Abstract
BackgroundLittle information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered.MethodsRecords of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster.ResultsTwo hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02–2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73–11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15–0.95, p < 0.05), while there were no variables associated with delay pre-disaster.ConclusionsThe triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster.
Highlights
Little information is available concerning how patient delay may be affected by mass disasters
The objectives of the present study are to identify 1) whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients, and 2) whether any of the following factors were associated with post-disaster patient delay: sociodemographic factors, access to medical institutions, and psychosocial stress
Because this study focused on the period before a confirmatory diagnosis, we included patients who were later referred to other academic institutions or cancer centers after a pathological diagnosis of breast cancer in the two study hospitals
Summary
Little information is available concerning how patient delay may be affected by mass disasters. A considerable proportion of patients seek medical consultation only after they notice symptoms, such as a breast lump [2]. The above literature highlights the importance of accounting for the social contexts patients inhabit, in order to fully understand the causes of patient delay. This is a difficult point to accomplish given that social contexts can change over time; previous studies have not addressed potential relationships between these changes and patient delay [4, 5, 8, 9]. Mass disasters provide a unique opportunity to assess how rapidly-changing social contexts may impact patient delay, as they can simultaneously disintegrate social connections of victims and access to medical institutions, while exposing disaster victims to high levels of stress [10,11,12,13]
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