Aims

Delays in breast cancer care, one important attributable factor for breast cancer being diagnosed at advanced stages, are not systematically studied in many countries. This study assessed the magnitude and factors associated with delays in breast cancer care in Sri Lanka, from symptom detection to treatment initiation.

Materials and methods

We interviewed 800 consecutively sampled female breast cancer patients, diagnosed within the last 12 months, using context-specific questionnaires and medical records. We defined the cut-off times for delays using international guidelines and features of the national health system and care-seeking patterns in the country. Delays were estimated as proportions with 95% confidence intervals and presented for: (i) presentation delay; (ii) diagnosis delay and (iii) treatment delay. We looked at how sociodemographic and healthcare availability and accessibility at the individual level were associated with delays using multivariate logistic regression, with a P value of 0.05 to define statistical significance.

Results

Nearly two-thirds of patients reported a presentation delay (63.3%, 95% confidence interval 59.9–66.6%). A diagnosis delay (36.7%, 95% confidence interval 33.4–40.0%) was also seen among one-third, whereas treatment delays (13.2%, 95% confidence interval 10.8–15.5%) were less common. Low family monthly income (odds ratio 6.3; 95% confidence interval 4.2–9.3) and poor knowledge on breast cancer (odds ratio 2.7; 95% confidence interval 1.8–3.8) were associated with presentation delay. Poor health literacy (odds ratio 1.7; 95% confidence interval 1.1–2.7) and the need to make more than two visits to the first contact health provider prior to diagnosis (odds ratio 7.2; 95% confidence interval 4.6–11.1) were associated with diagnosis delays, whereas directly contacting an appropriate specialised health provider once the lump was detected reduced diagnosis delay (odds ratio 0.3; 95% confidence interval 0.2–0.4). Having undergone a core biopsy (odds ratio 0.5; 95% confidence interval 0.3–0.8) and having a mammogram (odds ratio 0.6; 95% confidence interval 4.7–32.7) reduced the likelihood of treatment delays.

Conclusions

Our study findings show that delays in breast cancer care in Sri Lanka are much lower than those in other lower-middle income countries. However, there is significant room for improvement, especially in relation to the excellence in quality of care, such as improving access to mammography services. Periodical estimation of breast cancer delays enabling temporal comparisons will probably provide useful information to policy makers in improving care delivery for breast cancer patients and, hence, is recommended. Such future assessments designed for comparisons between different treatment modalities would provide more information to assist policy decisions in care improvement.

中文翻译：

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斯里兰卡，一个资源匮乏的国家，乳腺癌护理及其关联的介绍、诊断和治疗延误

目标

乳腺癌治疗延迟是乳腺癌在晚期被诊断出的一个重要归因因素，在许多国家都没有进行系统的研究。本研究评估了与斯里兰卡乳腺癌护理延迟相关的程度和因素，从症状检测到治疗开始。

材料和方法

我们使用特定背景的问卷和医疗记录采访了 800 名连续抽样的女性乳腺癌患者，这些患者在过去 12 个月内被诊断出来。我们使用国际指南和国家卫生系统的特点以及该国的就医模式确定了延误的截止时间。延迟被估计为具有 95% 置信区间的比例，并呈现为： (i) 呈现延迟；(ii) 诊断延迟和 (iii) 治疗延迟。我们使用多元逻辑回归研究了个人层面的社会人口和医疗保健可用性和可及性如何与延误相关，P值为 0.05 来定义统计显着性。

结果

近三分之二的患者报告出现延迟（63.3%，95% 置信区间 59.9-66.6%）。三分之一的患者也出现诊断延迟（36.7%，95% 置信区间 33.4-40.0%），而治疗延迟（13.2%，95% 置信区间 10.8-15.5%）不太常见。家庭月收入低（优势比 6.3；95% 置信区间 4.2-9.3）和对乳腺癌的了解不足（优势比 2.7；95% 置信区间 1.8-3.8）与就诊延迟相关。健康素养差（优势比 1.7；95% 置信区间 1.1-2.7）和需要在诊断前对第一个接触健康提供者进行两次以上就诊（优势比 7.2；95% 置信区间 4.6-11.1）与诊断延误，而一旦检测到肿块，直接联系适当的专业医疗服务提供者可减少诊断延迟（优势比 0.3；95% 置信区间 0.2-0.4）。接受核心活检（优势比 0.5；95% 置信区间 0.3-0.8）和乳房 X 光检查（优势比 0.6；95% 置信区间 4.7-32.7）降低了治疗延误的可能性。

结论

我们的研究结果表明，斯里兰卡的乳腺癌治疗延误远低于其他中低收入国家。然而，还有很大的改进空间，特别是在卓越的护理质量方面，例如改善获得乳房 X 光检查服务的机会。定期估计乳腺癌延迟，以便进行时间比较，可能会为决策者提供有用的信息，以改善对乳腺癌患者的护理服务，因此被推荐。为比较不同治疗方式而设计的此类未来评估将提供更多信息，以协助改善护理的政策决策。