Abstract
Background: Breast cancer can be invasive and advanced at diagnosis causing enormous suffering and premature death. Delay to stage diagnosis and treatment is related to survival evaluation and several factors determine delay. The aim of the study was to examine predictor covariates associated with breast cancer delay and its impact on patient prognosis and survival. Methods: This retrospective cross-sectional hospital-based study was carried out at Khartoum Oncology Hospital. Participants were 411 breast cancer patients diagnosed and treated during the period 2016. Patients’ pathological and socio-demographic data were extracted from their medical files and delay data from telephone questionnaire survey and survival times calculated from follow-up. Fisher exact test, Cox and Logistic regression models were used to examine relationships between demographic, clinical and delay variables and survival outcome. Results: The mean age of the study subjects was 50.07 years old and the majority were ≥45 years. Cancer delay analysis showed that there were different reasons for different types of delay but the majority of participants (86.2%) claimed fear of the disease and treatment and lack of information were real drivers of delay. The study confirmed the majority of participants expressed long delay estimated at 28.3 weeks and patient delay had a significant association with the advanced stage (P-value<0.05). The hazard ratio was four times for risk of dying from cancer for long delay compared to the short one. Conclusion: The results of the study suggest delays at diagnosis and treatment are more common steps leading to advanced stage at diagnosis and poor survival. Early detection of the disease provides tremendous opportunities for early diagnosis, effective treatment and high chances of survival.
Highlights
Cancer is a major public health problem worldwide, in low- and middle-income countries due to the aging population as well as wider social and environmental factors such as infectious disease, education and ethnicity.[1]
In Sudan, cancer can be described as of advanced stage at diagnosis and there is a noticeable delay at Khartoum Oncology Hospital (KOH), Khartoum, and National Cancer Institute (NCI), Wad Medani, central of Sudan, because patients come from all over the country, travelling long distance looking for medical care.[4]
Breast cancer patients peak at an age less than 50 years old and the majority are diagnosed at an advanced stage with invasive ductal carcinoma leading to poor survival.[7]
Summary
Cancer is a major public health problem worldwide, in low- and middle-income countries due to the aging population as well as wider social and environmental factors such as infectious disease, education and ethnicity.[1]. In Sudan, according to KOH annual statistics, breast cancer represents more than 36% of all cancers in women in 2016 and is increasing steadily and remains the most important type of cancer This alarming increase in breast cancer was attributed to changes in demography, economic and social factors, other disease factors and disease awareness.[6] Breast cancer patients peak at an age less than 50 years old (premenopausal) and the majority are diagnosed at an advanced stage with invasive ductal carcinoma leading to poor survival.[7]. The study confirmed the majority of participants expressed long delay estimated at 28.3 weeks and patient delay had a significant association with the advanced stage (P-value
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