巴基斯坦卡拉奇两家医院乳腺癌诊断中的患者延误：需要采取预防和挽救生命的措施。
Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed.
作者信息
Shamsi Uzma, Khan Shaista, Azam Iqbal, Usman Shaheryar, Maqbool Amir, Gill Tiffany, Iqbal Romaina, Callen David
机构信息
Adelaide Medical School, University of Adelaide, Adelaide, Australia.
Department of Surgery, Aga Khan University, Karachi, Pakistan.
出版信息
JCO Glob Oncol. 2020 Jun;6:873-883. doi: 10.1200/GO.20.00034.
PURPOSE
Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.
METHODS
Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.
RESULTS
The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months.
CONCLUSION
Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.
目的
巴基斯坦的乳腺癌患者通常在疾病晚期才前来就诊。本研究的目的是评估寻求医疗咨询的延迟频率和时长，并评估与之相关的因素。
方法
2015年2月至2017年8月期间，招募并访谈了499例新诊断的乳腺癌患者。通过面对面访谈和查阅医疗档案，收集了社会人口学因素、寻求医疗咨询的延迟情况、就诊时乳腺癌的分期以及乳腺癌的肿瘤特征等信息。
结果
乳腺癌患者的平均（标准差）年龄为48.0（12.3）岁。患者的平均（标准差）延迟时间为15.7（25.9）个月，55.2%的女性发现乳房肿块但因对肿块的重要性缺乏认识而未寻求医疗咨询。共有9.4%的女性最初决定使用补充和替代医学及传统疗法进行治疗；9.4%的女性乳房有肿块时前往医疗服务提供者处就诊，但未采取任何措施，她们在未进行乳房X光检查或活检的情况下被错误地告知肿块无害。对于26%的女性来说，就诊延迟是由对诊断和治疗的焦虑、恐惧和误解以及其他社会因素（包括对其与丈夫关系可能产生的不利影响）导致的。多变量分析显示，社会经济地位较低（比值比[OR]，8.11[95%可信区间，2.46至26.69]）和乳腺癌晚期（OR，4.83[95%可信区间，1.74至13.39]）与患者延迟≥3个月密切相关。
结论
在巴基斯坦，患者延迟是一个严重问题。迫切需要开展深入全面的乳腺癌教育，以消除与乳腺癌相关的误解和错误观念。
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