Cancer Res Treat.  2019 Jul;51(3):1098-1106. 10.4143/crt.2018.386.

Patient and Care Delays of Breast Cancer in China

Affiliations
  • 1Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. renzef@mail.sysu.edu.cn
  • 2Department of Pathology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
  • 3Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
  • 4Breast Tumor Center, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
  • 5Department of Breast and Thyroid Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Abstract

PURPOSE
This study differentiates patient and care delays of breast cancer and explores the related factors as well as the associations with the prognosis in Guangzhou, a southern city of China.
METHODS
A cohort of female incident breast cancer patients (n=1,551) was recruited from October 2008 to March 2012 and followed up until January 1, 2016 (n=1,374) in the affiliated hospitals of Sun Yat-sen University. The factors associated with patient and care delays were analyzed with multivariable logistic models. Cox proportional hazards regression models were constructed to estimate the impacts of the delays on the prognosis.
RESULTS
There were 40.4% patient delay (≥3 months) and 15.5% care delay (≥1 month). The patient delay, but not the care delay, was significantly related to the clinical stage and consequently worsened the prognosis of breast cancer (hazard ratio, 1.45; 95% confidence interval, 1.09 to 1.91 for progression-free survival). The factors related to an increased patient delay included premenopausal status, history of benign breast disease, and less physical examination.
CONCLUSION
Patient delay was the main type of delay in Guangzhou and resulted in higher clinical stage and poor prognosis of breast cancer. Screening for breast cancer among premenopausal women may be an effective way to reduce this delay.

Keyword

Breast neoplasms; Patient delay; Care delay; Related factors; Prognosis

MeSH Terms

Breast Diseases
Breast Neoplasms*
Breast*
China*
Cohort Studies
Female
Humans
Logistic Models
Mass Screening
Physical Examination
Prognosis
Solar System

Figure

  • Fig. 1. Patient numbers in baseline and successfully follow-up corresponding to patient and care delays.


Reference

References

1. Caplan L. Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health. 2014; 2:87.
Article
2. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999; 353:1119–26.
Article
3. Rabinovich M, Vallejo C, Perez J, Rodriguez R, Cuevas M, Machiavelli M, et al. Impact of delay to treatment upon survival in 1067 patients with breast-cancer. Int J Oncol. 1993; 2:197–201.
Article
4. Arndt V, Sturmer T, Stegmaier C, Ziegler H, Becker A, Brenner H. Provider delay among patients with breast cancer in Germany: a population-based study. J Clin Oncol. 2003; 21:1440–6.
Article
5. Yoo TK, Han W, Moon HG, Kim J, Lee JW, Kim MK, et al. Delay of treatment initiation does not adversely affect survival outcome in breast cancer. Cancer Res Treat. 2016; 48:962–9.
Article
6. Brazda A, Estroff J, Euhus D, Leitch AM, Huth J, Andrews V, et al. Delays in time to treatment and survival impact in breast cancer. Ann Surg Oncol. 2010; 17 Suppl 3:291–6.
Article
7. Mujar M, Dahlui M, Yip CH, Taib NA. Delays in time to primary treatment after a diagnosis of breast cancer: does it impact survival? Prev Med. 2013; 56:222–4.
Article
8. Shin DW, Cho J, Kim SY, Guallar E, Hwang SS, Cho B, et al. Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer. Ann Surg Oncol. 2013; 20:2468–76.
Article
9. Yun YH, Kim YA, Min YH, Park S, Won YJ, Kim DY, et al. The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery. Ann Oncol. 2012; 23:2731–7.
Article
10. Jones SC, Johnson K. Women's awareness of cancer symptoms: a review of the literature. Womens Health (Lond). 2012; 8:579–91.
Article
11. Yu W, Yu X, Hu H, Duan G, Liu Z, Wang Y. Use of hospital appointment registration systems in China: a survey study. Glob J Health Sci. 2013; 5:193–201.
Article
12. Violence against doctors: why China? Why now? What next? Lancet. 2014; 383:1013.
13. Huo Q, Cai C, Zhang Y, Kong X, Jiang L, Ma T, et al. Delay in diagnosis and treatment of symptomatic breast cancer in China. Ann Surg Oncol. 2015; 22:883–8.
Article
14. Neal RD, Allgar VL. Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the "National Survey of NHS Patients: Cancer". Br J Cancer. 2005; 92:1971–5.
Article
15. Hansen RP, Olesen F, Sorensen HT, Sokolowski I, Sondergaard J. Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study. BMC Health Serv Res. 2008; 8:49.
Article
16. He JR, Tang LY, Yu DD, Su FX, Song EW, Lin Y, et al. Epstein-Barr virus and breast cancer: serological study in a high-incidence area of nasopharyngeal carcinoma. Cancer Lett. 2011; 309:128–36.
Article
17. Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, et al. Breast cancer presentation and diagnostic delays in young women. Cancer. 2014; 120:20–5.
Article
18. Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Patient delay and stage of diagnosis among breast cancer patients in Germany: a population based study. Br J Cancer. 2002; 86:1034–40.
19. Zheng Y, Wu CX, Zhang ML. The epidemic and characteristics of female breast cancer in China. China Oncol. 2013; 23:561–9.
20. Leon-Rodriguez E, Molina-Calzada C, Rivera-Franco MM, Campos-Castro A. Breast self-exam and patient interval associate with advanced breast cancer and treatment delay in Mexican women. Clin Transl Oncol. 2017; 19:1276–82.
Article
21. Gangane N, Anshu , Manvatkar S, Ng N, Hurtig AK, San Sebastian M. Prevalence and risk factors for patient delay among women with breast cancer in rural India. Asia Pac J Public Health. 2016; 28:72–82.
Article
22. Abu-Helalah AM, Alshraideh HA, Al-Hanaqtah M, Da'na M, Al-Omari A, Mubaidin R. Delay in presentation, diagnosis, and treatment for breast cancer patients in Jordan. Breast J. 2016; 22:213–7.
Article
23. Wall P, Moore C, El-Tamer M, Reilly JJ. Diagnostic delay in breast disease: a system analysis of a public urban hospital. Arch Surg. 1998; 133:662–6.
24. Hershman D, McBride R, Jacobson JS, Lamerato L, Roberts K, Grann VR, et al. Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol. 2005; 23:6639–46.
Article
25. Gould-Martin K, Paganini-Hill A, Casagrande C, Mack T, Ross RK. Behavioral and biological determinants of surgical stage of breast cancer. Prev Med. 1982; 11:429–40.
Article
26. Afzelius P, Zedeler K, Sommer H, Mouridsen HT, Blichert-Toft M. Patient's and doctor's delay in primary breast cancer: prognostic implications. Acta Oncol. 1994; 33:345–51.
Article
27. Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet. 1999; 353:1127–31.
Article
28. Nosarti C, Crayford T, Roberts JV, Elias E, McKenzie K, David AS. Delay in presentation of symptomatic referrals to a breast clinic: patient and system factors. Br J Cancer. 2000; 82:742–8.
Article
29. Meechan G, Collins J, Petrie KJ. The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms. Prev Med. 2003; 36:374–8.
Article
30. Schernhammer ES, Laden F, Speizer FE, Willett WC, Hunter DJ, Kawachi I, et al. Rotating night shifts and risk of breast cancer in women participating in the nurses' health study. J Natl Cancer Inst. 2001; 93:1563–8.
Article
31. Wang Z, Li N, Jiang M, Dear K, Hsieh CR. Records of medical malpractice litigation: a potential indicator of health-care quality in China. Bull World Health Organ. 2017; 95:430–6.
Article
32. Guthrie TH. Breast cancer litigation: an update with practice guidelines. Breast J. 1999; 5:335–9.
Article
33. Mohd Mujar NM, Dahlui M, Emran NA, Abdul Hadi I, Wai YY, Arulanantham S, et al. Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia. PLoS One. 2017; 12:e0176394.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr