System Barriers to Treatment in Women with Locally

Abstract

Background: Breast cancer in the United States will affect approximately one in eight women. Despite a decrease in breast cancer mortality due to increased awareness and more effective screening, many patients still present for treatment after extended delays in diagnosis, resulting in large tumor size, locally advanced disease, inflammatory features, and greater likelihood of regional and distant metastasis. Purpose: The purpose of this study is to identify reasons why patients may encounter delays in obtaining a diagnosis, seeking medical care, and initiating treatment once symptoms appear. Methodology: A 39-item Likert-scale questionnaire was administered to 34 consecutive patients with histologically-verified stage III breast cancer and who had experienced a 3-month or greater delay in diagnosis or initiation of treatment from the time of onset of symptoms. Findings: Physician barriers: Roughly one-fourth of women reported that their physician did not believe that their breast lump/symptom was related to cancer (235%) and 177% of physicians did not think that a biopsy was necessary. System barriers: Among systems barriers, “delay in scheduling diagnostic tests” remained the most prevalent barrier to breast cancer treatment (382%). Delays due to obtaining insurance authorization for tests, treatment or doctor visits, accounted for 265% of the barriers. Other barriers, such as delays in referral to an oncologist, negative mammogram, and negative biopsy, continued to be present, but were not as frequently reported (less than 25%). Summary Concluding Statement: We observed substantial delays between symptom presentation and diagnosis in a proportion of patients who came to seek therapy at City Of Hope National Medical Center. We identified system and physician barriers contributing to this delay. These barriers could serve as the basis for future intervention studies to decrease the delay from time of presentation of breast signs/symptoms to diagnosis and treatment of breast cancer.