乌干达坎帕拉宫颈癌诊疗流程延误的预测因素

Predictors of delay in the cervical cancer care cascade in Kampala, Uganda.

作者信息

Swanson Megan, Ayadi Alison El, Nakalembe Miriam, Namugga Jane, Nakisige Carol, Chen Lee-May, Huchko Megan J

机构信息

University of California, San Francisco.

Makerere University College for Health Sciences School of Medicine.

出版信息

Res Sq. 2024 Dec 18:rs.3.rs-5467551. doi: 10.21203/rs.3.rs-5467551/v1.

DOI:10.21203/rs.3.rs-5467551/v1

PMID:39764093

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11702820/

Abstract

BACKGROUND

Cervical cancer is the fourth most common cancer among women with significant global disparities in disease burden. In lower-resource settings, where routine screening is uncommon, delays in diagnosis and treatment contribute to morbidity and mortality. Understanding care delays may inform strategies to decrease time to treatment, improving patient outcomes.

METHODS

We collected sociodemographic, reproductive health and care journey data from 268 Ugandan women newly diagnosed with cervical cancer. We explored the influence of patient, health provider, system, and disease factors on time to presentation (patient interval), diagnosis (diagnostic interval) and treatment (treatment interval) using survival analysis.

RESULTS

Median patient, diagnostic and treatment intervals were 74 days (IQR 26-238), 83 days (IQR 34-229), and 34 days (IQR 18-58), respectively. Patient interval was delayed by belief that symptoms would resolve (aHR 0.37, 95% CI 0.24-0.57), confusion about where to seek care (aHR 0.64, 95% CI 0.47-0.88), and utilization of traditional care (aHR 0.70, 95% CI 0.51-0.96). Patient interval facilitators included perceiving symptoms as serious (aHR 2.14, 95% CI 1.43-3.19) and suspecting cancer (aHR 1.82, 95% CI 1.12-2.97). Diagnostic interval delays included symptomatic bleeding (aHR 055, 95% CI 0.35-0.85) and visiting > 2 clinics (aHR 0.69, 95% CI 0.49-0.97); facilitators included early-stage disease (aHR 1.41, 95% CI 1.03-1.95) and direct tertiary care presentation (aHR 2.13, 95% CI 1.20-3.79). Treatment interval delays included anticipating long waits (aHR 0.68, 95% CI 0.46-1.02) and requiring blood transfusions (aHR 0.63, 95% CI 0.37-1.07); no facilitators were identified.

CONCLUSIONS

We identified potentially modifiable barriers and facilitators along the cervical cancer care cascade. Interventions targeting these factors may improve care timeliness but are unlikely to significantly improve morbidity or mortality. Expanding cervical cancer screening and vaccination are of utmost importance.

摘要

背景

宫颈癌是全球疾病负担存在显著差异的女性中第四常见的癌症。在资源匮乏地区，常规筛查并不常见，诊断和治疗的延迟导致了发病率和死亡率的上升。了解护理延迟情况可能有助于制定缩短治疗时间的策略，从而改善患者预后。

方法

我们收集了268名新诊断为宫颈癌的乌干达女性的社会人口统计学、生殖健康和就医历程数据。我们使用生存分析探讨了患者、医疗服务提供者、系统和疾病因素对就诊时间（患者间隔）、诊断时间（诊断间隔）和治疗时间（治疗间隔）的影响。

结果

患者、诊断和治疗间隔的中位数分别为74天（四分位间距26 - 238）、83天（四分位间距34 - 229）和34天（四分位间距18 - 58）。患者间隔因认为症状会自行缓解（风险比0.37，95%置信区间0.24 - 0.57）、对就医地点感到困惑（风险比0.64，95%置信区间0.47 - 0.88）以及使用传统治疗方法（风险比0.70，95%置信区间0.51 - 0.96）而延迟。患者间隔的促进因素包括将症状视为严重（风险比2.14，95%置信区间1.43 - 3.19）和怀疑患有癌症（风险比1.82，95%置信区间1.12 - 2.97）。诊断间隔延迟包括有症状性出血（风险比0.55，95%置信区间0.35 - 0.85）和就诊超过2家诊所（风险比0.69，95%置信区间0.49 - 0.97）；促进因素包括疾病处于早期阶段（风险比1.41，95%置信区间1.03 - 1.95）和直接到三级医疗机构就诊（风险比2.13，95%置信区间1.20 - 3.79）。治疗间隔延迟包括预计等待时间长（风险比0.68，95%置信区间0.46 - 1.02）和需要输血（风险比0.63，95%置信区间0.37 - 1.07）；未发现促进因素。