School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
The Daffodil Centre, University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
JCO Glob Oncol. 2024 Aug;10:e2400095. doi: 10.1200/GO.24.00095.
Longer time between breast cancer (BC) diagnosis and treatment initiation is associated with poorer survival, and this may be a factor behind disparities in global survival rates. We assessed time to BC treatment in the Kathmandu Valley, Nepal, including factors associated with longer waiting times and their impact on survival.
We conducted a retrospective population-based study of BC cases recorded in the Kathmandu Valley Population-Based Cancer Registry between 2018 and 2019. Fieldwork survey through telephone was undertaken to collect additional sociodemographic and clinical information. Logistic regression was performed to identify factors associated with longer time to treatment, and Kaplan-Meier and Cox proportional hazard regression was used to examine survival time and evaluate the association between longer time to treatment and survival.
Among the 385 patients with BC, one third waited >4 weeks from diagnosis to initial treatment. Lower education was associated with longer time to treatment (adjusted odds ratio, 1.63 [95% CI, 1.03 to 2.60]). The overall 3-year survival rate was 88.6% and survival was not associated with time to treatment ( = .50). However, advanced stage at diagnosis was associated with poorer survival (adjusted hazard ratio, 4.09 [95% CI, 1.27 to 13.23]). There was some indication that longer time to treatment was associated with poorer survival for advanced-stage patients, but data quality limited that analysis.
In the Kathmandu Valley, Nepal, women with a lower education tend to wait longer from BC diagnosis to treatment. Patients with advanced-stage BC had poorer survival, and longer waiting time may be associated with poorer survival for women diagnosed with advanced-stage disease.
乳腺癌（BC）诊断与治疗开始之间的时间间隔较长与生存率较差相关，这可能是全球生存率差异的一个因素。我们评估了尼泊尔加德满都谷地的 BC 治疗时间，包括与较长等待时间相关的因素及其对生存率的影响。
我们对 2018 年至 2019 年期间在加德满都谷地基于人群的癌症登记处记录的 BC 病例进行了回顾性基于人群的研究。通过电话进行实地工作调查，以收集额外的社会人口统计学和临床信息。进行逻辑回归以确定与治疗时间延长相关的因素，并使用 Kaplan-Meier 和 Cox 比例风险回归来检查生存时间，并评估治疗时间延长与生存之间的关联。
在 385 例 BC 患者中，有三分之一的患者从诊断到初始治疗等待时间超过 4 周。较低的教育程度与治疗时间延长相关（调整后的优势比，1.63 [95%CI，1.03 至 2.60]）。总体 3 年生存率为 88.6%，且生存率与治疗时间无关（ =.50）。然而，诊断时的晚期阶段与生存率较差相关（调整后的危险比，4.09 [95%CI，1.27 至 13.23]）。有一些迹象表明，治疗时间延长与晚期患者的生存率较差相关，但数据质量限制了该分析。
在尼泊尔加德满都谷地，受教育程度较低的女性往往从 BC 诊断到治疗的时间间隔较长。患有晚期 BC 的患者生存率较差，且较长的等待时间可能与晚期疾病患者的生存率较差相关。
