Freitas Angela Gabrielly Quirino, Weller Mathias
Universidade Estadual da Paraíba, Campina Grande, PB, Brasil,
Cien Saude Colet. 2015 Oct;20(10):3177-89. doi: 10.1590/1413-812320152010.19692014.
Delays in treating breast cancer have been associated with a more advanced stage of the disease and a decrease in patient survival rates. The scope of this integrative review was to analyze the main causal factors and types of patient and system delays. The underlying causal factors of delays were compared among studies conducted in developing and developed countries. Of the 53 studies selected, 24 were carried out in developing countries and 29 in developed countries, respectively. Non-attribution of symptoms to cancer, fear of the disease and treatment and low educational level were the most frequent causes of patient delay. Less comprehensive health insurance coverage, older/younger age and false negative diagnosis tests were the three most common causal factors of system delay. The effects of factors such as age were not decisive per se and depended mainly on the social and cultural context. Some factors caused both patient delay and system delay. Studies conducted in developing countries identified more causal factors of patient delay and had a stronger focus on patient delay or the combination of both. Studies conducted in developed countries had a stronger focus on aspects of system delay during treatment and guidance of breast cancer patients in the health care system.
乳腺癌治疗的延迟与疾病的更晚期阶段以及患者生存率的降低有关。本整合性综述的范围是分析患者和系统延迟的主要因果因素及类型。在发展中国家和发达国家进行的研究中，对延迟的潜在因果因素进行了比较。在所选取的53项研究中，分别有24项在发展中国家开展，29项在发达国家开展。将症状归因于癌症之外的其他原因、对疾病和治疗的恐惧以及教育水平低是患者延迟的最常见原因。医疗保险覆盖范围不够全面、年龄较大/较小以及诊断测试假阴性是系统延迟的三个最常见因果因素。年龄等因素本身并非决定性因素，主要取决于社会和文化背景。一些因素既导致患者延迟，也导致系统延迟。在发展中国家进行的研究确定了更多患者延迟的因果因素，并且更侧重于患者延迟或两者的结合。在发达国家进行的研究更侧重于医疗保健系统中乳腺癌患者治疗和指导期间的系统延迟方面。
