Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Medicine, Division of Critical Care, University of British Columbia, Vancouver, British Columbia, Canada.
Cancer. 2021 May 1;127(9):1432-1438. doi: 10.1002/cncr.33394. Epub 2020 Dec 28.
The majority of women in Nigeria present with advanced-stage breast cancer. To address the role of geospatial access, we constructed a geographic information-system-based model to evaluate the relationship between modeled travel time, stage at presentation, and overall survival among patients with breast cancer in Nigeria.
Consecutive patients were identified from a single-institution, prospective breast cancer database (May 2009-January 2019). Patients were geographically located, and travel time to the hospital was generated using a cost-distance model that utilized open-source data. The relationships between travel time, stage at presentation, and overall survival were evaluated with logistic regression and survival analyses. Models were adjusted for age, level of education, and socioeconomic status.
From 635 patients, 609 were successfully geographically located. The median age of the cohort was 49 years (interquartile range [IQR], 40-58 years); 84% presented with ≥stage III disease. Overall, 46.5% underwent surgery; 70.8% received systemic chemotherapy. The median estimated travel time for the cohort was 45 minutes (IQR, 7.9-79.3 minutes). Patients in the highest travel-time quintile had a 2.8-fold increase in the odds of presenting with stage III or IV disease relative to patients in the lowest travel-time quintile (P = .006). Travel time ≥30 minutes was associated with an increased risk of death (HR, 1.65; P = .004).
Geospatial access to a tertiary care facility is independently associated with stage at presentation and overall survival among patients with breast cancer in Nigeria. Addressing disparities in access will be essential to ensure the development of an equitable health policy.
在尼日利亚，大多数女性患有晚期乳腺癌。为了探讨地理空间可达性的作用，我们构建了一个基于地理信息系统的模型，以评估尼日利亚乳腺癌患者的模型旅行时间、就诊时的分期与总生存之间的关系。
我们从一个单机构前瞻性乳腺癌数据库（2009 年 5 月至 2019 年 1 月）中连续确定患者。使用利用开源数据的成本距离模型对患者进行地理定位并生成旅行时间。使用逻辑回归和生存分析评估旅行时间、就诊时的分期和总生存之间的关系。模型调整了年龄、教育水平和社会经济地位。
从 635 名患者中，成功定位了 609 名患者。队列的中位年龄为 49 岁（四分位距 [IQR]，40-58 岁）；84%的患者就诊时患有≥III 期疾病。总体而言，46.5%的患者接受了手术；70.8%的患者接受了全身化疗。该队列的中位估计旅行时间为 45 分钟（IQR，7.9-79.3 分钟）。与旅行时间最短的五分位数组患者相比，旅行时间最长的五分位数组患者就诊时患有 III 期或 IV 期疾病的几率增加了 2.8 倍（P =.006）。旅行时间≥30 分钟与死亡风险增加相关（HR，1.65；P =.004）。
在尼日利亚，获得三级保健机构的地理空间可达性与乳腺癌患者的就诊时的分期和总生存独立相关。解决可达性方面的差异对于确保制定公平的卫生政策至关重要。
