Quality of life and delays in breast cancer care in Sri Lanka

Abstract

Introduction: Delay in care adversely affect survival in breast cancer. Delays may lower the quality of life (QoL) too, but no evidence is available for Sri Lanka at present. Objectives:To determine if the overall delay in breast cancer care affect the QoL of patients in Sri Lanka Methods: An unmatched case-control study was conducted among 800 consecutively selected female breast cancer patients diagnosed with breast cancer within 12 months and started on definitive treatment. They were interviewed at follow-up clinics and wards at four provincial cancer treatment centres using a validated questionnaire and medical records to collect relevant dates. The QoL was determined by converting the score obtained by the validated Sinhala version of the EQ-5D-3L tool into health state utility values (HSUV). A gap of 10 weeks or more since the day of detection of breast lesion and receiving treatment was defined as the overall delay in care based on literature and local expert consensus. The statistical significance for the QoL difference between delayed and non-delayed patients was determined by 95% uncertainty interval for the mean difference for the HSUV. Results:The mean (SD) age of our study population was 55.5 (10.7) years. Overall delay in care was common (n=456; 57%). Most patients (69%) reported anxiety/depression related problems, followed by pain/discomfort (59%). A greater reduction in HSUVs between the breast lesion detection and initiation of primary treatment was seen among patients who experienced an overall delay in care (mean=-0.34; SD=0.46) compared to patients without delays (mean=-0.12; SD=0.17). This difference in the mean was statistically significant (95% CI=0.16, 0.27).Conclusions & Recommendations: Timely provision of medical interventions is likely to improve not only the survival but also the quality of life of breast cancer patients. Psychological issues are common among breast cancer patients in Sri Lanka.