Uganda Cancer Institute, Kampala, Uganda.
African Palliative Care Association, Entebbe, Uganda.
Afr Health Sci. 2022 Mar;22(1):327-337. doi: 10.4314/ahs.v22i1.40.
Cancer represents a growing public health concern. Late-stage at diagnosis, limited access to effective treatment, and loss to follow-up are responsible for dismal outcomes.
To describe care pathways, turnaround times, and identify barriers to timely initiation of cancer treatment.
Using a sequential mixed-methods design involving focus group discussions, we followed up 50 participants between January, and June 2018. We computed the median observed turnaround time to treatment (TTT) at each care step and reported delay as deviations from the proposed ideal turnaround times.
The ideal TTT with either chemotherapy, or radiotherapy, or surgery was 8, 14, and 21 days respectively. At a median follow-up time of 35.5 days (IQR 17-66), only 29 of the 50 study participants had completed all steps between registration and initiation of treatment, and the observed median TTT was 16 days (9 - 22 days) for chemotherapy, and 30 days (17 - 49 days) for radiotherapy, reflecting a significant delay (p-value = 0.017). Reported barriers were; shortage of specialists, patients required visits to outside facilities for staging investigations, prohibitive costs, poor navigation system and time wastage.
When compared to the recommended ideal turnaround time, there was significant institutional delay in access to chemotherapy and radiotherapy attributed to multiple external and internal healthcare system barriers.
癌症是一个日益严重的公共卫生问题。诊断时已处于晚期、获得有效治疗的机会有限以及随访失败是导致预后不良的原因。
描述癌症治疗的护理路径、周转时间，并确定及时开始癌症治疗的障碍。
采用序贯混合方法设计，包括焦点小组讨论，我们在 2018 年 1 月至 6 月期间对 50 名参与者进行了随访。我们计算了每个护理步骤的治疗（TTT）的中位数观察周转时间，并报告了与建议的理想 TTT 偏差的延迟。
理想的化疗、放疗或手术的 TTT 分别为 8、14 和 21 天。在中位随访时间为 35.5 天（IQR 17-66）时，仅有 50 名研究参与者中的 29 名完成了注册到开始治疗之间的所有步骤，观察到的中位数 TTT 为 16 天（9-22 天）化疗和 30 天（17-49 天）放疗，这反映出明显的延迟（p 值=0.017）。报告的障碍包括：专家短缺、患者需要到外部机构进行分期检查、费用过高、导航系统差和时间浪费。
与推荐的理想 TTT 相比，由于多种内外医疗系统障碍，在获得化疗和放疗方面存在显著的机构延迟。
