Treatment delays among women with breast cancer in a low socio-economic status region in Brazil

Abstract

BackgroundConsidering the inequalities and the areas of low socioeconomic status in Brazil, access to health services is a challenge and the delay between diagnosis and treatment represents an important factor of worse prognosis in patients with breast cancer. Herein, we describe the clinical and epidemiological profiles of women with breast cancer and evaluate their access to health services, as well as treatment delays, at a reference centre of the Cariri region, Ceará, Brazil.MethodsThis is a retrospective study that included 473 women treated with breast cancer between 2009 and 2011 at the Oncology Centre of the Cariri.ResultsThe majority of these patients were aged between 40 and 69 years old (65.7%), without a completed high school degree (89.2%). They were married (62.9%) and were already diagnosed but had not yet been subjected to any previous treatment (77.8%). It was observed that 91.8% were referred from the public health service, and treatment was paid for by the public health service in 92.9% of the cases. The patients whose source of referral was the public system waited longer between diagnosis and the treatment initiation (p = 0.031; Mann–Whitney’s test), with a median waiting time of 71.5 days versus 39 days for those receiving referrals from private services. In addition, those with public referrals prior to diagnosis also experienced a longer waiting time between the first medical visit and treatment initiation (77 days vs. 37 days; p = 0.036; Mann–Whitney’s test), with the waiting time for the biopsy being an important factor in this delay.ConclusionsLate diagnosis was often the result of inefficiency of the prevention policies coupled with difficulty accessing the public health network. It was commonly observed that, even after diagnosis, the patients needed to wait too long before entering the Oncology Service because of long waiting queues in the public health system.

Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

“…In contrast, a recent study performed in Rio de Janeiro revealed a delay of 68.8% among 526 patients ≥90 days between the first medical visit and the diagnosis [32]. Ceará, north-eastern Brazil, the median time between diagnosis and hospital admission was 39 and 71.5 days for patients referred by the private and public health system, respectively [25].…”

“…In a study that included data from 56,094 women in various Brazilian regions, the authors reported increased delays with respect to the time between diagnosis and treatment initiation for public referrals compared to private ones [32]. Long waiting times for specialized medical consultations and diagnostic exams were among the main problems in cancer treatment by public health services [25,37]. These long waiting times can often be the result of a lack of specialized services: waiting times of up to 30 days for specialized services after the detection of the first symptoms were reported [23].…”

“…In Brazil, a high number of studies performed in the South, Southeast and Center-West regions of the country have addressed causal factors of TTI [11][12][13][14][15][16][17][18][19][20][21][22]. Some other studies have been performed in the Northeast region [23][24][25]. Few studies have compared the TTI of breast cancer between public and private health services [21].…”

The Epidemiological Challenges of Breast Cancer among Premenopausal Women in Limited Resource Settings

“…However, when a patient arrives to a tertiary care hospital with a breast cancer diagnosis, 54 . A study including 473 women was performed between 2009 and 2011 in the Oncology Centre of the Cariri, Brazil, in which 33% of the population was premenopausal women, and a median of 71.5 days between diagnosis and treatment initiation was observed 54 .…”

“…However, when a patient arrives to a tertiary care hospital with a breast cancer diagnosis, 54 . A study including 473 women was performed between 2009 and 2011 in the Oncology Centre of the Cariri, Brazil, in which 33% of the population was premenopausal women, and a median of 71.5 days between diagnosis and treatment initiation was observed 54 . As evidenced by these delays, diagnostic processes have implications for the reproductive lives of patients [55][56][57][58] , for their family and work lives 59 , on their quality of life, and on survival 52 .…”