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Mistry T, Pal R, Ghosh S, Choudhury T, Mandal S, Nath P, Alam N, Nasare VD. Impact of Low BMI and Nutritional Status on Quality of Life and Disease Outcome in Breast Cancer Patients: Insights From a Tertiary Cancer Center in India. Nutr Cancer 2024:1-12. [PMID: 38836498 DOI: 10.1080/01635581.2024.2347396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/18/2024] [Indexed: 06/06/2024]
Abstract
This study investigates the impact of Body Mass Index (BMI) on Quality of Life (QoL) and treatment outcomes in breast cancer (BC) patients, particularly focusing on underweight individuals with compromised nutritional status. A nonrandomized prospective study comprising 121 newly diagnosed patients across various BMI categories utilized FACT-B & FACIT-Sp-12 questionnaires. Follow-ups occurred at baseline, during (3rd and 6th), and after (12th month) anthracycline-taxane chemotherapy, either sequentially or concomitantly. Patients with low BMI (<18.5 kg/m2; 53.7%) exhibited significantly poorer QoL, marked by compromised nutritional indicators (low MUAC and SFT). Repeated measures ANOVA identified significant correlations between BMI groups in functional, social, and emotional QoL aspects (p < 0.05), with no notable differences in other domains. A Chi-square (ꭓ2) test underscored a significant link between BMI and treatment response (p < 0.0001), showing higher rates of non-responders among underweight patients (p = 4.259e-14). The study advocates pretreatment consultation with a dietitian as standard care for Indian BC patients, offering complimentary nutritional support for improved QoL outcomes and treatment responses.
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Affiliation(s)
- Tanuma Mistry
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
- Department of Life Science & Biotechnology, Jadavpur University, Kolkata, India
| | - Ranita Pal
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
| | - Sushmita Ghosh
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
| | - Trisha Choudhury
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
| | - Syamsundar Mandal
- Department of Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata, India
| | - Partha Nath
- Department of Medical Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Neyaz Alam
- Department of Surgical Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Vilas D Nasare
- Department of Pathology & Cancer Screening, Chittaranjan National Cancer Institute, Kolkata, India
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Nila S, Dutta E, Prakash SS, Korula S, Oommen AM. Patient and caregiver perspectives of select non-communicable diseases in India: A scoping review. PLoS One 2024; 19:e0296643. [PMID: 38180969 PMCID: PMC10769076 DOI: 10.1371/journal.pone.0296643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-reported measures of encounters in healthcare settings and consideration of their preferences could provide valuable inputs to improve healthcare quality. Although there are increasing reports of user experiences regarding health care in India in recent times, there is a lack of evidence from Indian healthcare settings on the care provided for patients with chronic diseases. METHODS We selected diabetes mellitus and cancer as representatives of two common conditions requiring different care pathways. We conducted a scoping review of studies reporting experiences or preferences of patients/caregivers for these conditions, in PubMed, Global Index Medicus and grey literature, from the year 2000 onwards. Both published and emergent themes were derived from the data and summarised as a narrative synthesis. RESULTS Of 95 included studies (49 diabetes, 46 cancer), 73% (65) were exclusively quantitative surveys, 79% included only patients (75), and 59.5% (44) were conducted in government centres. Studies were concentrated in a few states in India, with the underrepresentation of vulnerable population groups and representative studies. There was a lack of standardised tools and comprehensive approaches for assessing experiences and preferences of patients and caregivers, concerning diabetes and cancers in India. The commonest type of care assessed was therapeutic (74), with 14 cancer studies on diagnosis and nine on palliative care. Repeated visits to crowded centres, drug refill issues, unavailability of specific services in government facilities, and expensive private care characterised diabetes care, while cancer care involved delayed diagnosis and treatment, communication, and pain management issues. CONCLUSIONS There is a need for robust approaches and standardised tools to measure responsiveness of the healthcare system to patient needs, across geographical and population subgroups in India. Health system reforms are needed to improve access to high-quality care for treatment and palliation of cancer and management of chronic diseases such as diabetes.
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Affiliation(s)
- Sindhu Nila
- KEM Hospital Research Centre, Rasta Peth, Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Eliza Dutta
- Indian Institute of Public Health, Shillong, Pasteur Hills, Lawmali, Shillong, Meghalaya, India
| | - S. S. Prakash
- Department of Biochemistry, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Paediatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Anu Mary Oommen
- Department of Community Health, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Kurian NM, Boby JM, Suneesh S, Datta S, Mathew A. A novel strategy to downstage breast cancer: impact of a phone helpline. Ecancermedicalscience 2023; 17:1637. [PMID: 38414941 PMCID: PMC10898877 DOI: 10.3332/ecancer.2023.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Indexed: 02/29/2024] Open
Abstract
Breast cancer incidence rates in India are rising. The majority of breast cancers are still diagnosed in later stages. There is also a burden of neglected cancers in India, where patients neglect their symptoms due to fear, ignorance, financial insecurity and lack of access to medical care. This results in greater morbidity and mortality from breast cancer. Systematic screening programs have been tested in an Indian setting, with limited success. An effective strategy to downstage breast cancer is an area of unmet need. We aimed to explore the effectiveness of an anonymous nurse-led telephone helpline in identifying patients with possible breast malignancies and to encourage them to seek healthcare. We created a telephone helpline system by training junior public health nurses (JPHNs) to provide counselling to women who may call with breast-related symptoms. We then created a short video message on the initiative and disseminated it using social media platforms. During the 1-year study period, 434 calls were received from individuals who reported having some breast symptoms. Among them, 28% (122 callers) had never consulted a doctor for their symptoms. 78 callers consulted a nearby doctor upon the advice of the JPHN. Among them, 14 callers (18%) were advised by the doctor to undergo investigations to rule out malignancy, while 64 (82%) of them were found to have some benign/normal breast conditions. 3 (21%) out of the 14 patients who underwent further evaluation were eventually diagnosed with breast cancer. Our study provides evidence that an anonymous nurse-led telephone helpline can be an effective strategy to reduce the incidence of neglected breast cancers and downstage the diagnoses.
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Affiliation(s)
| | | | | | - Sumit Datta
- MOSC Medical College, Kolenchery 682311, Kerala, India
| | - Aju Mathew
- MOSC Medical College, Kolenchery 682311, Kerala, India
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Kuru D, Kumar K A, Chaturvedi P. Barriers in quest for cancer care access in two states of northeast India. Int J Health Plann Manage 2023; 38:1396-1408. [PMID: 37270797 DOI: 10.1002/hpm.3667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The cancer burden in northeast India is high, with low survival and low case detection. Despite the availability of cancer institutes in the region, existing literature remarks on the increasing travel outside the region for cancer care. However, research is sparse on identifying impediment factors to the access of state cancer institutes. OBJECTIVE To examine the barriers to cancer care in five common cancer sites: oral, lungs, stomach, breast and cervix. METHOD Following a descriptive multiple-embedded case study design integrating quantitative and qualitative approaches, 388 participants were selected in phase one by stratified random sampling. In phase two, by purposive sampling, 21 semi-structured interviews were conducted. RESULT The result suggests that family decision is the central factor in cancer care access. Treatment initiation is delayed because the existing government health insurance scheme does not cover diagnostic tests. Adverse steps are taken to fund cancer treatment. Besides, opting for alternative medicines were due to fear of surgery, chemotherapy and recommendations by relatives. Arranging accommodation, transportation and infrastructure shortage was another hurdle. In contrast, the lack of awareness of the state cancer institutes was a barrier to its access. CONCLUSION This paper identifies and describes factors that hinder access to state cancer institutes. The findings could enhance policy interventions for efficient cancer care access in the region. Integration with NGOs working at the state level for cancer services would support ease of access by providing funds for diagnostic tests, accommodation and transportation, especially for those who cannot afford it.
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Affiliation(s)
- Dindi Kuru
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Anil Kumar K
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Deputy Director, Centre for Cancer Epidemiology, Tata Memorial Cancer Hospital, Mumbai, Maharashtra, India
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Dehdar S, Salimifard K, Mohammadi R, Marzban M, Saadatmand S, Fararouei M, Dianati-Nasab M. Applications of different machine learning approaches in prediction of breast cancer diagnosis delay. Front Oncol 2023; 13:1103369. [PMID: 36874113 PMCID: PMC9978377 DOI: 10.3389/fonc.2023.1103369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Background The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal. Objectives The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran. Methods In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey. Results Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis. Conclusion Machine learning techniques suggest that women with an urban residency who got married or had their first child at an age older than 30 and those without children are at a higher risk of diagnosis delay. It is necessary to educate them about BC risk factors, symptoms, and self-breast examination to shorten the delay in diagnosis.
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Affiliation(s)
- Samira Dehdar
- Computational Intelligence & Intelligent Optimization Research Group, Business and Economic School, Persian Gulf University, Bushehr, Iran
| | - Khodakaram Salimifard
- Computational Intelligence & Intelligent Optimization Research Group, Business and Economic School, Persian Gulf University, Bushehr, Iran
| | - Reza Mohammadi
- Business Analytics Section, Amsterdam Business School, University of Amsterdam, Amsterdam, Netherlands
| | - Maryam Marzban
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
| | - Sara Saadatmand
- Computational Intelligence & Intelligent Optimization Research Group, Business and Economic School, Persian Gulf University, Bushehr, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Dianati-Nasab
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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George S. Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India. JOURNAL OF SOCIAL AND ECONOMIC DEVELOPMENT 2022; 25:52-69. [PMID: 36466373 PMCID: PMC9685046 DOI: 10.1007/s40847-022-00221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.
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Affiliation(s)
- Sobin George
- Centre for the Study of Social Change and Development, Institute for Social and Economic Change, Bengaluru, India
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Abo Al-Shiekh SS, Alajerami YS, Abushab KM, Najim AA, AlWaheidi S, Davies EA. Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: a cross-sectional survey. BMJ Open 2022; 12:e061847. [PMID: 36270752 PMCID: PMC9594579 DOI: 10.1136/bmjopen-2022-061847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify factors related to women's delay in presenting with breast cancer symptoms to improve diagnosis in the occupied Palestinian territory (oPt). DESIGN Cross-sectional. SETTING Two government cancer hospitals. PARTICIPANTS A consecutive sample of 130 Palestinian women living in Gaza with newly diagnosed breast cancer were approached in the waiting rooms of cancer hospitals in Gaza between 1 January 2017 and 31 December 2017. 120 women took part and returned the completed questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical information about breast cancer was collected from hospital cancer records. An interval of 3 months or more between women's self-discovery of symptoms and their first presentation to a medical provider was considered as a delay. RESULTS 94% (122/130) of women attending cancer hospitals in Gaza agreed to take part in the study. Their mean age was 51 years (range: 23-72), 33.6% (31/122) had a family history of breast cancer and 74.5% (41/55) of those whose cancer stage was known had been diagnosed at stage III or IV. Around one-half (62/122) said they had not recognised the seriousness of their breast changes but only 20% (24/122) of women delayed seeking healthcare by 3 months and more. The two only factors associated to late presentation were that the woman considered their symptoms not serious (p<0.001) and lack of pain (p=0.012). Lower socioeconomic status, older age, lower education and negative family history of breast cancer were not statistically associated with women's delay. CONCLUSIONS Women's awareness about the seriousness of breast changes and the critical importance of seeking prompt diagnosis needs to be improved using context-relevant and evidence-based awareness campaigns. This should be accompanied with training of female nurses on promoting early detection and improvement in diagnostic facilities to ensure timely diagnosis of cancer in the oPt.
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Affiliation(s)
| | | | - Khaled M Abushab
- Department of Medical Imaging, Al-Azhar University, Gaza, Palestine
| | - Ahmed A Najim
- Nursing Department, Al-Azhar University, Gaza, Palestine
| | | | - Elizabeth A Davies
- Health and Social Care Research, King's College London, London, UK
- Knowledge and Intelligence, Public Health England, London, UK
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Momenimovahed Z, Momenimovahed S, Allahqoli L, Salehiniya H. Factors Related to the Delay in Diagnosis of Breast Cancer in the Word: A Systematic Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mehrotra R, Yadav K. Breast cancer in India: Present scenario and the challenges ahead. World J Clin Oncol 2022; 13:209-218. [PMID: 35433294 PMCID: PMC8966510 DOI: 10.5306/wjco.v13.i3.209] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/17/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the commonest malignancy among women globally. From being fourth in the list of most common cancers in India during the 1990s, it has now become the first. In this review, we examine the available literature to understand the factors that contributed to the high burden of breast cancer in the country. We also provide the landscape of changes in the field of early diagnosis and the treatment modalities as well as the limitations of the Indian healthcare delivery systems (e.g., delayed diagnosis, human resources and funding for treatment). This review also sheds light on the newer interventions and the future of breast cancer management keeping in mind the coronavirus disease 2019 imposed limitations.
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Affiliation(s)
- Ravi Mehrotra
- Department of Health Research, Ministry of Health and Family Welfare, India Cancer Research Consortium, New Delhi 110001, India
- CHIP Foundation, Noida 201301, India
| | - Kavita Yadav
- Centre of Social Medicine & Community Health, Jawahar Lal Nehru University, New Delhi 110067, India
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting. Indian J Surg Oncol 2020; 11:287-293. [PMID: 32523277 DOI: 10.1007/s13193-020-01037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most common cancer among females worldwide, with over 2 million cases diagnosed every year. In India, it is the most common malignancy overall (15.4%) and accounts for about 27% female cancers. Morbidity and mortality remain high despite improvements in BC therapeutics. Conventionally, a gap of more than 3 months between noticing symptoms and commencing treatment is considered delay in BC management. Delays make BC an important public health problem and lead to poor outcomes. This study aims to identify patient perceived barriers to BC management. A self-designed structured questionnaire consisting of questions pertaining to multiple aspects of BC presentation and management was prepared. The study was conducted from October 2017 to September 2018 and results were analyzed. A delay of 3 months or more was seen in 284 of the 435 patients (65.3%), among which 179 was patient delay, 69 due to provider delay, and 36 due to a combined contribution of both factors. Provider factors were associated with prolonged delay. Misdiagnosis at first consult was the most common factor perceived by patients as a barrier, followed by delay in referral, distance from hospitals, lack of information, financial constraints, and logistic issues. A significant patient and provider delay exists in BC management which prevents effective early therapy. Effective tackling of these barriers may result in the betterment of BC management outcomes. Robust screening, education of patients and providers, and awareness promotion and infrastructure development will be useful in this regard.
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Kumar A, Bhagabaty SM, Tripathy JP, Selvaraj K, Purkayastha J, Singh R. Delays in Diagnosis and Treatment of Breast Cancer and the Pathways of Care: A Mixed Methods Study from a Tertiary Cancer Centre in North East India. Asian Pac J Cancer Prev 2019; 20:3711-3721. [PMID: 31870113 PMCID: PMC7173377 DOI: 10.31557/apjcp.2019.20.12.3711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION In India, mortality rate in breast cancer is high because more than half are diagnosed late at locally advanced or metastatic stages. This might be due to presentation delay (recognition of symptoms to first provider consultation) and treatment delay (first provider consultation to initiation of treatment), together known as overall delay. We aimed to estimate the overall delay in diagnosis and treatment in breast cancer and the associated factors, describe pathway of care and explore the reasons for delay from a patients' and providers' perspective. METHODS Explanatory sequential mixed-methods study with a quantitative component (retrospective cohort study including breast cancer patients registered at Dr. Borooah Cancer Institute (BBCI), Guwahati during February-June 2019) followed by descriptive qualitative component (in-depth interviews with 15 patients and 10 care providers). RESULTS Of 269 breast cancer patients, median (Inter Quartile Range) overall delay was 203 (110-401) days, presentation delay was 35 (10-112) days and treatment delay was 130 (75-258) days. Majority of patients approached private sector (190, 70.6%) as the first care provider. Nearly half of all patients (136, 50.6%) visited one health care provider before reaching the BBCI and another one-third (90, 33.5%) visited two providers. Reasons for presentation delay were misconception about the disease, perceived stigma, fear and denial of cancer, attribution of symptoms to trivial conditions, family responsibilities and embarrassment of breast examination by a male doctor. Treatment delay was due to initial visit to, misclassification of disease severity, dissatisfaction with care at public facilities, poor accessibility and affordability, fear of treatment and its side effects. CONCLUSION Treatment delay was the major contributor to overall delay. Private providers need to be sensitized and trained in screening of breast cancer and referral of suspected cases of cancer. More awareness is needed about warning symptoms of breast cancer and misconceptions regarding the disease.<br />.
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Affiliation(s)
- Arvind Kumar
- Public Health, Cluster Coordinator, Doctors For You, Guwahati, India
| | | | - Jaya Prasad Tripathy
- Department of Community Medicine, Assistant Professor, All India Institute of Medical Sciences, Nagpur, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, Assistant Professor, All India Institute of Medical Sciences, Nagpur, India
| | - Joydeep Purkayastha
- Department of Preventive Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Ravikant Singh
- Public Health, Cluster Coordinator, Doctors For You, Guwahati, India
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Agodirin O, Olatoke S, Rahman G, Olaogun J, Kolawole O, Agboola J, Olasehinde O, Katung A, Ayandipo O, Etonyeaku A, Ajiboye A, Oguntola S, Fatudimu O. Impact of Primary Care Delay on Progression of Breast Cancer in a Black African Population: A Multicentered Survey. J Cancer Epidemiol 2019; 2019:2407138. [PMID: 31485229 PMCID: PMC6702851 DOI: 10.1155/2019/2407138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/30/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reports are scanty on the impact of long primary care interval in breast cancer. Exploratory reports in Nigeria and other low-middle-income countries suggest detrimental impact. The primary aim was to describe the impact of long primary care interval on breast cancer progression, and the secondary aim was to describe the factors perceived by patients as the reason(s) for long intervals. METHOD Questionnaire-based survey was used in 9 Nigerian tertiary institutions between May 2017 and July 2018. The study hypothesis was that the majority of patients stayed >30 days, and the majority experienced stage migration in primary care interval. Assessment of the impact of the length of interval on tumor stage was done by survival analysis technique, and clustering analysis was used to find subgroups of the patient journey. RESULTS A total of 237 patients presented to primary care personnel with tumor ≤5cm (mean 3.4±1.2cm). A total of 151 (69.3%, 95% CI 62.0-75.0) stayed >30 days in primary care interval. Risk of stage migration in primary care interval was 49.3% (95% CI 42.5%-56.3%). The most common reasons for long intervals were symptom misinformation and misdiagnosis. Clustering analysis showed 4 clusters of patients' experience and journey: long interval due to distance, long interval due to misinformation, long interval due to deliberate delaying, and not short interval-prepared for treatment. CONCLUSION The majority of patients stayed longer than 30 days in primary care interval. Long primary care interval was associated with a higher risk of stage migration, and more patients reported misinformation and misdiagnosis as reasons for a long interval.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | - Ganiyu Rahman
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Julius Olaogun
- Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladapo Kolawole
- Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - John Agboola
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | | | - Aba Katung
- Department of Surgery, Federal Medical Center, Owo, Nigeria
| | | | | | - Anthony Ajiboye
- Department of Surgery, Bowen University Teaching Hospital, Nigeria
| | - Soliu Oguntola
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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Nouws S, Brandão M, Fontes F, Pereira S, Dias T, Ribeiro AI, Lunet N, Peleteiro B. Factors associated with time to breast cancer diagnosis and treatment in unscreened women in Portugal. Women Health 2018; 59:601-614. [PMID: 30462571 DOI: 10.1080/03630242.2018.1539430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Delays in detection, diagnosis and treatment may lead to poorer prognosis in women with breast cancer. We quantified time intervals from first detection (FD) to diagnosis (D) and first treatment (FT) and identified associated factors. We studied 282 patients diagnosed with breast cancer during 2012 at the Breast Clinic of the Portuguese Institute of Oncology in Porto, Portugal using face-to-face interview and medical records. Associations of sociodemographic and clinical characteristics with time intervals was computed using adjusted percentage differences (adjPD) after logarithmic transformation, odds ratios (adjOR) for comparing the highest and lowest thirds of the distribution and 95 percent confidence intervals (CI) for both measures, using linear and logistic regression, respectively. The median times between FD and D and FT were 31 and 44 days, respectively. Significantly longer periods between FD and D were found in symptomatic women (adjPD = 99.5, 95 percent CI: 37.1, 190.0; adjOR = 3.16, 95 percent CI: 1.57, 6.33). More advanced stage was associated with shorter intervals between D and FT (adjPD = -33.8, 95 percent CI: -44.2, -21.5; adjOR = 0.14, 95 percent CI: 0.05, 0.34). Although some differences according to clinical characteristics were observed, they did not seem to translate into inequities in access to public healthcare in this group of women.
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Affiliation(s)
- Sónia Nouws
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
| | - Mariana Brandão
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Filipa Fontes
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
| | - Susana Pereira
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Teresa Dias
- b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Ana Isabel Ribeiro
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,b Instituto Português de Oncologia do Porto Francisco Gentil , Porto , Portugal
| | - Nuno Lunet
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,c Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina , Universidade do Porto , Porto , Portugal
| | - Bárbara Peleteiro
- a EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal.,c Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina , Universidade do Porto , Porto , Portugal
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15
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Nair D, Singhvi H, Mair M, Qayyumi B, Deshmukh A, Pantvaidya G, Nair S, Chaturvedi P, Laskar SG, Prabhash K, DCruz A. Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India. Indian J Cancer 2018; 54:616-620. [PMID: 30082545 DOI: 10.4103/ijc.ijc_445_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes. AIM The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes. SETTINGS AND DESIGN This was a retrospective analysis of prospectively collected data in a tertiary cancer center. MATERIALS AND METHODS This study included 850 surgically treated oral cancer cases between January and December 2012. STATISTICAL ANALYSIS We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression. RESULTS The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula. CONCLUSION The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment.
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Affiliation(s)
- Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Hitesh Singhvi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Manish Mair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Burhanuddin Qayyumi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kumar Prabhash
- Medical Oncologist, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anil DCruz
- Director, Tata Memorial Centre, Mumbai, Maharashtra, India
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16
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Suleiman NN, Nascimento N, Botelho JMS, Coelho RC. Overview of female breast cancer in northern Tocantins - Brazil. ACTA ACUST UNITED AC 2018; 44:316-322. [PMID: 29019533 DOI: 10.1590/0100-69912017004001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE to evaluate the temporal variation of the percentages of female breast cancer in early and late stages and analyze socio-demographic variables associated with these stages. METHODS study of secondary data performed between the years of 2000 and 2015 in the Araguaína Regional Hospital - Araguaína - TO - Brasil. RESULTS breast cancer in advanced stages were diagnosed in 51.1% of the cases and at an early stage in 48.9%. There was no difference between the percentages of patients with early and late stages over the years. Women of race/black, illiterate and origin of the southeast of Pará presented a higher percentage of late staging at diagnosis. CONCLUSIONS most women was diagnosed with advanced disease; the time evolution of the proportion of cases (advanced/early) did not demonstrate variational changes over the years; association of the disease has been identified in advanced stage in women of race/black, illiterate and from the southeast of Pará state.
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Affiliation(s)
- Nader Nazir Suleiman
- Instituto Tocantinense Presidente Antônio Carlos - ITPAC, UNACON - Hospital Regional de Araguaína, Araguaína, TO, Brasil.,Hospital Regional de Araguaína
| | - Nanci Nascimento
- - Instituto de Pesquisas Energéticas e Nucleares - IPEN/USP, Tecnologia Nuclear - Aplicações, São Paulo, SP, Brasil
| | - João Manuel Santos Botelho
- Instituto Tocantinense Presidente Antônio Carlos - ITPAC, UNACON - Hospital Regional de Araguaína, Araguaína, TO, Brasil.,Hospital Regional de Araguaína
| | - Rachel Carvalho Coelho
- Instituto Tocantinense Presidente Antônio Carlos - ITPAC, UNACON - Hospital Regional de Araguaína, Araguaína, TO, Brasil.,Hospital Regional de Araguaína
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17
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Stamatovic L, Vasovic S, Trifunovic J, Boskov N, Gajic Z, Parezanovic A, Icevic M, Cirkovic A, Milic N. Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia. Psychooncology 2017; 27:576-582. [PMID: 28857314 DOI: 10.1002/pon.4551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.
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Affiliation(s)
- L Stamatovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - S Vasovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - J Trifunovic
- Oncology Institute of Vojvodina, Novi Sad, Serbia
| | - N Boskov
- General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Z Gajic
- General Hospital Kruševac, Kruševac, Serbia
| | | | | | - A Cirkovic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.,Department for Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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18
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Youl PH, Aitken JF, Turrell G, Chambers SK, Dunn J, Pyke C, Baade PD. The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1156. [PMID: 27869758 PMCID: PMC5129366 DOI: 10.3390/ijerph13111156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 01/07/2023]
Abstract
Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a "non-lump" symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.
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Affiliation(s)
- Philippa H Youl
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia.
- School of Population Health, University of Queensland, Brisbane, QLD 4072, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Gavin Turrell
- Institute of Health and Ageing, Australian Catholic University, Fitzroy, VIC 3115, Australia.
| | - Suzanne K Chambers
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
| | - Jeffrey Dunn
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia.
- School of Social Science, University of Queensland, Brisbane, QLD4072, Australia.
| | - Christopher Pyke
- Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia.
| | - Peter D Baade
- Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia.
- School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
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19
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Sánchez G, Niño CG, Estupiñán AC. Determinantes del tratamiento oportuno en mujeres con cáncer de mama apoyadas por seis organizaciones no gubernamentales en Colombia. REVISTA FACULTAD NACIONAL DE SALUD PÚBLICA 2016. [DOI: 10.17533/udea.rfnsp.v34n3a04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Gupta A, Dhillon PK, Govil J, Bumb D, Dey S, Krishnan S. Multiple Stakeholder Perspectives on Cancer Stigma in North India. Asian Pac J Cancer Prev 2016; 16:6141-7. [PMID: 26320509 DOI: 10.7314/apjcp.2015.16.14.6141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer is a leading cause of death worldwide. A large proportion of cancer deaths are preventable through early detection but there are a range of social, emotional, cultural and financial dimensions that hinder the effectiveness of cancer prevention and treatment efforts. Cancer stigma is one such barrier and is increasingly recognized as an important factor influencing health awareness and promotion, and hence, disease prevention and control. The impact and extent of stigma on the cancer early detection and care continuum is poorly understood in India. OBJECTIVES To evaluate cancer awareness and stigma from multiple stakeholder perspectives in North India, including men and women from the general population, health care professionals and educators, and cancer survivors. MATERIALS AND METHODS A qualitative study was conducted with in-depth interviews (IDIs) and focus group discussions (FGDs) among 39 individuals over a period of 3 months in 2014. Three groups of participants were chosen purposively - 1) men and women who attended cancer screening camps held by the Indian Cancer Society, Delhi; 2) health care providers and 3) cancer survivors. RESULTS Most participants were unaware of what cancers are in general, their causes and ways of prevention. Attitudes of families towards cancer patients were observed to be positive and caring. Nevertheless, stigma and its impact emerged as a cross cutting theme across all groups. Cost of treatment, lack of awarenes and beliefs in alternate medicines were identified as some of the major barriers to seeking care. CONCLUSIONS This study suggests a need for spreading awareness, knowledge about cancers and assessing associated impact among the people. Also Future research is recommended to help eradicate stigma from the society and reduce cancer-related stigma in the Indian context.
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Affiliation(s)
- Adyya Gupta
- South Asia Network for Chronic Disease (SANCD), Public Health Foundation of India, New Delhi, India E-mail :
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21
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Chintamani. Is Indian Cancer Unique? Indian J Surg 2015; 77:255-7. [DOI: 10.1007/s12262-015-1398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Ozmen V, Boylu S, Ok E, Canturk NZ, Celik V, Kapkac M, Girgin S, Tireli M, Ihtiyar E, Demircan O, Baskan MS, Koyuncu A, Tasdelen I, Dumanli E, Ozdener F, Zaborek P. Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies. Eur J Public Health 2015; 25:9-14. [PMID: 25096257 PMCID: PMC4304375 DOI: 10.1093/eurpub/cku086] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One of the most important factors in breast cancer (BC) mortality is treatment delay. The primary goal of this survey was to identify factors affecting the total delay time (TDT) in Turkish BC patients. METHODS A total of 1031 patients with BC were surveyed using a uniform questionnaire. The time between discovering the first symptom and signing up for the first medical visit (patient delay time; PDT) and the time between the first medical visit and the start of therapy (system delay time; SDT) were modelled separately with multilevel regression. RESULTS The mean PDT, SDT and TDT were 4.8, 10.5 and 13.8 weeks, respectively. In all, 42% of the patients had a TDT >12 weeks. Longer PDT was significantly correlated with disregarding symptoms and having age of between 30 and 39 years. Shorter PDT was characteristic of patients who: had stronger self-examination habits, received more support from family and friends and had at least secondary education. Predictors of longer SDT included disregard of symptoms, distrust in success of therapy and medical system and having PDT in excess of 4 weeks. Shorter SDT was linked to the age of >60 years. Patients who were diagnosed during a periodic check-up or opportunistic mammography displayed shorter SDT compared with those who had symptomatic BC and their first medical examination was by a surgeon. CONCLUSION TDT in Turkey is long and remains a major problem. Delays can be reduced by increasing BC awareness, implementing organized population-based screening programmes and founding cancer centres.
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Affiliation(s)
- Vahit Ozmen
- 1 Department of General Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sukru Boylu
- 2 Department of General Surgery, Medical Faculty, Adnan Menderes University, Aydin, Turkey
| | - Engin Ok
- 3 Department of General Surgery, Medical Faculty, Erciyes University, Kayseri, Turkey
| | - Nuh Zafer Canturk
- 4 Department of General Surgery, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Varol Celik
- 5 Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Murat Kapkac
- 6 Department of General Surgery, Medical Faculty, Ege University, Izmir, Turkey
| | - Sadullah Girgin
- 7 Department of General Surgery, Medical Faculty, Dicle University, Diyarbakir, Turkey
| | - Mustafa Tireli
- 8 Department of General Surgery, Medical Faculty, Celal Bayar University, Manisa, Turkey
| | - Enver Ihtiyar
- 9 Department of General Surgery, Medical Faculty, Osmangazi University, Eskisehir, Turkey
| | - Orhan Demircan
- 10 Department of General Surgery, Medical Faculty, Acibadem University, Adana, Turkey
| | - Mazhar Semih Baskan
- 11 Department of General Surgery, Medical Faculty, Ankara University, Ankara, Turkey
| | - Ayhan Koyuncu
- 12 Department of General Surgery, Medical Faculty, Cumhuriyet University, Sivas, Turkey
| | - Ismet Tasdelen
- 13 Department of Medical Oncology, Medical Faculty, Uludag University, Bursa, Turkey
| | - Esra Dumanli
- 14 Medical Department, Roche Mustahzarlari San. A.S., Istanbul, Turkey
| | - Fatih Ozdener
- 14 Medical Department, Roche Mustahzarlari San. A.S., Istanbul, Turkey
| | - Piotr Zaborek
- 15 Collegium of World Economy, Warsaw School of Economics, Warsaw, Poland
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23
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Freitas R, Siqueira LB, Carrijo ENDA, Lacerda RP, Paulinelli RR, Rahal RMS, Oliveira LFP. Temporal variation of breast cancer surgical treatment in a university hospital in Brazil's Central West region. Rev Col Bras Cir 2014; 40:180-5. [PMID: 23912363 DOI: 10.1590/s0100-69912013000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the types of surgical treatments for breast cancer performed by the Mastology program of the Clinics Hospital, Federal University of Goiás (HC-UFG). METHODS We conducted a cross-sectional, cohort study on the breast operations performed at HC-UFG from January 2002 to December 2009. We evaluated the surgical records for: surgical time and size, surgeon, type of operation, diagnosis, and type of anesthesia. The medical charts were researched for: pathology report of the tumor, lymph node involvement, primary tumor size, staging and performance of neoadjuvant therapies. We excluded operations for the removal of benign breast tumors. The temporal variation was analyzed using Poisson regression, considering the annual percentage change (APC). RESULTS 403 operations were performed for breast cancer during the study period, with an average of 50.38 operations per year. The most common histological type was invasive ductal carcinoma (72.6%). The mean age of patients was 52 years, and 29% had disease in stages III and IV. The temporal trend revealed a significant increase in tumor size (p <0.01), the clinical stages III and IV (p = 0.01) and the use of neoadjuvant chemotherapy (p = 0.02). There was increase in mastectomies (APC = 9 cases/year, p = .04). There was no increase in cases of breast conservation treatments or of mastectomies with immediate reconstruction. CONCLUSION In recent years, the HC-UFG has had an increased number of mastectomies as a result of increased incidence of locoregionally advanced breast cancer.
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Affiliation(s)
- Ruffo Freitas
- Faculdade de Medicina, Universidade Federal de Goiás-UFGO, Goiânia, Goiás State, Brazil.
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24
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Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, Fan L, Li J, Chavarri-Guerra Y, Liedke PER, Pramesh CS, Badovinac-Crnjevic T, Sheikine Y, Chen Z, Qiao YL, Shao Z, Wu YL, Fan D, Chow LWC, Wang J, Zhang Q, Yu S, Shen G, He J, Purushotham A, Sullivan R, Badwe R, Banavali SD, Nair R, Kumar L, Parikh P, Subramanian S, Chaturvedi P, Iyer S, Shastri SS, Digumarti R, Soto-Perez-de-Celis E, Adilbay D, Semiglazov V, Orlov S, Kaidarova D, Tsimafeyeu I, Tatishchev S, Danishevskiy KD, Hurlbert M, Vail C, St Louis J, Chan A. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014; 15:489-538. [PMID: 24731404 DOI: 10.1016/s1470-2045(14)70029-4] [Citation(s) in RCA: 312] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cancer is one of the major non-communicable diseases posing a threat to world health. Unfortunately, improvements in socioeconomic conditions are usually associated with increased cancer incidence. In this Commission, we focus on China, India, and Russia, which share rapidly rising cancer incidence and have cancer mortality rates that are nearly twice as high as in the UK or the USA, vast geographies, growing economies, ageing populations, increasingly westernised lifestyles, relatively disenfranchised subpopulations, serious contamination of the environment, and uncontrolled cancer-causing communicable infections. We describe the overall state of health and cancer control in each country and additional specific issues for consideration: for China, access to care, contamination of the environment, and cancer fatalism and traditional medicine; for India, affordability of care, provision of adequate health personnel, and sociocultural barriers to cancer control; and for Russia, monitoring of the burden of cancer, societal attitudes towards cancer prevention, effects of inequitable treatment and access to medicine, and a need for improved international engagement.
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Affiliation(s)
- Paul E Goss
- Harvard Medical School, Boston, MA, USA; Avon Breast Cancer Center of Excellence, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Brittany L Lee-Bychkovsky
- Harvard Medical School, Boston, MA, USA; Department of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA; International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Lei Fan
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Breast Surgery Department, Shanghai, China
| | - Junjie Li
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Breast Surgery Department, Shanghai, China
| | - Yanin Chavarri-Guerra
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pedro E R Liedke
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Oncologia Hospital de Clínicas de Porto Alegre and Instituto do Cancer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - C S Pramesh
- Department of Surgical Oncology/Clinical Research, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Tanja Badovinac-Crnjevic
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; University Hospital Zagreb, Department of Oncology, Zagreb, Croatia
| | - Yuri Sheikine
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Zhu Chen
- State Key Lab of Medical Genomics, Shanghai Institute of Hematology, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - You-lin Qiao
- Department of Cancer Epidemiology, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiming Shao
- Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Breast Surgery Department, Shanghai, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Daiming Fan
- Fourth Military Medical University, State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Xi'an, Shaanxi Province, China
| | - Louis W C Chow
- Organisation for Oncology and Translational Research, Hong Kong, China; UNIMED Medical Institute, Comprehensive Centre for Breast Diseases, Hong Kong, China
| | - Jun Wang
- Institute of Public Health Economics and Management, Central University of Finance and Economics, Beijing, China
| | - Qiong Zhang
- Department of Economics, School of Economics, Central University of Finance and Economics, Beijing, China
| | - Shiying Yu
- Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gordon Shen
- University of California, Berkeley, CA, USA; Cancer Institute & Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arnie Purushotham
- King's Health Partners Cancer Centre, King's College London, Guy's Hospital, London, UK
| | - Richard Sullivan
- King's Health Partners Cancer Centre, King's College London, Guy's Hospital, London, UK; Institute of Cancer Policy, King's College London, Guy's Hospital, London, UK
| | - Rajendra Badwe
- Administration, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Shripad D Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Reena Nair
- Department of Clinical Hematology, Tata Medical Center, Kolkata, West Bengal, India
| | - Lalit Kumar
- Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Purvish Parikh
- Clinical Research and Education, BSES GH Municipal Hospital, Mumbai, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Subramania Iyer
- Amrita Institute of Medical Sciences & Research Centre, Head & Neck/Plastic & Reconstructive Surgery, Kochi, Kerala, India
| | | | | | - Enrique Soto-Perez-de-Celis
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Dauren Adilbay
- Astana Oncology Center, Head and Neck Oncology, Astana, Kazakhstan
| | - Vladimir Semiglazov
- Reproductive System Tumors Department, NN Petrov Research Institute of Oncology, St Petersburg, Russia
| | - Sergey Orlov
- Department of Thoracic Oncology, Saint Petersburg Medical University, Saint Petersburg, Russia
| | | | - Ilya Tsimafeyeu
- Russian Society of Clinical Oncology, Kidney Cancer Research Bureau, Moscow, Russia
| | - Sergei Tatishchev
- Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | | | - Marc Hurlbert
- Avon Foundation Breast Cancer Crusade, New York, NY, USA
| | - Caroline Vail
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica St Louis
- International Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Arlene Chan
- Breast Cancer Research Centre-Western Australia and Curtin University, Perth, WA, Australia
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Abstract
Head and neck cancers are the most common cancers in developing countries, especially in Southeast Asia. Head and neck cancers are more common in males compared to females. This is mainly attributed to tobacco, areca nut, alcohol, etc. Oral cancers are most common amongst all head and neck squamous cell cancers (HNSCC). HNSCC in the developing world differ from those in the Western world in terms of age, site of disease, etiology, and molecular biology. Poverty, illiteracy, advanced stage at presentation, lack of access to health care, and poor treatment infrastructure pose a major challenge in management of these cancers. The annual GDP (gross domestic product) spent on health care is very low in developing countries compared to the developed countries. Cancer treatment leads to a significant financial burden on the cancer patients and their families. Several health programs have been implemented to curb this rising burden of disease. The main aims of these health programs are to increase awareness among people regarding tobacco and to improve access to health care facilities, early diagnosis, treatment, and palliative care.
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26
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Chintamani. The paradigm shifts in the management of breast cancer-have we finally arrived? Indian J Surg 2013; 75:419-23. [PMID: 24465095 PMCID: PMC3900753 DOI: 10.1007/s12262-013-1022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Chintamani
- Vardhman Mahvir Medical College, Safdarjang Hospital, New Delhi, India
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27
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Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, Kahan Z, Mardiak J, Pieńkowski T, Semiglazova T, Stamatovic L, Timcheva C, Vasovic S, Vrbanec D, Zaborek P. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health 2013; 24:761-7. [PMID: 24029456 DOI: 10.1093/eurpub/ckt131] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient- and system-related delays in commencing breast cancer treatment in different countries. METHODS A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy). RESULTS The average patient-related delay time and total delay time were 4.7 (range: 3.4-6.2) weeks and 14.4 (range: 11.5-29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3-24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times. CONCLUSIONS The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.
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Affiliation(s)
- Jacek Jassem
- 1 Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Vahit Ozmen
- 2 Department of Surgery, Istanbul University, Istanbul, Turkey
| | - Florin Bacanu
- 3 Departament of Clinical Oncology, Sf Maria Hospital, Bucharest, Romania
| | - Monika Drobniene
- 4 Radiotherapy and Drug Therapy Center, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Janis Eglitis
- 5 Department of Breast Surgery, Oncology Centre of Latvia, Riga East University Hospital, Riga, Latvia
| | | | - Zsuzsanna Kahan
- 7 Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Jozef Mardiak
- 8 2nd Department of Oncology, National Cancer Institute and Medical School of Comenius University, Bratislava, Slovak Republic
| | - Tadeusz Pieńkowski
- 9 Department of Oncology and Surgery, Medical Centre of Postgraduate Education, Otwock, Poland
| | - Tatiana Semiglazova
- 10 Department of Medical Oncology, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - Ljiljana Stamatovic
- 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia
| | - Constanta Timcheva
- 12 Department of Chemotherapy, Specialized Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - Suzana Vasovic
- 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia
| | - Damir Vrbanec
- 13 Department of Medical Oncology, Clinic of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Piotr Zaborek
- 14 Collegium of World Economy, Warsaw School of Economics, Warsaw, Poland
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28
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Sentinel Lymph Node Biopsy in Breast Cancer-Should It Be the Standard of Care in India? Indian J Surg 2012; 74:205-7. [DOI: 10.1007/s12262-012-0588-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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