From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study
| 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.date.updated | 2018-04-09T15:13:03Z | |
| 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.identifier.apacitation | 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. <i>BMC Cancer</i>, http://hdl.handle.net/11427/27931 | en_ZA |
| dc.identifier.chicagocitation | Moodley, Jennifer, Lydia Cairncross, Thurandrie Naiker, and Deborah Constant "From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study." <i>BMC Cancer</i> (2018) http://hdl.handle.net/11427/27931 | en_ZA |
| 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.ris | TY - Journal Article AU - Moodley, Jennifer AU - Cairncross, Lydia AU - Naiker, Thurandrie AU - Constant, Deborah AB - 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. DA - 2018-03-21 DB - OpenUCT DO - 10.1186/s12885-018-4219-7 DP - University of Cape Town J1 - BMC Cancer LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study TI - From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study UR - http://hdl.handle.net/11427/27931 ER - | en_ZA |
| dc.identifier.uri | http://dx.doi.org/10.1186/s12885-018-4219-7 | |
| dc.identifier.uri | http://hdl.handle.net/11427/27931 | |
| dc.identifier.vancouvercitation | Moodley J, Cairncross L, Naiker T, Constant D. From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study. BMC Cancer. 2018; http://hdl.handle.net/11427/27931. | en_ZA |
| dc.language.iso | en | |
| dc.publisher | BioMed Central | |
| dc.publisher.institution | University of Cape Town | |
| dc.rights.holder | The Author(s). | |
| 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 | |
| uct.type.filetype | Text | |
| uct.type.filetype | Image |