肯尼亚乳腺癌的延迟就诊、诊断和治疗。
Delayed breast cancer presentation, diagnosis, and treatment in Kenya.
机构信息
Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya.
African Caribbean Cancer Consortium, Philadelphia, USA.
出版信息
Breast Cancer Res Treat. 2023 Dec;202(3):515-527. doi: 10.1007/s10549-023-07067-y. Epub 2023 Sep 5.
PURPOSE
In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital.
METHODS
Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment.
RESULTS
The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings (equivalent to ~ $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had ≥ 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, and healthcare practitioner misdiagnosis and/or strikes delayed patient diagnosis and treatment.
CONCLUSIONS
BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.
目的
本混合方法研究旨在评估肯尼亚某医院导致乳腺癌（BC）诊断和治疗延迟的因素。
方法
通过便利抽样，招募了被诊断为 BC 的个体（无论是转诊患者还是首发患者）参与本研究。收集了患者的社会人口统计学、健康史和癌症史、在肯雅塔国家医院（KNH）的诊断和治疗数据。为了进行定量分析，我们使用回归分析，按症状发作时间分层，检查了社会人口统计学和健康史因素与诊断时的分期、诊断前就诊次数、诊断时间和初始干预时间之间的关系。为了进行定性分析，对每 5 名患者中的第 5 名进行了深入访谈，以评估诊断和治疗延迟的原因。
结果
最终的分析样本包括 378 名平均年龄为 50 岁的女性 BC 患者。这些女性的社会经济地位普遍较低：49.2%的人仅接受过小学或以下教育，57.4%失业，大多数（74.6%）家庭月收入低于 5000 肯尼亚先令（相当于约 41 美元）。从 BC 症状出现到 KNH 就诊的中位时间为 13（IQR=3-36）周，从就诊到诊断的中位时间为 17.5（IQR=7-36.5）周，从诊断到接受初始干预的中位时间为 6（IQR=3-13）周。从未/未婚、受教育程度较低、较贫困、使用激素避孕药具和有≥3个孩子的女性 BC 患者更有可能经历诊断和治疗延迟。定性数据显示，经济限制、患者对 BC 的缺乏认识以及医疗保健提供者的误诊和/或罢工导致了患者的诊断和治疗延迟。
结论
BC 患者在诊断和治疗前经历了漫长的医疗保健系统延迟。教育社区和提供者了解 BC 并加快转诊可能会最大限度地减少这种延迟，并随后降低肯尼亚的 BC 死亡率。
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