Abstract
Timely care is essential to increase breast cancer survival. However, patients in Ethiopia still face multilevel barriers on their pathway to timely treatment initiation. This cross-sectional study at Tikur Anbessa Specialized Hospital Oncology Unit in Addis Ababa assessed systemic treatment initiation intervals of breast cancer patients and quantified the impact of socio-demographic and clinical factors, perceived barriers, and the patients´ perceived social support status on timely systemic treatment initiation (chemotherapy or hormonal therapy). A structured questionnaire was designed based on Pechansky´s "Concept of Access". Applying simple and multivariate logistic regression we analysed the influence of patients´ characteristics as well as their perceived barriers on timely treatment initiation. We measured social support with the Multidimensional Score of Perceived Social Support (MSPSS) and used the Wilcoxon Rank-Sum Test to assess its relationship with timely treatment initiation. Of 196 patients included into the study, 53% received systemic treatment within 90 days of their pathological diagnosis-the median treatment initiation interval was 85 days (IQR 123.5). Older women and patients diagnosed at late stages had higher odds of timely treatment initiation. Not being able to pay for services and lack of transport were most often perceived as barriers towards timely care. However, none of the perceived barriers showed a substantial influence on timely treatment initiation in the multivariate regression model. The patients´ perceived social support was found to be high, with an average MSPSS score of 73 out of 84 (SD 13,63). No impact of the perceived social support status on timely treatment initiation was found. The percentage of breast cancer patients waiting longer than 90 days from pathological diagnosis to systemic treatment initiation in Ethiopia remains unacceptably high. While women generally feel well supported by their social environment, costs and accessibility of treatment are perceived to be major barriers towards timely treatment initiation.
Highlights
Breast cancer is the most frequent cancer in women in Sub-Saharan Africa (SSA) [1] and is becoming a major health burden, as life expectancy, reproductive patterns and lifestyles are changing [2]
Women with breast cancer at Tikur Anbessa Specialized Hospital Oncology Unit felt highly supported by their social environment, we could not find an association between social support and timely treatment initiation
While we could not find a correlation between perceived barriers and timely treatment initiation, the findings show the strong influence of the socio-economic status on timely treatment initiation in countries where treatment-costs are being paid out-of-pocket [21]
Summary
Breast cancer is the most frequent cancer in women in Sub-Saharan Africa (SSA) [1] and is becoming a major health burden, as life expectancy, reproductive patterns and lifestyles are changing [2]. Survival rates differ significantly between low- or middle-income and high-income countries [3]. This has been largely attributed to late stages at diagnosis and extended intervals until treatment initiation in countries with high cancer mortality [3]. In the US, studies found a two-fold increased risk of mortality from breast cancer for women with low levels of social integration and lower odds of treatment initiation for socially isolated women [4, 5]
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