Delays on Treatment and Associated Factors in a Cohort of Women Diagnosed With Breast Cancer in Rio De Janeiro, Brazil

Abstract

Background: The majority of breast cancer death occurs in developing countries. Mortality reductions achieved in the last decades in developed countries have not been reached in developing countries mainly because of a lack of access to early medical attention and delays on treatment. There are very few research studies on the reasons behind delayed medical attention for breast cancer in women in developing countries. Aim: To estimate the treatment delay, and associated factors, among women diagnosed with breast cancer treated on the National Cancer Institute in Rio de Janeiro, Brazil. Methods: A retrospective study on a cohort of 3220 women newly diagnosed with breast cancer between 2011 and 2013 was accomplished. Times from diagnose to treatment initiation were analyzed according to the Brazilian law for cancer patient treatment (≤ 60 > days). Association between sociodemographic, life style, clinical and treatment variables, and delays on treatment were estimated using X2-test and logistic regression model, with 95% confidential interval. Results: Over 50% of women was 50-69 years old, white (50.5%), presented early stage at diagnosis (63.8%), and refereed from public health service (76.9%). From those who had a histopathological diagnosis on the first visit at NCI (N=2,554), median time from diagnose to 1st treatment was 108 days, varying from 97 days (stage T0-2N>1-X/T3-4N0/X) to 133 days (stage Tis). Among those, prevalence of treatment delay was 89.1%; time interval > 30 days from diagnosis and 1st visit at NCI (OR=29.84; CI: 19.80-44.97) and age (50-69: OR=1.61; CI: 1.24-2.11, ≥70 years: OR=1.91; CI: 1.27-2.89) were statistically associated with treatment delay; while high education (OR=0.31; CI: 0.13-0.73) and late stage at diagnosis (OR=0.63; CI: 0.49-0.80) were negatively associate with treatment delay. Among those who arrived without diagnosis (n=666), prevalence of treatment delay was 34.7%. Considering the whole cohort (N=3220) age ≥70 years old (OR=1.42; 1.04-1.94), living outside Rio city (OR=1.53; 1.26-1.87), and chemotherapy (OR=1.44; 1.06-1.95) were positively associated with delay; while college education (OR=0.73; 0.57-0.94) and late stage (OR=0.71; 0.53-0.96) were negatively associated with treatment delay. Conclusion: Increased breast cancer treatment delay was observed among women who arrived with histopathological diagnosis. Time interval from diagnosis on the 1st visit at cancer center was the main factor associated to treatment delay, followed by old age; while high education level and late stage at diagnosis were negatively associated with treatment delays. Considering the whole cohort, old age, living outside Rio and chemotherapy were positively associated to delays on treatment, while college education level and late stage were negatively associated with treatment delay.