Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
National Cancer Hospital, Vietnam National Cancer Institute, Hanoi, Vietnam.
Cancer Med. 2021 Nov;10(21):7683-7691. doi: 10.1002/cam4.4244. Epub 2021 Oct 19.
Delays in diagnosis and treatment from first noticeable breast cancer symptoms are associated with poor outcomes. Understanding the reasons and barriers for patients' delay in seeking medical care is critical to mitigating the problem.
In-person surveys were conducted among 462 women, aged 18-79, with incident breast cancer cases, recruited from two cancer hospitals in North Vietnam. Delay, defined as the time interval between symptom recognition to the diagnosis and initiation of treatment equal to or exceeding 3 months, was categorized as follows: no delay (<3 months), moderate delay (3-8 months), and serious delay (≥9 months). Multivariable multinomial logistic regression was applied in data analyses.
Over one-quarter patients (31.5%) experienced moderate delays, and close to one-fifth (17.5%) experienced serious delays. Adjusted odds ratios and 95% confidence intervals for moderate and serious delays were 5.60 (3.00-10.47) and 4.25 (2.05-8.85) for financial and physical barriers, respectively. Moderate delay was positively associated with psychological barriers (5.55 [1.75-17.57]) and lack of proper knowledge (3.15 [1.47-6.74]). The associations of barriers with delays in diagnosis and treatment appeared stronger among women living in rural areas. A lack of proper knowledge was significantly associated with delay among young women (<45 years old) and those with high incomes, while psychological barriers were significantly associated with delay among older women (≥45 years old).
Delays in diagnosis and treatment are common among Vietnamese breast cancer patients and are affected by several noted barriers. Proper policy needs to be developed to address this public health issue.
从首次出现乳腺癌症状到开始治疗的时间延迟与不良结局有关。了解患者寻求医疗护理的延迟原因和障碍对于缓解该问题至关重要。
在越南北部的两家癌症医院招募了 462 名年龄在 18-79 岁之间的新发乳腺癌患者进行面对面调查。将延迟定义为从症状识别到诊断和开始治疗的时间间隔等于或超过 3 个月，分为以下几类：无延迟（<3 个月）、中度延迟（3-8 个月）和严重延迟（≥9 个月）。数据分析采用多变量多项逻辑回归。
超过四分之一的患者（31.5%）出现中度延迟，近五分之一（17.5%）出现严重延迟。财务和身体障碍导致中度和严重延迟的调整后比值比（OR）和 95%置信区间（CI）分别为 5.60（3.00-10.47）和 4.25（2.05-8.85）。中度延迟与心理障碍（5.55 [1.75-17.57]）和缺乏适当的知识（3.15 [1.47-6.74]）呈正相关。在农村地区的女性中，障碍与诊断和治疗延迟的关联更为明显。缺乏适当的知识与年轻女性（<45 岁）和高收入女性的延迟显著相关，而心理障碍与年龄较大女性（≥45 岁）的延迟显著相关。
越南乳腺癌患者的诊断和治疗延迟较为常见，受到多种已知障碍的影响。需要制定适当的政策来解决这一公共卫生问题。
