Factors Associated With Treatment Delay in Breast Cancer: A Prospective Study

Abstract

The frequency of breast cancer (BC) is increasing among Pakistani females. It has been estimated that one out every nine women is predicted to develop BC, which is the highest disease occurring rate in the Asian population. The study aimed to evaluate the factors responsible for delay in diagnosis of BC in Sindh, Pakistan. Methodology This study was conducted at the Medical Oncology Department of Jinnah Postgraduate Medical Center Karachi from December 2018 to June 2019. All women between 17 and 80 years diagnosed with BC who had treatment delay of more than six months were included in the study using a non-probability consecutive sampling technique. The face-to-face interviews were conducted by the researcher himself and all the data regarding demographics and factors related to treatment delay of BC was noted in a structured questionnaire. Data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results Appointment delay was significantly associated with a treatment-seeking delay in patients (p=0.03). Lack of awareness was another significant factor associated with treatment delay in BC patients. About 50 (70.4%) women who reported a lack of awareness sought treatment after 10 months of their first onset of symptoms (p=0.001). Cultural beliefs were a significant cause of treatment delay of 10-12 months in 71.8% of patients (p=0.021). Financial constraints significantly correlated with treatment delay (p=0.015). Conclusion The cultural beliefs, poor financial status, and lack of awareness are the significant factors for the treatment delay in BC patients. Promoting female health awareness can tackle many of these issues.

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

“…Of the 26 [ 23 – 48 ] studies included in this review, 15 used quantitative [ 23 , 24 , 26 , 31 , 33 – 37 , 41 – 46 ], nine used qualitative [ 25 , 27 – 30 , 32 , 38 – 40 ], and two used mixed-methods design [ 47 , 48 ]. The cumulative sample size of breast cancer patients was 4457.…”

“…The sample sizes of the studies ranged from 10 to 499 for the quantitative, qualitative, and mixed studies. The studies were conducted across 10 countries in Asia: 18 studies are from South Asia [ 23 , 24 , 29 – 31 , 33 , 34 , 37 – 39 , 41 – 48 ], seven studies are from Southeast Asia [ 25 – 28 , 32 , 36 , 40 ], and a study from Western Asia [ 35 ] (see Table 2 ).…”

“…A long waiting list for surgery [ 47 ] was a factor contributing to delays among women with breast cancer in seeking prompt treatment. We identified that women who were not given appointments [ 28 ] and those who experienced appointment delays [ 33 , 37 , 38 ] in health facilities were likely to seek late or even quit treatment. For example, a woman narrated: “… I was forced to wait for more than 3 hours even though I had an appointment.…”

“…Long-distance and a lack of access to hospitals [ 30 , 36 , 39 , 43 , 45 , 48 ], limited cancer screening centers [ 38 ], and hospitals not having screening facilities were predominant factors influencing delays in seeking diagnosis and treatment. Inaccessibility [ 37 ] and the non-availability of healthcare facilities [ 31 ] were barriers to the early diagnosis and treatment of breast cancer among women. Referral delays by medical practitioners [ 26 , 27 , 34 , 42 ] were also identified as barriers to early diagnosis and treatment.…”

“…Long-distance to hospital. Service delivery Health system financing Rahool et al, (2021) [ 37 ] Pakistan The study aimed to evaluate the factors responsible for the delay in diagnosis of BC in Sindh, Pakistan Cross-sectional study 197 breast cancer patients Inaccessibility to healthcare. Unavailability of a female doctor.…”