与乌干达癌症研究所就诊的乳腺癌患者的诊断和治疗前间隔相关的因素：一项横断面研究。

Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute: A cross-sectional study.

机构信息

Department of Community Health & Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Department of Public Health, School of Health Sciences, Soroti University, Soroti, Uganda.

出版信息

Cancer Med. 2023 Oct;12(19):19701-19713. doi: 10.1002/cam4.6618. Epub 2023 Oct 3.

DOI:10.1002/cam4.6618

PMID:37787090

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10587984/

Abstract

BACKGROUND

Most breast cancer (BC) patients in Uganda are diagnosed with advanced-stage disease and experience poor outcomes. This study examined the diagnostic and pre-treatment intervals and factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI).

METHODS

This was a cross-sectional, facility-based study. Data were collected using structured questionnaire administered by trained research assistants and analyzed using STATA version 14.0. Modified Poisson regressions models were used to determine the strength of associations between independent variables and diagnostic and pre-treatment intervals.

RESULTS

The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140) stage IV cancers. The median interval from first consultation to diagnosis, i.e. diagnostic interval (DI) was 5.6 months (IQR: 1.5-17.0), while the median interval from histological diagnosis to start of chemotherapy, i.e. pre-treatment interval (PTI) was 1.7 months (IQR: 0.7-4.5). Majority (85%, n = 341) of participants were diagnosed at ≥3 months from first consultation with clinicians. Participants with tertiary education and those who lived within 100-199 km from the UCI were about four times and twice more likely to be diagnosed early (DI <3 months from first consultation) ([aPR = 3.88; 95% CI: 1.15-13.0] and [aPR = 2.19; 95% CI: 1.06-4.55]), respectively. About half (48.3%; n = 176) of participants started chemotherapy within 1 month of cancer diagnosis. Patients who lived more than 300 km from the UCI were less likely to start chemotherapy within 1 month of histology diagnosis of cancer. [Correction added on October 17, 2023 after first online publication. The term ', i.e.' has been included in the results section in this version.] CONCLUSION: Majority of breast cancer patients are diagnosed late and in advanced stages. There is need to promote all efforts toward timely diagnosis when cancers are still in early stages by identifying factors responsible for prolonged diagnostic intervals among breast cancer patients.

摘要

背景

乌干达大多数乳腺癌（BC）患者被诊断为晚期疾病，治疗效果不佳。本研究旨在探讨在乌干达癌症研究所（UCI）就诊的 BC 患者的诊断前间隔和治疗前间隔及其相关因素。

方法

这是一项横断面、基于医疗机构的研究。研究数据通过训练有素的研究助理使用结构化问卷收集，并使用 STATA 版本 14.0 进行分析。采用修正泊松回归模型确定自变量与诊断前间隔和治疗前间隔之间的关联强度。

结果

401 名参与者的平均年龄（±SD）为 47.1±11.7 岁。四分之一的患者为 III 期（41.9%，n=168），超过三分之一（34.7%，n=140）为 IV 期癌症。从首次就诊到诊断的中位间隔，即诊断间隔（DI）为 5.6 个月（IQR：1.5-17.0），从组织学诊断到开始化疗的中位间隔，即治疗前间隔（PTI）为 1.7 个月（IQR：0.7-4.5）。大多数（85%，n=341）患者在首次就诊后≥3 个月才被诊断出患有疾病。具有高等教育背景和居住在 UCI 方圆 100-199 公里内的患者，早期诊断（DI＜3 个月）的可能性分别是其他患者的约四倍和两倍多（aPR=3.88；95%CI：1.15-13.0 和 aPR=2.19；95%CI：1.06-4.55）。约一半（48.3%，n=176）的患者在癌症诊断后 1 个月内开始化疗。居住在 UCI 300 公里以上的患者，在癌症组织学诊断后 1 个月内开始化疗的可能性较小。