Department of Physician Assistant Studies, Saint Catherine's University, St Paul, MN.
Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands.
JCO Glob Oncol. 2021 Sep;7:1500-1508. doi: 10.1200/GO.21.00253.
Cancer is a growing problem in Africa, and delays in receiving timely cancer care often results in poorer outcomes. The purpose of this study was to identify the patient and health-system factors associated with delayed cancer care in adults living in the Northern Zone of Tanzania.
Between July 2018 and July 2019, we surveyed adult patients presenting to an oncology clinic in Northern Tanzania. Delayed presentation was defined as 12 weeks or longer from initial symptoms to presentation for cancer care. Multivariate logistic regression and adjusted relative risk (aRR) were used to identify factors predicting delayed presentation.
Among 244 adult patients with cancer who completed the survey, 78% (n = 191) had delayed presentation. Patient-related factors associated with delayed presentation included lower educational attainment ( = .03), increased travel time ( = .05), lack of cancer knowledge ( < .05), and fear of cancer and cancer treatments ( < .05) on multivariate analysis. On analysis of aRR, patients without private car and those with health insurance had higher risk of delayed presentation (aRR: 1.27; 95% CI, 1.02 to 1.32 and aRR: 1.15; 95% CI, 1.01 to 1.32). There was a strong association with increased number of visits before presentation at the cancer center and delayed presentation ( = .0009).
Cancer awareness and prevention efforts targeting patients and community-level health care workers are key to reduce delays in cancer care in Northern Tanzania.
癌症在非洲是一个日益严重的问题，癌症患者往往因延迟获得及时的治疗而导致预后较差。本研究旨在确定坦桑尼亚北部地区成年癌症患者延迟获得癌症治疗的患者和卫生系统相关因素。
2018 年 7 月至 2019 年 7 月，我们对坦桑尼亚北部一家肿瘤诊所的成年癌症患者进行了调查。延迟就诊定义为从最初症状出现到就诊接受癌症治疗的时间超过 12 周。我们采用多变量逻辑回归和调整后的相对风险（aRR）来确定预测延迟就诊的因素。
在 244 名完成调查的成年癌症患者中，78%（n = 191）存在延迟就诊。患者相关因素与延迟就诊有关，包括受教育程度较低（ <.03）、旅行时间延长（ <.05）、缺乏癌症知识（ <.05）以及对癌症和癌症治疗的恐惧（ <.05）。分析 aRR 发现，没有私家车和有医疗保险的患者延迟就诊的风险更高（aRR：1.27；95%CI，1.02 至 1.32 和 aRR：1.15；95%CI，1.01 至 1.32）。在癌症中心就诊前的就诊次数与延迟就诊呈强相关（ =.0009）。
针对患者和社区卫生保健工作者的癌症意识和预防工作对于减少坦桑尼亚北部癌症治疗的延误至关重要。
