From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study

 

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dc.contributor.author Moodley, Jennifer
dc.contributor.author Cairncross, Lydia
dc.contributor.author Naiker, Thurandrie
dc.contributor.author Constant, Deborah
dc.date.accessioned 2018-05-04T08:47:46Z
dc.date.available 2018-05-04T08:47:46Z
dc.date.issued 2018-03-21
dc.identifier.citation Moodley, J., Cairncross, L., Naiker, T., & Constant, D. (2018). From symptom discovery to treatment-women's pathways to breast cancer care: a cross-sectional study. BMC cancer, 18(1), 312.
dc.identifier.uri http://dx.doi.org/10.1186/s12885-018-4219-7
dc.identifier.uri http://hdl.handle.net/11427/27931
dc.description.abstract Background Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey. Methods A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI. Results The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40–0.86), initial symptom denial (HR 0.43, 95% CI 0.19–0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33–0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47–0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80–11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15–2.76). Conclusion The Model of Pathways to Treatment provides a useful framework to explore patient’s journeys to care and identified opportunities for targeted interventions.
dc.language.iso en
dc.publisher BioMed Central
dc.rights.uri https://creativecommons.org/licenses/by/4.0/
dc.source BMC Cancer
dc.source.uri https://bmccancer.biomedcentral.com/
dc.subject.other Breast cancer
dc.subject.other Cancer symptoms
dc.subject.other Timely diagnosis
dc.subject.other Delay in diagnosis
dc.subject.other Breast cancer knowledge
dc.subject.other South Africa
dc.title From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study
dc.type Journal Article
dc.date.updated 2018-04-09T15:13:03Z
dc.rights.holder The Author(s).
dc.publisher.institution University of Cape Town
uct.type.filetype Text
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