ObjectivesImproving help-seeking behaviour is a key component of down-staging breast cancer and improving survival, but the specific challenges faced by low-income women in an Asian setting remain poorly characterized. Here, we determined the extent of help-seeking delay among Malaysian breast cancer patients and explored sub-groups of women who may face specific barriers.MethodsTime to help-seeking was assessed in 303 women diagnosed with advanced breast cancer between January 2015 and March 2020 at a suburban tertiary hospital in Malaysia. Two-step cluster analysis was conducted to identify subgroups of women who share similar characteristics and barriers. Barriers to help-seeking were identified from nurse interviews and were analyzed using behavioural frameworks.ResultsThe average time to help-seeking was 65 days (IQR = 250 days), and up to 44.5% of women delayed by at least 3 months. Three equal-sized clusters emerged with good separation by time to help-seeking (p<0.001). The most reported barrier across clusters was poor knowledge (36.3%), regardless of help-seeking behaviour (p=0.931). Unexpectedly, women with no delay (9 days average) and great delay (259 days average) were more similar to each other than to women with mild delays (58 days average). In contrast, women who experienced great delay reported poor motivation (p=0.066) and social opportunities (p=0.374) to seek help.ConclusionsDown-staging of breast cancer in Malaysia will require a multi-pronged approach aimed at alleviating culturally specific social and emotional barriers, eliminating misinformation, and instilling motivation to seek help for breast health for the women most vulnerable to help-seeking delays.
PURPOSE Women in low to middle-income countries (LMICs), such as in Malaysia, face complex barriers to healthcare because of social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast cancer care. Patient Navigation has emerged as a cost-effective and impactful approach to enable women to access care. METHODS We have established a hospital-based partnership model between a non-profit organization and national healthcare service to address the barriers faced by low-income women to improve the timeliness of diagnosis and treatment and reduce poor adherence to treatment. The navigation team provides resources required to overcome financial and logistic barriers, counseling to address knowledge and emotional needs and to ensure treatment adherence. RESULTS To determine the effectiveness of the program, timeliness of diagnosis and treatment, and rates of treatment adherence were compared with a historical cohort from the same hospital. The proportion of patients who met the healthcare system's targets for timeliness to cancer diagnosis increased from 50.4% to 67.3% ( P < .05) and that for initiation of primary treatment increased from 36.5% to 49.5% ( P < .05). The overall treatment default rates reduced from 8.6% to 2.6% ( P < .05). CONCLUSION In summary, Patient Navigation is feasible and potentially effective for addressing barriers to cancer care and could be a key element of cancer control in LMICs.
Background Improving help-seeking behaviour is a key component of down-staging breast cancer and improving survival, but the specific challenges faced by low-income women in an Asian setting remain poorly characterized. Here, we determined the extent of help-seeking delay among Malaysian breast cancer patients who presented at late stages and explored sub-groups of women who may face specific barriers. Methods Time to help-seeking was assessed in 303 women diagnosed with advanced breast cancer between January 2015 and March 2020 at a suburban tertiary hospital in Malaysia. Two-step cluster analysis was conducted to identify subgroups of women who share similar characteristics and barriers. Barriers to help-seeking were identified from nurse interviews and were analyzed using behavioural frameworks. Results The average time to help-seeking was 65 days (IQR = 250 days), and up to 44.5% of women delayed by at least 3 months. Three equal-sized clusters emerged with good separation by time to help-seeking (p < 0.001). The most reported barrier across clusters was poor knowledge about breast health or breast cancer symptoms (36.3%), regardless of help-seeking behaviour (p = 0.931). Unexpectedly, women with no delay (9 days average) and great delay (259 days average) were more similar to each other than to women with mild delays (58 days average), but, women who experienced great delay reported poor motivation due to fear and embarrassment (p = 0.066) and a lack of social support (p = 0.374) to seek help. Conclusions Down-staging of breast cancer in Malaysia will require a multi-pronged approach aimed at modifying culturally specific social and emotional barriers, eliminating misinformation, and instilling motivation to seek help for breast health for the women most vulnerable to help-seeking delays.
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