% of the 26,258 patients in the cohort. Neighborhood SES factors such as county income (P < 0.001) and education level (P < 0.001) were significant predictors of testis cancer-specific survival (tCSS). Controlling for SES and other variables, Hispanic ethnicity remained a significant predictor of tCSS. Compared to NHWs, HWs experienced a 41% greater cancer-specific mortality (HR: 1.406, 95% CI: 1.178-1.678, P < 0.001). The mechanism underlying the increased testis cancer mortality experienced by Hispanic patients remains unknown.
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Bright K, Barghash M, Donach M, de la Barrera MG, Schneider RJ, Formenti SC. The role of health system factors in delaying final diagnosis and treatment of breast cancer in Mexico City, Mexico. Breast 2011; 20 Suppl 2:S54-9. [PMID: 21371885 DOI: 10.1016/j.breast.2011.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In Mexico, breast cancer is the leading cancer-related death among women and most cases are diagnosed at advanced stages (50-60%). We hypothesized health system factors could be partly responsible for this delay and performed a prospective review of 166 new breast cases at a major public hospital in Mexico City. Our analysis confirmed the prevalence of locally advanced and metastatic disease (47% of patients). A subset analysis of 32 women with confirmed stage I-IIIC breast cancer found an average time interval of 1.8 months from symptom onset to first primary care consultation (PCC), with an additional 6.6 months from first PCC to confirmed diagnosis, and 0.6 months from diagnosis to treatment initiation. Patients underwent an average of 7.9 clinic visits before confirmed diagnosis. Findings suggest that protracted referral time from primary to specialty care accounts for the bulk of delay, with earlier stage patients experiencing longer delays. These findings reveal a critical need for further study and exploration of interventions.
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Affiliation(s)
- Kristin Bright
- New York University School of Medicine, New York, NY, USA.
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Inequity in access to cancer care: a review of the Canadian literature. Cancer Causes Control 2011; 22:359-66. [PMID: 21221758 DOI: 10.1007/s10552-010-9722-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 12/23/2010] [Indexed: 12/24/2022]
Abstract
Despite the policy and research attention on ensuring equitable access--equal access for equal need--to health care, research continues to identify inequities in access to cancer services. We conducted a literature review to identify the current state of knowledge about inequity in access to cancer health services in Canada in terms of the continuum of care, disease sites, and dimensions of inequity (e.g., income). We searched MEDLINE, CINAHL, and Embase for studies published between 1990 and 2009. We retrieved 51 studies, which examine inequity in access to cancer services from screening to end-of-life care, for multiple cancer types, and a variety of socioeconomic, geographic, and demographic factors that may cause concern for inequity in Canada. This review demonstrates that income has the most consistent influence on inequity in access to screening, while age and geography are most influential for treatment services and end-of-life care, even after adjusting for patient need. Our review also reports on methods used in the literature and new techniques to explore. Equitable access to cancer care is vitally important in all health systems. Obtaining information on the current status of inequities in access to cancer care is a critical first step toward action.
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Bouche G, Ingrand I, Mathoulin-Pelissier S, Ingrand P, Breton-Callu C, Migeot V. Determinants of variability in waiting times for radiotherapy in the treatment of breast cancer. Radiother Oncol 2010; 97:541-7. [PMID: 20950880 DOI: 10.1016/j.radonc.2010.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/31/2010] [Accepted: 09/10/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Gauthier Bouche
- Epidemiology & Biostatistics, INSERM CIC-P 802, Université de Poitiers, France
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Bondy JN, Thind A, Stewart M, Manuel D, Freeman T. Wait times for women with abnormal uterine bleeding in South-Western Ontario. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:703-7. [PMID: 20707962 DOI: 10.1016/s1701-2163(16)34577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Women referred to an obstetrician-gynaecologist because of abnormal uterine bleeding (AUB) should be seen within 12 weeks, according to the benchmarks recommended for medically acceptable wait times established by the Society of Obstetricians and Gynaecologists of Canada. Our study aimed to determine the proportion of patients having wait times that meet this recommendation, and to understand patient-level sources of variation in these waits. METHODS We performed a secondary analysis of data from the Delivering Primary Healthcare Information (DELPHI) project database. Electronic medical record data from 10 family practices across south-western Ontario were used to study AUB wait times. RESULTS Over a 30-month period, 223 referrals were made to obstetrician-gynaecologists because of AUB. The mean wait time for initial assessment was 70.4 days (median = 51 days); the range among referring practices varied from 36 to 111 days. Seventy-one percent of women were seen by the obstetrician-gynaecologist within the recommended time of 12 weeks or less. Multi-level regression analysis indicated that older patients were more likely to have shorter waits. The intraclass correlation was 0.256, indicating that nearly a quarter of the variation in wait time was explained at the practice level. CONCLUSION Nearly 30% of women referred to specialists because of AUB wait longer than the period of time recommended by the SOGC, with younger women more likely to wait longer. This difference may be due to the perception of an increased risk of malignancy in older women. Future research on correlates of AUB wait times should take factors such as severity and prior family physician work up into account.
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Affiliation(s)
- Jennifer N Bondy
- Schulich School of Medicine, University of Western Ontario, London, ON
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Maree JE, Wright SC. How would early detection be possible? An enquiry into cancer related knowledge, understanding and health seeking behaviour of urban black women in Tshwane, South Africa. Eur J Oncol Nurs 2010; 14:190-6. [DOI: 10.1016/j.ejon.2009.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 10/26/2009] [Accepted: 10/29/2009] [Indexed: 11/26/2022]
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Current world literature. Curr Opin Obstet Gynecol 2008; 20:602-7. [PMID: 18989138 DOI: 10.1097/gco.0b013e32831ceeb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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