Abstract
Describe the surgical pathway and identify the different waiting times to surgery of women with a breast cancer in the Gynecology Department of the University Hospital of Sousse in Tunisia. It is a descriptive prospective study based on an assessment of professional practices using the process approach method. The study focused on the surgical management of women with breast cancer followed and scheduled for surgical treatment.The data were collected using a data collection sheet, developed according to a literature review. The sample consisted of 77 women. Ten waiting times have been calculated. Global time to first treatment (surgical treatment) was 78.5days with an interquartile range (IIQ) of [55.5-113.25days]. The information period was 10days with an IIQ of 3-19days. The global time of access to surgery was 43.5days with an IIQ of 40-54.75. Delays in access to care appear to be a potential marker of inequalities in access to care and an indicator of the performance of the healthcare system and can influence patient prognosis. The reduction of these delays must be integrated into a continuous quality improvement approach.
Highlights
Cancer constitutes an enormous burden on society in both more and less economically developed countries and becomes the second leading cause of death in the world [1]
Delays in access to care appear to be a potential marker of inequalities in access to care and an indicator of the performance of the health care system and can influence patient prognosis. The reduction of these delays must be integrated into a continuous quality improvement approach. To our knowledge this is the first study in Tunisia to investigate step by step the surgical pathway of women with breast cancer
This is the first study to analyze the global and the different waiting times to surgical treatment of women with breast cancer at the same time, making it possible to identify any malfunctions that occur during this process and to investigate the causes
Summary
Cancer constitutes an enormous burden on society in both more and less economically developed countries (respectively MEDCs and LEDCs) and becomes the second leading cause of death in the world [1]. About one in six deaths is due to cancer [2,3]. Breast cancer is the most common cancer diagnosed in women worldwide and is the major cause of cancer death among this group [2,3], making it a global public health issue. In Tunisia, breast cancer is the leading cancer in women representing 30% of all female cancers. Its incidence in 2017 is estimated at 50.17/100000 persons years, and is still increasing on rise and the diagnosis is still made late [4]. The average clinical tumor size at the time of diagnosis exceeds 4 cm with an average consultation time of six months. More than half of the women are diagnosed at a locally advanced (40%) or metastatic stage (15%), resulting in a poor outcome in terms of survival [5,6]
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