Cervical Cancer Treatment Delays and Associated Factors in a Cohort of Women From a Developing Country

Abstract

PURPOSE To estimate treatment delays and associated factors among women diagnosed with cervical cancer who were treated at the main cancer center in Rio de Janeiro, Brazil. MATERIALS AND METHODS A retrospective cohort study was performed comprising 865 women newly diagnosed with cervical cancer between 2012 and 2014. Times from diagnosis to treatment initiation (less than or equal to 60 days) and from diagnosis to treatment ending (less than or equal to 120 days) were analyzed according to the Brazilian law for the treatment of patients with cancer. Associations between treatment delays and sociodemographic, economic, lifestyle, clinical, and treatment variables were estimated using logistic regression models, with 95% CIs. RESULTS The average age was 48 (± 13.7) years, and the median age was 47 years; 36.2% of patients had stage IIIB to IVA disease. The median time from diagnosis to treatment initiation was 114 days, which was statistically higher among women with stage IIB to IVA (105.5 days) compared with those with earlier stages (119 days). The delay in treatment initiation occurred in 92.8% of participants; the median time from diagnosis to treatment ending was 274 days, with a delay (more than 120 days) for 92.6% of patients. The median time interval from diagnosis to the first visit to the cancer center was 28 days, with a delay of more than 30 days for 46.6% of patients. Age (odds ratio [OR], 1.05; 95% CI,1.02 to 1.08), stage IIIB to IVA (OR, 0.38; 95% CI, 0.16 to 0.90), time to first visit to the cancer center (OR, 11.52; 95% CI, 4.32 to 30.66), chemoradiation treatment (OR, 4.56; 95% CI, 1.81 to 11.47), and adequate treatment (OR, 2.57; 95% CI, 1.26 to -5.40) were independently associated with delay of treatment initiation. CONCLUSION Significant delays in treatment initiation and ending were observed in this studied population. The treatment initiation delay was positively associated with age, time interval more than 30 days from diagnosis to first specialist assessment at the cancer center, treatment with chemoradiation, and adequate treatment.

“Swords and Shields” against COVID-19 for patients with cancer at “clean” and “pandemic” hospitals: are we ready for the second wave?

“…We consider that the number of newly diagnosed cancer patients might have decreased significantly in the pandemic as a result of these concerns of both healthcare professionals and patients. Delay in cancer diagnosis and treatment is negatively correlated with survival [ 27 ]. The possible effect of pandemic on cancer mortality has been investigated in the USA and an approximately 1% increase in mortality due to delays in cancer screening and treatment has been predicted (approximately 10,000 more deaths) [ 28 ].…”

Factors associated with delays in time to treatment initiation in Colombian women with cervical cancer: A cross-sectional analysis

“…In respect of clinical data, the stage at diagnosis (0, I, II, III, and IV) was classified based on the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) system ( Bhatla et al, 2018 ) and then were grouped as in-situ (0), local early stages/bulky (stages IA1 to IIA2), locally advanced (stages IIB2-IIIA) and metastatic (IIIB-IVB) ( Marth et al, 2017 ). Histology was grouped as squamous carcinoma, adenocarcinoma/adenosquamous carcinoma, and no specified ( Ferreira da Silva et al, 2019 , Perri et al, 2014 ). Finally, treatment was grouped as surgery, radiation, or chemotherapy.…”

“…Delays in accessing timely and appropriate treatment are among the various conditions that result in poor prognosis ( Ferreira da Silva et al, 2019 , Ramey et al, 2018 , Perri et al, 2014 ). Treatment of CC usually consists of chemoradiation or radical hysterectomy/trachelectomy with lymph node dissection in early stages and chemoradiation in advanced stages.…”

“…Treatment of CC usually consists of chemoradiation or radical hysterectomy/trachelectomy with lymph node dissection in early stages and chemoradiation in advanced stages. Treatment may be adjusted according to the patient's health conditions, age, desire for parity, or comorbidities ( Ferreira da Silva et al, 2019 ). Delays in access to treatment are given for different reasons such as second medical or pathological opinions, or geographical, administrative, economic, or cultural barriers, substantially affect the living conditions of women with this disease because time intervals are important to ensure the effectiveness of treatment ( Ferreira da Silva et al, 2019 , Chen et al, 2019 ).…”

“…Treatment may be adjusted according to the patient's health conditions, age, desire for parity, or comorbidities ( Ferreira da Silva et al, 2019 ). Delays in access to treatment are given for different reasons such as second medical or pathological opinions, or geographical, administrative, economic, or cultural barriers, substantially affect the living conditions of women with this disease because time intervals are important to ensure the effectiveness of treatment ( Ferreira da Silva et al, 2019 , Chen et al, 2019 ). Delays of more than three months in therapeutic cancer care could decrease the prognosis and increase morbidity, reduction of survival is a subject of discussion due to differences in the results of several studies ( Ferreira da Silva et al, 2019 , Ramey et al, 2018 , Perri et al, 2014 ), though, analyses of delay of treatment for women with CC have been more limited in scope ( Ramey et al, 2018 ).…”