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Geremew H, Golla EB, Simegn MB, Abate A, Ali MA, Kumbi H, Wondie SG, Mengstie MA, Tilahun WM. Late-stage diagnosis: The driving force behind high breast cancer mortality in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0307283. [PMID: 39028722 PMCID: PMC11259299 DOI: 10.1371/journal.pone.0307283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia. METHODS Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger's regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237. RESULTS The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis. CONCLUSION Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages.
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Affiliation(s)
- Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | | | - Mulat Belay Simegn
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Alegntaw Abate
- Department of Medical Laboratory Science, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mohammed Ahmed Ali
- Department of Midwifery, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Hawi Kumbi
- Department of Laboratory, Adama Hospital Medical College, Adama, Ethiopia
| | - Smegnew Gichew Wondie
- Department of Human Nutrition, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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An J, Steffen AD, Collins EG, Molina Y, Li X, Ferrans CE. Act or Wait? Presentation Delay in Symptomatic Breast Cancer in China. Cancer Nurs 2024:00002820-990000000-00258. [PMID: 38857168 DOI: 10.1097/ncc.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND In Western countries, factors contributing to breast cancer presentation delay have been identified, but little is known about presentation delay in China, where culture and healthcare systems are quite different. OBJECTIVE To describe the delay interval among newly diagnosed breast cancer patients in China and to identify factors influencing delay, including the COVID-19 pandemic. METHODS Using a cross-sectional design, we recruited 154 participants within 3 months of pathological diagnosis of breast cancer. Data were collected using standardized scales and open-ended questions. RESULTS We found 44.8% of participants delayed ≥1 month, and 24.7% delayed ≥3 months before presentation, after self-discovery of symptoms. Logistic regression analysis showed that factors associated with longer delay (≥1 month) included preferring female physicians for breast examination, fewer negative emotions (afraid, anxious, distressed) regarding breast symptoms, more competing priorities, believing folk therapy can help treat lumps, and visiting a secondary or tertiary hospital instead of primary healthcare providers (P < .05 for all). Interaction tests showed perceived seriousness of symptoms significantly predicted delay of ≥1 month only when perceived healthcare access or trust in physicians was low. Patients (14%) reported delaying due to fear of COVID-19 infection and inability to leave home. CONCLUSIONS Presentation delays were substantial and multilevel barriers to timely presentation were identified, which would be expected to contribute to later-stage cancer at diagnosis. IMPLICATIONS FOR PRACTICE Findings suggest that nursing interventions and improved health policies are urgently needed in China, including breast cancer education to increase awareness.
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Affiliation(s)
- Jinghua An
- Author Affiliations: Rutgers Cancer Institute of New Jersey, New Brunswick (Dr An); College of Nursing (Drs An, Steffen, Collins, and Ferrans) and School of Public Health (Dr Molina), University of Illinois at Chicago; and School of Nursing, Xi'an Jiaotong University, Shaanxi, China (Dr Li)
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Mistry T, Pal R, Ghosh S, Choudhury T, Mandal S, Nath P, Alam N, Nasare VD. Impact of Low BMI and Nutritional Status on Quality of Life and Disease Outcome in Breast Cancer Patients: Insights From a Tertiary Cancer Center in India. Nutr Cancer 2024; 76:596-607. [PMID: 38836498 DOI: 10.1080/01635581.2024.2347396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/18/2024] [Indexed: 06/06/2024]
Abstract
This study investigates the impact of Body Mass Index (BMI) on Quality of Life (QoL) and treatment outcomes in breast cancer (BC) patients, particularly focusing on underweight individuals with compromised nutritional status. A nonrandomized prospective study comprising 121 newly diagnosed patients across various BMI categories utilized FACT-B & FACIT-Sp-12 questionnaires. Follow-ups occurred at baseline, during (3rd and 6th), and after (12th month) anthracycline-taxane chemotherapy, either sequentially or concomitantly. Patients with low BMI (<18.5 kg/m2; 53.7%) exhibited significantly poorer QoL, marked by compromised nutritional indicators (low MUAC and SFT). Repeated measures ANOVA identified significant correlations between BMI groups in functional, social, and emotional QoL aspects (p < 0.05), with no notable differences in other domains. A Chi-square (ꭓ2) test underscored a significant link between BMI and treatment response (p < 0.0001), showing higher rates of non-responders among underweight patients (p = 4.259e-14). The study advocates pretreatment consultation with a dietitian as standard care for Indian BC patients, offering complimentary nutritional support for improved QoL outcomes and treatment responses.
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Affiliation(s)
- Tanuma Mistry
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
- Department of Life Science & Biotechnology, Jadavpur University, Kolkata, India
| | - Ranita Pal
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
| | - Sushmita Ghosh
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
| | - Trisha Choudhury
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
| | - Syamsundar Mandal
- Department of Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Partha Nath
- Department of Medical Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Neyaz Alam
- Department of Surgical Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Vilas D Nasare
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
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4
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Wang Y, Bai Z, Liu Q, Yu H, Tang Z, Liu X, Liu Q. Analysis on status quo and related factors of delays in diagnosis and treatment of breast cancer in Ningxia Hui Autonomous Region. Medicine (Baltimore) 2024; 103:e37826. [PMID: 38669416 PMCID: PMC11049709 DOI: 10.1097/md.0000000000037826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to explore factors contributing to the delays in the diagnosis and treatment of breast cancer (BC) in Ningxia Hui Autonomous Region. We conducted a cohort analysis of 1012 patients with BC diagnosed at the General Hospital of Ningxia Medical University between January 2018 and December 2019. Sociodemographic data were collected through questionnaires, and clinical data were gathered and analyzed from relevant databases. Furthermore, observations were made regarding delays in the diagnosis and treatment of BC, followed by an analysis of the correlations between patient delay and both sociological factors within the population and clinical factors specific to patients with BC. Subsequently, the factors associated with patient delay and system delay were examined using Cox regression analysis, along with the inclusion of neoadjuvant therapy. In the prevention and treatment of BC in Ningxia, the patient delay rate was 33.20%, the diagnosis delay rate was 17.89%, the treatment delay rate was 0.0099% and the system delay rate was 41.60%. There was a higher proportion of patient delay and system delay in aged patients (age ≥ 61 years) with rural registered permanent residence (RPR), multiple clinical symptoms (such as nipple spillage, axillary abnormalities, etc), a T4 tumor size classification, and the initial use of neoadjuvant therapy. Besides, significant positive correlations were observed between patient delay and system delay time with BC stage. Patients aged 51 to 60 and those with molecular types (Limanal1B: ki-67 > 14%, Limanal1B: HER-2 positive) were prone to patient delay, whereas molecular characteristics influenced system delay, unrelated to sociodemographic factors. The study identifies significant age, residency, and tumor molecular subtype correlations with diagnostic and treatment delays in Ningxia's patients with BC, predominantly affecting women aged 41 to 60, especially urban dwellers. These findings underscore the need for targeted interventions to reduce delays and improve BC care in this region.
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Affiliation(s)
- Yuchen Wang
- Department of Third Oncology Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhoulan Bai
- Department of Radiotherapy, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Qingyuan Liu
- Department of Third Oncology Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hui Yu
- Department of Third Oncology Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhenning Tang
- Department of Third Oncology Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiang Liu
- Ningxia Medical University, Yinchuan, China
| | - Qilun Liu
- Department of Third Oncology Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
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Malapati SH, Hyland CJ, Liang G, Edelen MO, Fazzalari A, Kaur MN, Bain PA, Mody GN, Pusic AL. Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review. J Patient Rep Outcomes 2024; 8:25. [PMID: 38416222 PMCID: PMC10899941 DOI: 10.1186/s41687-024-00687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs. METHODS MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively. RESULTS The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted. CONCLUSIONS Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.
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Affiliation(s)
- Sri Harshini Malapati
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Colby J Hyland
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - George Liang
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Maria O Edelen
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Amanda Fazzalari
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Gita N Mody
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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Kurian NM, Boby JM, Suneesh S, Datta S, Mathew A. A novel strategy to downstage breast cancer: impact of a phone helpline. Ecancermedicalscience 2023; 17:1637. [PMID: 38414941 PMCID: PMC10898877 DOI: 10.3332/ecancer.2023.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Indexed: 02/29/2024] Open
Abstract
Breast cancer incidence rates in India are rising. The majority of breast cancers are still diagnosed in later stages. There is also a burden of neglected cancers in India, where patients neglect their symptoms due to fear, ignorance, financial insecurity and lack of access to medical care. This results in greater morbidity and mortality from breast cancer. Systematic screening programs have been tested in an Indian setting, with limited success. An effective strategy to downstage breast cancer is an area of unmet need. We aimed to explore the effectiveness of an anonymous nurse-led telephone helpline in identifying patients with possible breast malignancies and to encourage them to seek healthcare. We created a telephone helpline system by training junior public health nurses (JPHNs) to provide counselling to women who may call with breast-related symptoms. We then created a short video message on the initiative and disseminated it using social media platforms. During the 1-year study period, 434 calls were received from individuals who reported having some breast symptoms. Among them, 28% (122 callers) had never consulted a doctor for their symptoms. 78 callers consulted a nearby doctor upon the advice of the JPHN. Among them, 14 callers (18%) were advised by the doctor to undergo investigations to rule out malignancy, while 64 (82%) of them were found to have some benign/normal breast conditions. 3 (21%) out of the 14 patients who underwent further evaluation were eventually diagnosed with breast cancer. Our study provides evidence that an anonymous nurse-led telephone helpline can be an effective strategy to reduce the incidence of neglected breast cancers and downstage the diagnoses.
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Affiliation(s)
| | | | | | - Sumit Datta
- MOSC Medical College, Kolenchery 682311, Kerala, India
| | - Aju Mathew
- MOSC Medical College, Kolenchery 682311, Kerala, India
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Wu J, Zeng N, Wang L, Yao L. The stigma in patients with breast cancer: A concept analysis. Asia Pac J Oncol Nurs 2023; 10:100293. [PMID: 37886719 PMCID: PMC10597826 DOI: 10.1016/j.apjon.2023.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/07/2023] [Indexed: 10/28/2023] Open
Abstract
Objective Stigma is a common problem among patients having breast cancer. However, the concept of stigma is vague and not specifically described or clearly defined in the literature. The lack of description or definition has further limited stigma research among patients having breast cancer. Therefore, this study aimed to clarify and analyze the concept of stigma in patients with breast cancer. Methods Walker and Avant's concept analysis method was applied to analyze the connotation of stigma in patients with breast cancer. PubMed, Web of Science, PsycINFO, CNKI, Wanfang, VIP, and SinoMed databases were searched from inception until May 31, 2023. Results Five stigma-related attributes of patients having breast cancer were identified: (1) impaired body image and physiological function; (2) negative stereotypes; (3) mixed negative feelings about developing breast cancer; (4) a feeling of avoidance; (5) experienced discrimination. Antecedents included the implementation of breast surgery and postoperative time, negative psychological factors, lack of social support, and cultural beliefs. This stigma among patients having breast cancer had significant negative effects on their quality of individual life and marriage, postoperative rehabilitation, and healthcare-seeking behavior. Conclusions The concept analysis results clarified the concept of stigma in patients with breast cancer and provided theoretical guidance for the development of the conceptual model of stigma in these patients. What is more, it offered a theoretical basis for future studies related to the development of stigma assessment tools for breast cancer patients and for devising nursing intervention strategies.
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Affiliation(s)
- Jieming Wu
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Ni Zeng
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Liping Wang
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Liyan Yao
- School of Nursing, Hangzhou Normal University, Hangzhou, China
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Hanafi I, Alsalkini M, Husein S, Salamoon M. The delay of breast cancer diagnosis and management during the Syrian war. Cancer Epidemiol 2023; 82:102290. [PMID: 36384074 DOI: 10.1016/j.canep.2022.102290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/23/2022] [Accepted: 10/29/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early detection of breast cancer (BC) is crucial for better prognosis especially in low-income countries, where advanced cancer stages are common. The Syrian war severely affected the healthcare system restraining the proper timely management of BC cases. We aimed to investigate the prevalence of patient- and system-related delays in BC diagnosis and management in Syria in addition to their predisposing characteristics and impact on the staging. METHODS This is a cross-sectional retrospective cohort study on patients followed by the BC unit at Al-Bairouni main cancer center in Syria. The data were collected through personal interviews and retrospective revision of patients' records. RESULTS A total number of 519 patients were recruited; A quarter of them (n = 126) reported more than three months intervals between symptoms recognition and presentation to a physician. Additionally, 72 (13.9 %) patients received a confirmed diagnosis more than three months after presentation, and 12 (2.3 %) started treatment at least three months after the diagnosis. Patients who suffered from war-related inaccessibility to healthcare were 2.55 [1.58-4.11] times more likely to report significant delays. Additionally, the most common self-reported reasons for patient delay were the lack of awareness, which was more evident for less common symptoms like the change in breasts size, and shyness. Patients who reported significant delays were more likely to receive an advanced-stage diagnosis. CONCLUSION War-related inaccessibility to healthcare rendered a significant group of BC patient susceptible to evident delay. This combined with significant system delays because of the overwhelmed hospitals, high costs, and insufficient personnel, equipment, medications, and training. However, personal factors, which might not be directly related to the war, like the inadequate awareness of rare symptoms and shyness still necessitate urgent interventions on the public knowledge and performed screening practices. These delays associated with receiving advanced-stage diagnoses and minimizing them can return better prognoses.
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Affiliation(s)
- Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria.
| | | | - Sara Husein
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maher Salamoon
- Department of Oncology, Faculty of Medicine, Damascus University, Damascus, Syria
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Petrova D, Garrido D, Špacírová Z, Fernández-Martínez NF, Ivanova G, Rodríguez-Barranco M, Pollán M, Barrios-Rodríguez R, Sánchez MJ. Duration of the patient interval in breast cancer and factors associated with longer delays in low-and middle-income countries: A systematic review with meta-analysis. Psychooncology 2023; 32:13-24. [PMID: 36345154 PMCID: PMC10100001 DOI: 10.1002/pon.6064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/02/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Breast cancer survival is lower in low- and middle-income countries (LMICs) partially due to many women being diagnosed with late-stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta-analysis of the duration of the patient interval in LMICs and investigate the socio-demographic and socio-cultural factors related to longer delays in presentation. METHODS We conducted a systematic review with meta-analysis (pre-registered protocol CRD42020200752). We searched seven information sources (2009-2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. RESULTS The longest patient intervals were reported in studies from the Middle East (3-4 months), followed by South-East Asia (2 months), Africa (1-2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio-economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South-East Asia, and Africa and distrust in the healthcare system in Eastern Europe. CONCLUSIONS There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dunia Garrido
- Department of Developmental and Educational Psychology, University of Granada, Granada, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Interlevel Clinical Management Unit for Prevention, Promotion and Health Surveillance, Reina Sofía University Hospital, Córdoba, Spain
| | - Ganka Ivanova
- Department of Applied Psychology, College of Education, Social Sciences and Humanities, Al-Ain University, Abu Dhabi, United Arab Emirates
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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10
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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] [MESH Headings] [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
- Mo-Im Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Vida Nyagre Yakong
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Ahmed-Rufai Yahaya
- Hariri School of Nursing, American University of Beruit, Beirut, Lebanon
- Department of Internal Medicine, Tamale Teaching Hospital, Tamale, Ghana
| | - Jinhee Shin
- Woosuk University, College of Nursing, Wanju, Republic of Korea
| | - Veronica Millicent Dzomeku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Hewage SA, Samaraweera S, Joseph N, Kularatna S, Gunawardena N. Presentation, Diagnosis and Treatment Delays in Breast Cancer Care and Their Associations in Sri Lanka, a Low-resourced Country. Clin Oncol (R Coll Radiol) 2022; 34:598-607. [PMID: 35672184 DOI: 10.1016/j.clon.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
AIMS Delays in breast cancer care, one important attributable factor for breast cancer being diagnosed at advanced stages, are not systematically studied in many countries. This study assessed the magnitude and factors associated with delays in breast cancer care in Sri Lanka, from symptom detection to treatment initiation. MATERIALS AND METHODS We interviewed 800 consecutively sampled female breast cancer patients, diagnosed within the last 12 months, using context-specific questionnaires and medical records. We defined the cut-off times for delays using international guidelines and features of the national health system and care-seeking patterns in the country. Delays were estimated as proportions with 95% confidence intervals and presented for: (i) presentation delay; (ii) diagnosis delay and (iii) treatment delay. We looked at how sociodemographic and healthcare availability and accessibility at the individual level were associated with delays using multivariate logistic regression, with a P value of 0.05 to define statistical significance. RESULTS Nearly two-thirds of patients reported a presentation delay (63.3%, 95% confidence interval 59.9-66.6%). A diagnosis delay (36.7%, 95% confidence interval 33.4-40.0%) was also seen among one-third, whereas treatment delays (13.2%, 95% confidence interval 10.8-15.5%) were less common. Low family monthly income (odds ratio 6.3; 95% confidence interval 4.2-9.3) and poor knowledge on breast cancer (odds ratio 2.7; 95% confidence interval 1.8-3.8) were associated with presentation delay. Poor health literacy (odds ratio 1.7; 95% confidence interval 1.1-2.7) and the need to make more than two visits to the first contact health provider prior to diagnosis (odds ratio 7.2; 95% confidence interval 4.6-11.1) were associated with diagnosis delays, whereas directly contacting an appropriate specialised health provider once the lump was detected reduced diagnosis delay (odds ratio 0.3; 95% confidence interval 0.2-0.4). Having undergone a core biopsy (odds ratio 0.5; 95% confidence interval 0.3-0.8) and having a mammogram (odds ratio 0.6; 95% confidence interval 4.7-32.7) reduced the likelihood of treatment delays. CONCLUSIONS Our study findings show that delays in breast cancer care in Sri Lanka are much lower than those in other lower-middle income countries. However, there is significant room for improvement, especially in relation to the excellence in quality of care, such as improving access to mammography services. Periodical estimation of breast cancer delays enabling temporal comparisons will probably provide useful information to policy makers in improving care delivery for breast cancer patients and, hence, is recommended. Such future assessments designed for comparisons between different treatment modalities would provide more information to assist policy decisions in care improvement.
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Affiliation(s)
- S A Hewage
- National Cancer Control Programme, Elvitigala Mawatha, Colombo, Sri Lanka.
| | - S Samaraweera
- National Cancer Control Programme, Elvitigala Mawatha, Colombo, Sri Lanka
| | - N Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - S Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - N Gunawardena
- WHO Country Office for Sri Lanka, Colombo, Sri Lanka
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12
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Mehrotra R, Yadav K. Breast cancer in India: Present scenario and the challenges ahead. World J Clin Oncol 2022; 13:209-218. [PMID: 35433294 PMCID: PMC8966510 DOI: 10.5306/wjco.v13.i3.209] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/17/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the commonest malignancy among women globally. From being fourth in the list of most common cancers in India during the 1990s, it has now become the first. In this review, we examine the available literature to understand the factors that contributed to the high burden of breast cancer in the country. We also provide the landscape of changes in the field of early diagnosis and the treatment modalities as well as the limitations of the Indian healthcare delivery systems (e.g., delayed diagnosis, human resources and funding for treatment). This review also sheds light on the newer interventions and the future of breast cancer management keeping in mind the coronavirus disease 2019 imposed limitations.
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Affiliation(s)
- Ravi Mehrotra
- Department of Health Research, Ministry of Health and Family Welfare, India Cancer Research Consortium, New Delhi 110001, India
- CHIP Foundation, Noida 201301, India
| | - Kavita Yadav
- Centre of Social Medicine & Community Health, Jawahar Lal Nehru University, New Delhi 110067, India
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Li B, Xia L, Yang J, Wen M, Yu M, Mou E, Liu S, Li H, Wang H. Enhancing social support and knowledge perception decreases patient delay in breast cancer. Gland Surg 2021; 10:2220-2231. [PMID: 34422593 PMCID: PMC8340337 DOI: 10.21037/gs-21-227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patient delay commonly appears in breast cancer (BC), but the findings for influential factors may be contaminated by recall bias. The real factors in patient delay (divided into appraisal delay and utilization delay) for women with BC urgently need to be objectively analyzed for preventing the progression of this disease. METHODS Women meeting strict inclusion and exclusion criteria were asked to fill in a questionnaire, which included three sections of sociodemographic characteristics, medical history, and knowledge of BC. Later on, the outcomes were processed according to the verification of BC by pathological diagnosis. Then, multiple linear regression was conducted to analyze the potential factors of the delay and to explore their relations between these factors and BC. RESULTS Appraisal delay is the leading component of patient delay. Appraisal delay's time distribution of a higher percentage at delay time 0-29 and >360 days, while other delay time occupies lower percentage, which is highly consistent with that of patient delay, while utilization delay mainly occurs in the 0-29 days period. Concerning the influential factors for the different phases of delay, age (P=0.051, P=0.035 separately in appraisal and patient delay), residential address (P=0.036, P=0.010) and symptom disclosure to others (P=0.015, P=0.015) led to a decrease of appraisal and patient delay. However, reasons for first medical consultation (P=0.033, P=0.006) and knowledge of BC (P=0.027, P=0.002) would accelerate appraisal and patient delay. Many factors related to hospitals, such as hospital category for first medical consultation (P=0.030) and examinations for first medical consultation (P=0.055) would reduce utilization delay. CONCLUSIONS Obstacles in medical consultation for younger women should be removed, and early interventions are needed to avoid progression of BC.
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Affiliation(s)
- Baisen Li
- Department of Radiotherapy Center, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Xia
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Yang
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Wen
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Miao Yu
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Exian Mou
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiwei Liu
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Wang
- Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Tesfaw A, Tiruneh M, Tamire T, Yosef T. Factors associated with advanced-stage diagnosis of breast cancer in north-west Ethiopia: a cross-sectional study. Ecancermedicalscience 2021; 15:1214. [PMID: 33912239 PMCID: PMC8057775 DOI: 10.3332/ecancer.2021.1214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background Breast cancer tumours are the most common malignant tumours among women in Ethiopia. Although advanced-stage diagnosis of breast cancer is a common problem, evidence-based information is lacking about the magnitude and determinants of advanced-stage presentation in north-west Ethiopia. Methods An institution-based, cross-sectional study was conducted at the oncology units of the University of Gondar and Felege Hiwot specialised hospitals. Stages III and IV were considered advanced stage, whereas stages I and II were considered early stages. Data were collected prospectively on newly diagnosed breast cancer patients and entered using the EPI Info version 7.2 and analysed using Statistical Package for the Social Sciences version 23. Multivariable logistic regression was used to identify the determinants of advanced-stage diagnosis of breast cancer. A p-value < 0.05 was used as the cut-off point to select the determinants of the advanced stage. Result About 71.2% of breast cancer patients presented with advanced-stage disease. The median age of patients was 40 years. Rural residence (adjusted odds ratio (AOR) = 1.7; 95% confidence interval (CI): 1.02, 2.96), painless breast lump/wound (AOR = 2.5; 95% CI: 1.45, 4.13), travel distance ≥5 km (AOR = 3.2; 95% CI: 1.72, 5.29), not practising breast self-examination (BSE) (AOR = 2.9; 95% CI: 1.30, 6.52), time to presentation ≥3 months (AOR = 1.4; 95% CI: 1.02, 2.37) and misdiagnosed at first visit (AOR = 1.9; 95% CI: 1.09, 3.59) were determinants of advanced-stage breast cancer. Conclusion Nearly three-quarters of the patients were diagnosed with advanced-stage breast cancer. Not practising BSE, travel distance ≥5 km, rural residence, painless breast wound/lump and being misdiagnosed at first visit were important determinants of advanced-stage diagnosis of breast cancer. Focused awareness creation programmes for the public and increasing cancer diagnostic centres in the country are crucial to downstage breast cancer at presentation.
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Affiliation(s)
- Aragaw Tesfaw
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Tadese Tamire
- Debre Tabor University, College of Health Sciences, Department of Anesthesia, PO Box 272, Debre Tabor, Ethiopia
| | - Tewodros Yosef
- Mizan-Tepi University, Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, PO Box 260, Mizan-Aman, Ethiopia
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15
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Latha T, D'almeida D. Barriers for early detection of breast cancer among South Indian women. Indian J Community Med 2021; 46:706-709. [PMID: 35068739 PMCID: PMC8729280 DOI: 10.4103/ijcm.ijcm_751_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/20/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Breast cancer is one of the most common neoplasms in women across the world. Early diagnosis of breast cancer results in reduced morbidity, mortality, and improved quality of life. Objective: This study was conducted to identify the barriers among Indian women diagnosed with breast cancer in an advanced stage. Methods: A cross-sectional descriptive survey was conducted in a tertiary care teaching hospital, Southern India, among breast cancer patients. A total of 202 women with breast cancer (Stage 3 and 4) were recruited based on the predefined inclusion and exclusion criteria. The data were collected using a demographic proforma and barrier checklist and analyzed using SPSS 16.0 version. Results: The mean age of the women was 51.5 ± 10.7 years. The majority of them were Hindu (87.6%), housewives (69.8%), with primary education (39.6%). The women have cited several barriers including financial (54.5%), lack of knowledge about breast cancer (49.5%), frightened about diagnostic test result (56.9%), afraid of anticipated surgery (54.5%), and the dearth of accessibility to health resources (52%). Conclusions: The presence of barriers in early diagnosis of breast cancer occurs in various contexts and should be recognized and minimized by all health-care providers to reduce the associated health-care cost, morbidity, and mortality.
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16
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Hewage S, Samaraweera S, Joseph N, Kularatna S, Gunawardena N. Does the choice of care pathways matter in timely breast cancer care in Sri Lanka? Cancer Epidemiol 2020; 70:101862. [PMID: 33348244 DOI: 10.1016/j.canep.2020.101862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND An understanding on the use of care pathways facilitates identification of timeliness in breast cancer care. Aims of this study were to describe different breast cancer care pathways used by female breast cancer patients in Sri Lanka and to identify whether they experienced timely breast cancer care. METHODS We conducted a cross-sectional study among 800 female breast cancer patients with a histological/ cytological confirmation, from four state cancer treatment centers. We conceptualized five different care pathways with essential care points and in-between time intervals to be explored using an interviewer administered tool. Dates were cross-checked with the medical record. The difference of time intervals spent in different care pathways was tested for significance using one-way ANOVA test. RESULTS Mean (SD) age was 55.5 (10.7) years. A vast majority of 98.4 % (n = 787) self-detected the breast lesion, while only 13 had been detected through screening. Following self-detection, two thirds (n = 473, 59.1 %, 95 % CI = 55.7-62.5) had first consulted a primary healthcare physician, and a third n = 287, 35.8 %, 95 % CI = 32.6-39.3) had consulted an appropriate specialist first. Presentation interval among those who visited an Ayurvedic physician first was significantly longer than other pathways (p < 0.0001). Diagnosis interval for those who consulted an appropriate consultant was significantly shorter than other pathways (p < 0.0001). CONCLUSIONS Women take up numerous care paths following self-detection of a breast lesion. Empowering women on appropriate care pathways and expanding dedicated breast clinics where women to be first seen by an appropriate specialist are likely to improve timely breast cancer care in Sri Lanka.
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Affiliation(s)
- Sumudu Hewage
- National Cancer Control Programme, No. 555/5, Public Health Building Complex, Elvitigala Mawatha, Colombo 5, Sri Lanka.
| | - Sudath Samaraweera
- National Cancer Control Programme, No. 555/5, Public Health Building Complex, Elvitigala Mawatha, Colombo 5, Sri Lanka
| | - Nuradh Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Australia
| | - Nalika Gunawardena
- WHO Country Office for Sri Lanka, No. 5, Anderson Road, Colombo 5, Sri Lanka
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Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study. Sci Rep 2020; 10:21477. [PMID: 33293634 PMCID: PMC7723040 DOI: 10.1038/s41598-020-78517-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
One of the reasons for high mortality of breast cancer (BC) is long delay in seeking medical care and end stage at presentation. This study was designed to measure the association between a wide range of socio-demographic and clinical factors with diagnostic delay in BC and stage at presentation among Iranian patients. From June 2017 to December 2019, 725 patients with newly diagnosed BC in Shiraz and Kermanshah were selected and information on BC diagnosis delay was obtained from the patient’s medical record. Data on socio-economic status was obtained via a structured interview. Our findings suggest that 45.8% of the patients were diagnosed at a late stage (stage 3 or higher). A total of 244 (34%) patients had more than 3 months delay in diagnosis. We found a significant association between stage at diagnosis and place of residence (adjusted odds ratio (aOR rural vs. urban = 1.69, 95% CI 1.49–1.97), marital status (aOR 1.61, 95% CI 1.42–1.88), family history of BC (aOR 1.46, 95% CI 1.01–2.13), and history of benign breast disease (BBD) (aOR 1.94, 95% CI 1.39–2.72) or unaware of breast self-examination (BSE) (aOR 1.42, 95% CI 1.42–1.85), delay time (aOR 3.25, 95% CI 1.04–5.21), and left breast tumor (aOR right vs. left 2.64, 95% CI 1.88–3.71) and smoking (aOR no vs. yes 1.59, 95% CI 1.36–1.97). Also, delay in diagnosis was associated with age, family income, health insurance, place of residence, marital status, menopausal status, history of BBD, awareness of breast self-examination, type of first symptoms, tumor histology type, BMI and comorbidity (p < 0.05 for all). Factors including history of BBD, awareness of BSE, and suffering from chronic diseases were factors associated with both delay in diagnosis and end stage of disease. These mainly modifiable factors are associated with the progression of the disease.
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Tesfaw A, Demis S, Munye T, Ashuro Z. Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1391-1401. [PMID: 33173301 PMCID: PMC7646382 DOI: 10.2147/jmdh.s275157] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Unlike developed countries, there is high mortality of breast cancer in low- and middle-income countries associated with prolonged patient delays and advanced stage presentations. However, evidence-based information about patient delay in presentation and contributing factors to diagnosis of breast cancer in Ethiopia is scarce. Methods Institution-based cross-sectional study was conducted at oncology units of the University of Gondar and Felege Hiwot specialized hospitals. A total of 371 female breast cancer patients who were newly diagnosed from September 2019 to April 30, 2020 were included. Data were entered using EPI info version 7.2 and analyzed in SPSS version 23. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Multivariable logistic regression at a P-value<0.05 significance level was used to identify predictors of patient delay. Results A total of 281 (75.7%) patients had long patient delay of ≥90 days (3 months) with the average patient delay time of 8 months, and advanced stage diagnosis was found on 264 (71.2%) of patients. The median age of patients was 40 years. Rural residence (AOR=3.72; 95% CI=1.82–7.61), illiterate (AOR=3.8; 95% CI=1.71–8.64), having a painless wound (AOR=3.32; 95% CI=1.93, 5.72), travel distance ≥5 km (AOR=1.66; 95% CI=1.09–3.00), having no lump/swelling in the armpit (AOR=6.16; 95% CI=2.80–13.54), and no history of any breast problem before (AOR=2.46; 95% CI=(1.43–4.22) were predictors for long patient delay. Conclusion Long patient delay and advanced stage diagnosis of breast cancer are higher in our study. Travel distance ≥5 km, rural residence, no history of any breast problem before, having no lump/swelling in the arm pit, a painless lump in the breast, and being illiterate were important predictors for patient delay. Therefore, public awareness programs about breast cancer should be designed to prevent patient delay in presentation and to promote early detection of cases before advancement.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and neonatal Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Comprehensive Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Zemachu Ashuro
- Dilla University, College of Health Sciences, Dilla, Southern Ethiopia
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Fletcher-Brown J, Carter D, Pereira V, Chandwani R. Mobile technology to give a resource-based knowledge management advantage to community health nurses in an emerging economies context. JOURNAL OF KNOWLEDGE MANAGEMENT 2020. [DOI: 10.1108/jkm-01-2020-0018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Knowledge is a key success factor in achieving competitive advantage. The purpose of this paper is to examine how mobile health technology facilitates knowledge management (KM) practices to enhance a public health service in an emerging economies context. Specifically, the acceptance of a knowledge-resource application by community health workers (CHWs) to deliver breast cancer health care in India, where resources are depleted, is explored.
Design/methodology/approach
Fieldwork activity conducted 20 semi-structured interviews with frontline CHWs, which were analysed using an interpretive inductive approach.
Findings
The application generates knowledge as a resource that signals quality health care and yields a positive reputation for the public health service. The CHW’s acceptance of technology enables knowledge generation and knowledge capture. The design facilitates knowledge codification and knowledge transfer of breast cancer information to standardise quality patient care.
Practical implications
KM insights are provided for the implementation of mobile health technology for frontline health-care professionals in an emerging economies context. The knowledge-resource application can deliver breast cancer care, in localised areas with the potential for wider contexts. The outcomes are valuable for policymakers, health service managers and KM practitioners in an emerging economies context.
Social implications
The legacy of the mobile heath technology is the normalisation of breast cancer discourse and the technical up-skilling of CHWs.
Originality/value
First, this paper contributes three propositions to KM scholarship, in a public health care, emerging economies context. Second, via an interdisciplinary theoretical lens (signalling theory and technology acceptance model), this paper offers a novel conceptualisation to illustrate how a knowledge-resource application can shape an organisation’s KM to form a resource-based competitive advantage.
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Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting. Indian J Surg Oncol 2020; 11:287-293. [PMID: 32523277 DOI: 10.1007/s13193-020-01037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most common cancer among females worldwide, with over 2 million cases diagnosed every year. In India, it is the most common malignancy overall (15.4%) and accounts for about 27% female cancers. Morbidity and mortality remain high despite improvements in BC therapeutics. Conventionally, a gap of more than 3 months between noticing symptoms and commencing treatment is considered delay in BC management. Delays make BC an important public health problem and lead to poor outcomes. This study aims to identify patient perceived barriers to BC management. A self-designed structured questionnaire consisting of questions pertaining to multiple aspects of BC presentation and management was prepared. The study was conducted from October 2017 to September 2018 and results were analyzed. A delay of 3 months or more was seen in 284 of the 435 patients (65.3%), among which 179 was patient delay, 69 due to provider delay, and 36 due to a combined contribution of both factors. Provider factors were associated with prolonged delay. Misdiagnosis at first consult was the most common factor perceived by patients as a barrier, followed by delay in referral, distance from hospitals, lack of information, financial constraints, and logistic issues. A significant patient and provider delay exists in BC management which prevents effective early therapy. Effective tackling of these barriers may result in the betterment of BC management outcomes. Robust screening, education of patients and providers, and awareness promotion and infrastructure development will be useful in this regard.
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Mutar MT, Goyani MS, Had AM, Mahmood AS. Pattern of Presentation of Patients With Breast Cancer in Iraq in 2018: A Cross-Sectional Study. J Glob Oncol 2020; 5:1-6. [PMID: 31721627 PMCID: PMC6882514 DOI: 10.1200/jgo.19.00041] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study aims to describe the pattern of presentation of Iraqi female patients with breast cancer by assessing the grades and stages of their cancers at the time of presentation, to identify patients’ main complaints, and to discover whether there is any difference in presentation between patients in Iraq and those in other countries. PATIENTS AND METHODS This is a retrospective cross-sectional study that was performed in the National Center of Cancer in 2018. The target population was female patients with breast cancer who came to the Center for treatment and follow-up. A sample of 171 patients was drawn from this population. Self-evaluation forms were used in interviews with the patients to collect personal and sociodemographic data; clinical and histologic characteristics of the patients’ tumors were obtained from their medical records. Ethical approval was obtained. RESULTS Forty-five percent of the patients were younger than age 50 years, and 25% were younger than age 45 years. In all, 42.9% of the patients were diagnosed with stage III and 25% with stage IV cancer, and metastasis was diagnosed in 24.1%. In our study population, 53.4% of the tumors were found in the right breast, and 3.9% of patients had bilateral breast tumors. The most common histopathologic type was invasive ductal carcinoma (81.4%) followed by invasive lobular carcinoma (6.9%) and tubular carcinoma (5.9%). The patients’ most common complaints were breast lump (71.3%) and pain (18.9%). No correlation was found between tumor stage and breast self-examination, family history, education, occupation, histopathology, or grade. CONCLUSION Most of the patients are diagnosed at a late stage when treatment is less effective.
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22
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Somanna SN, Nandagudi Srinivasa M, Chaluvarayaswamy R, Malila N. Time Interval between Self-Detection of Symptoms to Treatment of Breast Cancer. Asian Pac J Cancer Prev 2020; 21:169-174. [PMID: 31983180 PMCID: PMC7294006 DOI: 10.31557/apjcp.2020.21.1.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background: In India breast cancer is the number one cancer among females with an incidence rate of 25.8 per 100,000 women and mortality of 12.7 per 100,000 women. India continues to have a low 5-year survival rate of breast cancer with only 66.1% as compared to 90% in developed countries. The major reason for low survival is that patients are diagnosed with cancer at high stage. The present study attempts to delineate the time interval between self-detection of breast cancer symptoms and seeking care and to find the main reasons for delay in seeking care. Methods: A cross sectional study was undertaken from October 2016 to March 2017 in a population based cancer registry (PBCR) and hospital based cancer registry (HBCR) located in south of India. Histologically confirmed breast cancer patients (N=181) were interviewed at hospital using a pre-tested semi structured questionnaire. Results: The median time interval between the self-detection of breast cancer symptoms and first contact with general physician was 60 [IQR 30-180] days. The median time to diagnosis from the first contact was 30 [IQR 10 - 60] days and the overall median time span from self-detection of symptoms to treatment was 150 [IQR 95-265] days. The major reason given for not seeking medical care in time was lack of awareness in identifying the cancer symptoms both among patients and primary care providers. Conclusion: There was considerable delay from self-detection of symptoms to cancer specific primary treatment of breast cancer. We found lack of awareness among patients as well as in primary care providers to be the major concern for delay. Awareness among the target population and health care professionals would have to be improved for early diagnostics and access to care.
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Affiliation(s)
| | | | - Ramesh Chaluvarayaswamy
- Department of Epidemiology and Biostatistics, Kidwai Memorial Institute of Oncology, Bangalore, India
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Kumar A, Bhagabaty SM, Tripathy JP, Selvaraj K, Purkayastha J, Singh R. Delays in Diagnosis and Treatment of Breast Cancer and the Pathways of Care: A Mixed Methods Study from a Tertiary Cancer Centre in North East India. Asian Pac J Cancer Prev 2019; 20:3711-3721. [PMID: 31870113 PMCID: PMC7173377 DOI: 10.31557/apjcp.2019.20.12.3711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION In India, mortality rate in breast cancer is high because more than half are diagnosed late at locally advanced or metastatic stages. This might be due to presentation delay (recognition of symptoms to first provider consultation) and treatment delay (first provider consultation to initiation of treatment), together known as overall delay. We aimed to estimate the overall delay in diagnosis and treatment in breast cancer and the associated factors, describe pathway of care and explore the reasons for delay from a patients' and providers' perspective. METHODS Explanatory sequential mixed-methods study with a quantitative component (retrospective cohort study including breast cancer patients registered at Dr. Borooah Cancer Institute (BBCI), Guwahati during February-June 2019) followed by descriptive qualitative component (in-depth interviews with 15 patients and 10 care providers). RESULTS Of 269 breast cancer patients, median (Inter Quartile Range) overall delay was 203 (110-401) days, presentation delay was 35 (10-112) days and treatment delay was 130 (75-258) days. Majority of patients approached private sector (190, 70.6%) as the first care provider. Nearly half of all patients (136, 50.6%) visited one health care provider before reaching the BBCI and another one-third (90, 33.5%) visited two providers. Reasons for presentation delay were misconception about the disease, perceived stigma, fear and denial of cancer, attribution of symptoms to trivial conditions, family responsibilities and embarrassment of breast examination by a male doctor. Treatment delay was due to initial visit to, misclassification of disease severity, dissatisfaction with care at public facilities, poor accessibility and affordability, fear of treatment and its side effects. CONCLUSION Treatment delay was the major contributor to overall delay. Private providers need to be sensitized and trained in screening of breast cancer and referral of suspected cases of cancer. More awareness is needed about warning symptoms of breast cancer and misconceptions regarding the disease.<br />.
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Affiliation(s)
- Arvind Kumar
- Public Health, Cluster Coordinator, Doctors For You, Guwahati, India
| | | | - Jaya Prasad Tripathy
- Department of Community Medicine, Assistant Professor, All India Institute of Medical Sciences, Nagpur, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, Assistant Professor, All India Institute of Medical Sciences, Nagpur, India
| | - Joydeep Purkayastha
- Department of Preventive Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Ravikant Singh
- Public Health, Cluster Coordinator, Doctors For You, Guwahati, India
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Wahabi K, Perwez A, Kamarudheen S, Bhat ZI, Mehta A, Rizvi MMA. Parkin gene mutations are not common, but its epigenetic inactivation is a frequent event and predicts poor survival in advanced breast cancer patients. BMC Cancer 2019; 19:820. [PMID: 31429726 PMCID: PMC6700819 DOI: 10.1186/s12885-019-6013-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/05/2019] [Indexed: 12/20/2022] Open
Abstract
Background Progression of breast cancer involves both genetic and epigenetic factors. Parkin gene has been identified as a tumor suppressor gene in the pathogenesis of various cancers. Nevertheless, the putative role of Parkin in breast cancer remains largely unknown. Therefore, we evaluated the regulation of Parkin through both genetic and epigenetic mechanisms in breast carcinoma. Method A total of 156 breast carcinoma and their normal adjacent tissue samples were included for mutational analysis through SSCP, and sequencing. MS-PCR was employed for methylation study whereas Parkin protein expression was evaluated using immunohistochemistry and western blotting. For the survival analysis, Kaplan–Meier curve and Cox’s proportional hazard model were used. Results In expression analysis, Parkin protein expression was found to be absent in 68% cases of breast cancer. We found that aberrant promoter methylation of Parkin gene is a frequent incident in breast cancer tumors and cell lines. Our MS-PCR result showed that Parkin promoter methylation has a significant role (p = 0.0001) in reducing the expression of Parkin protein. Consistently, expression of Parkin was rectified by treatment with 5-aza-2-deoxycytidine. We also found significant associations of both Parkin negative expression and Parkin promoter methylation with the clinical variables. Furthermore, we found a very low frequency (5.7%) of Parkin mutation with no clinical significance. In survival analysis, patients having Parkin methylation and Parkin loss had a worse outcome compared to those harboring none of these events. Conclusion Overall, these results suggested that promoter methylation-mediated loss of Parkin expression could be used as a prognostic marker for the survival of breast cancer. Electronic supplementary material The online version of this article (10.1186/s12885-019-6013-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khushnuma Wahabi
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Ahmad Perwez
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Shabeena Kamarudheen
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Zafar Iqbal Bhat
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Anurag Mehta
- Department of Laboratory & Transfusion Services and Director Research, Rajiv Gandhi Cancer Institute, Rohini, Delhi, 110085, India
| | - M Moshahid A Rizvi
- Genome Biology Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, 110025, India.
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Rani NFA, Rahman AA. Women and Risk: Does TakafulHave the Solution? NEW DEVELOPMENTS IN ISLAMIC ECONOMICS 2018:117-134. [DOI: 10.1108/978-1-78756-283-720181008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Li YL, Qin YC, Tang LY, Liao YH, Zhang W, Xie XM, Liu Q, Lin Y, Ren ZF. Patient and Care Delays of Breast Cancer in China. Cancer Res Treat 2018; 51:1098-1106. [PMID: 30428639 PMCID: PMC6639234 DOI: 10.4143/crt.2018.386] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose This study differentiates patient and care delays of breast cancer and explores the related factors as well as the associations with the prognosis in Guangzhou, a southern city of China. Methods A cohort of female incident breast cancer patients (n=1,551) was recruited from October 2008 to March 2012 and followed up until January 1, 2016 (n=1,374) in the affiliated hospitals of Sun Yat-sen University. The factors associated with patient and care delays were analyzed with multivariable logistic models. Cox proportional hazards regression models were constructed to estimate the impacts of the delays on the prognosis. Results There were 40.4% patient delay (≥3 months) and 15.5% care delay (≥1 month). The patient delay, but not the care delay, was significantly related to the clinical stage and consequently worsened the prognosis of breast cancer (hazard ratio, 1.45; 95% confidence interval, 1.09 to 1.91 for progression-free survival). The factors related to an increased patient delay included premenopausal status, history of benign breast disease, and less physical examination. Conclusion Patient delay was the main type of delay in Guangzhou and resulted in higher clinical stage and poor prognosis of breast cancer. Screening for breast cancer among premenopausal women may be an effective way to reduce this delay.
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Affiliation(s)
- Yue-Lin Li
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ya-Chao Qin
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lu-Ying Tang
- Department of Pathology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Huang Liao
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Zhang
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiang Liu
- Breast Tumor Center, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Lin
- Department of Breast and Thyroid Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Fang Ren
- Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Alkhasawneh E, Al-Farsi Y, Al-Simadi F, Leocadio M. Development and Validation of a Culturally-Tailored Breast Cancer Health Education Programme for Arab Women. Sultan Qaboos Univ Med J 2017; 17:e181-e190. [PMID: 28690890 DOI: 10.18295/squmj.2016.17.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/08/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to develop and validate a health education programme to encourage breast cancer awareness and early detection behaviours among Arab women. METHODS This study took place between December 2015 and March 2016. The Enabling Systems Raising Awareness model was used to develop a breast cancer health education programme which was subsequently implemented by trained health educators at three female-only fitness clubs in Muscat, Oman. Breast cancer knowledge among 53 women was assessed using the breast module of the Cancer Awareness Measure before and after each health education session. Overall pre- and post-session knowledge scores were then compared. Additionally, three focus group discussions were conducted with 10 participants from each location. Thematic analysis was used to analyse the transcribed discussions and collect feedback on the programme. RESULTS The health education sessions resulted in a statistically significant increase in overall mean knowledge scores (P <0.001). Participants also reported significantly improved intentions to undertake early detection practices (P <0.001). The focus group discussions yielded distinct themes and valuable feedback which can be utilised in the future to create an improved version of the programme. CONCLUSION While the health education programme significantly improved breast cancer and early detection knowledge among a cohort of Arab women, it still required critical improvements in terms of structure and administration. Additional studies are required in order to evaluate long-term behavioural outcomes resulting from the improved programme.
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Affiliation(s)
- Esra Alkhasawneh
- Department of Maternal & Child Health Nursing, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Fayez Al-Simadi
- Department of Sociology, College of Arts & Social Sciences, Yarmouk University, Irbid, Jordan
| | - Michael Leocadio
- Department of Fundamentals & Administration, College of Nursing, Sultan Qaboos University, Muscat, Oman
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