National Council of Science and Technology (CONACYT) - Mexican National Cancer Institute, Epidemiology Unit, Mexico City, Mexico
Centro de Investigación y Docencia Económicas (CIDE), Economics Division, Mexico City, Mexico.
Oncologist. 2018 Apr;23(4):440-453. doi: 10.1634/theoncologist.2017-0431. Epub 2017 Dec 28.
Most breast cancer patients in low- and middle-income settings are diagnosed at advanced stages due to lengthy intervals of care. This study aimed to understand the mechanisms through which delays occur in the patient interval and diagnosis interval of care.
We conducted a cross-sectional survey including 886 patients referred to four major public cancer hospitals in Mexico City. Based in a conceptual model of help-seeking behavior, a path analysis strategy was used to identify the relationships between explanatory factors of patient delay and diagnosis delay.
The patient and the diagnosis intervals were greater than 3 months in 20% and 65% of participants, respectively. We present explanatory models for each interval and the interrelationship between the associated factors. The patient interval was longer among women who were single, interpreted their symptoms as not worrisome, concealed symptoms, and perceived a lack of financial resources and the difficulty of missing a day of work as barriers to seek care. These barriers were more commonly perceived among patients who were younger, had lower socioeconomic status, and lived outside of Mexico City. The diagnosis interval was longer among those who used several different health services prior to the cancer hospital and perceived medical errors in these services. More health services were used among those who perceived errors and long waiting times for appointments, and who first consulted private services.
Our findings support the relevance of strengthening early cancer diagnosis strategies, especially the improvement of quality of primary care and expedited referral routes to cancer services.
This study's findings suggest that policy in low- and middle-income countries (LMICs) should be directed toward reducing delays in diagnosis, before the implementation of mammography screening programs. The results suggest several factors susceptible to early diagnosis interventions. To reduce patient delays, the usually proposed intervention of awareness promotion could better work in LMIC contexts if the message goes beyond the advertising of screening mammography to encourage the recognition of potential cancer symptoms and sharing of symptoms with significant others. To reduce diagnosis delay, efforts should focus on strengthening the quality of public primary care services and improving referral routes to cancer care centers.
由于护理时间较长，中低收入国家的大多数乳腺癌患者在晚期才被诊断出来。本研究旨在了解患者就诊间隔和诊断间隔护理中延迟发生的机制。
我们进行了一项横断面调查，包括来自墨西哥城四家主要公立癌症医院的 886 名患者。基于寻求帮助行为的概念模型，采用路径分析策略来确定患者延迟和诊断延迟的解释因素之间的关系。
20%和 65%的参与者的就诊间隔和诊断间隔分别超过 3 个月。我们为每个间隔呈现了解释模型，以及相关因素之间的相互关系。单身、将症状解释为不严重、隐瞒症状、认为缺乏经济资源和因工作而错过一天的工作困难是寻求医疗的障碍的女性，其就诊间隔更长。这些障碍在更年轻、社会经济地位较低和居住在墨西哥城以外的患者中更为常见。在癌症医院之前使用了多种不同的卫生服务，并认为这些服务中存在医疗错误的患者，其诊断间隔更长。在认为有医疗错误、预约等待时间长、首先咨询私人服务的患者中，使用了更多的卫生服务。
我们的研究结果支持加强早期癌症诊断策略的重要性，特别是改善初级保健质量和加快向癌症服务机构转诊的重要性。
本研究结果表明，在实施乳房 X 线筛查计划之前，中低收入国家（LMICs）的政策应针对减少诊断延迟。研究结果表明，有几个因素可能容易受到早期诊断干预的影响。为了减少患者的延迟，通常提出的提高认识的干预措施，如果不仅仅是宣传筛查乳房 X 线摄影以鼓励识别潜在的癌症症状并与重要他人分享症状，那么在 LMIC 环境中可能会更好地发挥作用。为了减少诊断延迟，应努力加强公共初级保健服务的质量，并改善向癌症护理中心转诊的途径。
