Cancer Research Malaysia, Subang Jaya, Malaysia.
Kementerian Kesihatan Malaysia (Hospital Tengku Ampuan Rahimah, Klang), Klang, Malaysia.
BMC Health Serv Res. 2023 Mar 1;23(1):206. doi: 10.1186/s12913-023-09046-x.
Improving help-seeking behaviour is a key component of down-staging breast cancer and improving survival, but the specific challenges faced by low-income women in an Asian setting remain poorly characterized. Here, we determined the extent of help-seeking delay among Malaysian breast cancer patients who presented at late stages and explored sub-groups of women who may face specific barriers.
Time to help-seeking was assessed in 303 women diagnosed with advanced breast cancer between January 2015 and March 2020 at a suburban tertiary hospital in Malaysia. Two-step cluster analysis was conducted to identify subgroups of women who share similar characteristics and barriers. Barriers to help-seeking were identified from nurse interviews and were analyzed using behavioural frameworks.
The average time to help-seeking was 65 days (IQR = 250 days), and up to 44.5% of women delayed by at least 3 months. Three equal-sized clusters emerged with good separation by time to help-seeking (p < 0.001). The most reported barrier across clusters was poor knowledge about breast health or breast cancer symptoms (36.3%), regardless of help-seeking behaviour (p = 0.931). Unexpectedly, women with no delay (9 days average) and great delay (259 days average) were more similar to each other than to women with mild delays (58 days average), but, women who experienced great delay reported poor motivation due to fear and embarrassment (p = 0.066) and a lack of social support (p = 0.374) to seek help.
Down-staging of breast cancer in Malaysia will require a multi-pronged approach aimed at modifying culturally specific social and emotional barriers, eliminating misinformation, and instilling motivation to seek help for breast health for the women most vulnerable to help-seeking delays.
改善寻求帮助的行为是降低乳腺癌分期和提高生存率的关键组成部分，但在亚洲环境中，低收入女性所面临的具体挑战仍未得到充分描述。在这里，我们确定了在马来西亚一家郊区三级医院就诊的晚期乳腺癌患者中寻求帮助的延迟程度，并探讨了可能面临特定障碍的女性亚组。
在马来西亚一家郊区三级医院就诊的 303 名患有晚期乳腺癌的女性中，评估了从确诊到寻求帮助的时间。采用两步聚类分析确定具有相似特征和障碍的女性亚组。从护士访谈中确定寻求帮助的障碍，并使用行为框架进行分析。
平均寻求帮助的时间为 65 天（IQR=250 天），多达 44.5%的女性延迟了至少 3 个月。通过时间来寻求帮助，可以明显将三个大小相等的聚类分开（p<0.001）。无论寻求帮助的行为如何，报告最多的障碍是对乳房健康或乳腺癌症状的了解不足（36.3%）（p=0.931）。出乎意料的是，没有延迟（平均 9 天）和严重延迟（平均 259 天）的女性彼此之间比轻度延迟（平均 58 天）的女性更为相似，但是经历严重延迟的女性由于恐惧和尴尬而缺乏寻求帮助的动机（p=0.066），并且缺乏社会支持（p=0.374）。
要在马来西亚降低乳腺癌的分期，需要采取多管齐下的方法，旨在改变特定于文化的社会和情感障碍，消除错误信息，并激发最容易出现寻求帮助延迟的女性寻求乳房健康帮助的动机。
