Presentation, Diagnosis, and Treatment Among Patients With Breast Cancer in Malaysia

Abstract

Purpose Breast cancer is the most common form of cancer among women in Malaysia. Although there is a scarcity of data on the relation between delays and survival, it is generally accepted that optimum outcomes are dependent on the early detection and adherence to treatment. This study was conducted to evaluate the time intervals and associated factors with delays in presentation, diagnosis, and treatment among patients with breast cancer who attended public hospitals in Malaysia. Methods A retrospective cohort study was conducted in six public hospitals involving all patients with newly diagnosed breast cancer from January 1, 2012, to December 31, 2012. Data were collected through review of medical records and interviews using a structured questionnaire. Presentation delay was defined as time taken from the discovery of symptoms to the first presentation at primary care of more than 3 months. Diagnosis delay was defined as time taken from the first presentation to diagnosis disclosure of more than 1 month, and treatment delay was defined as time taken from diagnosis disclosure to initial treatment of more than 1 month. We used univariable logistic regression and multiple logistic regressions for analysis. A total of 340 patients with breast cancer were included in the study. Median times for presentation, diagnosis, and treatment were 2.4 months, 26 days, and 21 days, respectively. The presentation delay rate was 35%, and the factors associated with it were location (Kelantan: odds ratio [OR], 4.78) and use of complementary and alternative medicine (OR, 1.67). The diagnosis delay rate was 41.8%, and the factors associated with it were symptoms without lump (OR, 1.98), undergoing two or more biopsies (OR, 3.02), and surgical biopsy (OR, 2.56). Meanwhile, the treatment delay rate was 35.3%, and the factors associated with it were location (Johor: OR, 4.95; Kelantan: OR, 6.68; and Sarawak: OR, 3.88) and those diagnosed at other hospitals (OR, 2.18). Results Delays in presentation, diagnosis, and treatment were high among patients with breast cancer who attended public hospitals in Malaysia. Factors that influenced delays were locality, socio-culture, patients, and health systems. Mutual collaboration involving patients and health care sectors and a comprehensive intervention study are suggested to improve the quality of breast cancer care in Malaysia. Conclusion Delays in presentation, diagnosis, and treatment were high among patients with breast cancer who attended public hospitals in Malaysia. Factors that influenced delays were locality, socio-culture, patients, and health systems. Mutual collaboration involving patients and health care sectors and a comprehensive intervention study are suggested to improve the quality of breast cancer care in Malaysia. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.