Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa.
Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, Cape, Town, South Africa.
BMC Cancer. 2018 Mar 21;18(1):312. doi: 10.1186/s12885-018-4219-7.
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.
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.
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).
The Model of Pathways to Treatment provides a useful framework to explore patient's journeys to care and identified opportunities for targeted interventions.
通常情况下，南非的女性在出现症状后自行到医疗机构就诊时才被诊断出患有乳腺癌。本研究旨在确定女性接受乳腺癌治疗的途径以及与这一过程相关的因素。
2015 年 5 月至 2016 年 5 月，在西开普省的一家三级医院进行了一项横断面研究。对新确诊的乳腺癌患者进行访谈，以确定其社会人口统计学特征、对危险因素、体征和症状的认识、乳房变化的评估、临床特征以及治疗过程中的关键时间事件。该研究以治疗途径模型为分析框架。从女性首次注意到乳房变化到预定治疗日期的总时间（TT）分为三个区间：患者区间（PI）、诊断区间（DI）和治疗前区间（PTI）。对于 PI、DI 和 PTI，通过 Wilcoxon 秩和检验和 Kruskal-Wallis 检验对不同特征的中位数时间间隔进行了双变量比较。使用 Cox 比例风险模型来确定与 PI、DI 和 PTI 独立相关的因素。
201 名参与者的中位年龄为 54 岁，22%为晚期疾病。中位 TT 为 110 天，患者、诊断和治疗前的中位数分别为 23、28 和 37 天。与 PI 相关的因素包括：年龄较大（风险比（HR）0.59，95%置信区间 0.40-0.86）、初始症状否认（HR 0.43，95%置信区间 0.19-0.97）和等待肿块增大后再寻求治疗（HR 0.51，95%置信区间 0.33-0.77）。患有合并症的女性 DI 显著延长（HR 0.67，95%置信区间 0.47-0.96），而提到否认初始乳房症状的女性（HR 4.61，95%置信区间 1.80-11.78）也是如此。PTI 与就诊时的晚期疾病有关（HR 1.78，95%置信区间 1.15-2.76）。
治疗途径模型为探索患者接受治疗的途径提供了一个有用的框架，并确定了有针对性干预的机会。
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