Delayed breast cancer presentation, diagnosis, and treatment in Kenya

被引:0
作者
Daniel, Ojuka [1 ,8 ]
Ashrafi, Adiba [2 ]
Muthoni, Musibi Alice [3 ,8 ]
Njoki, Njiraini [3 ]
Eric, Hungu [3 ,4 ]
Marilynn, Omondi [3 ,4 ]
Faith, Aseta Bonareri [1 ]
Beth, Wambui Githambo [1 ]
Nyakio, Mburu [1 ]
Odero-Marah, Valerie [5 ,8 ]
Ragin, Camille [6 ,8 ]
Llanos, Adana A. M. [2 ,7 ,8 ]
机构
[1] Univ Nairobi, Dept Surg, POB 19676 00202, Nairobi, Kenya
[2] Columbia Univ, Irving Med Ctr, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY USA
[3] Kenyatta Natl Hosp, Canc Treatment Ctr, Nairobi, Kenya
[4] Kenyatta Natl Hosp, Dept Surg, Nairobi, Kenya
[5] Morgan State Univ, Ctr Urban Hlth Dispar Res & Innovat, Biol Dept, Baltimore, MD USA
[6] Fox Chase Canc Ctr, Canc Prevent & Control Program, Philadelphia, PA USA
[7] Columbia Univ, Irving Med Ctr, Herbert Irving Comprehens Canc Ctr, New York, NY USA
[8] African Caribbean Canc Consortium, Philadelphia, PA 19111 USA
关键词
Delays; Diagnosis; Outcomes; Stages; Presentation; SUB-SAHARAN AFRICA; STAGE; OPPORTUNITIES; CHALLENGES; PATIENT; WOMEN; CARE;
D O I
暂无
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital. Methods Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment. Results The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings ( equivalent to similar to $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had >= 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, and healthcare practitioner misdiagnosis and/or strikes delayed patient diagnosis and treatment. Conclusions BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.
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页数:13
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共 32 条
[1]   Breast Cancer in Nigeria: Is Non-Adherence to Chemotherapy Schedules a Major Factor in the Reported Poor Treatment Outcome? [J].
Adisa, Adewale O. ;
Gukas, Isaac D. ;
Lawal, Oladejo O. ;
Adesunkanmi, Abdul Rasheed K. .
BREAST JOURNAL, 2010, 16 (02) :206-207
[2]  
Ahmed Awad Ali Mohamed, 2014, Breast Dis, V34, P131, DOI 10.3233/BD-140363
[3]   Emerging breast cancer epidemic: evidence from Africa [J].
Akarolo-Anthony, Sally N. ;
Ogundiran, Temidayo O. ;
Adebamowo, Clement A. .
BREAST CANCER RESEARCH, 2010, 12
[4]  
Allgar VL, 2005, BRIT J CANCER, V92, P1959, DOI 10.1038/sj.bjc.6602587
[5]  
Aloulou S, 2015, PAN AFR MED J, V21, DOI 10.11604/pamj.2015.21.162.4363
[6]   Patient delay and stage of diagnosis among breast cancer patients in Germany -: a population based study [J].
Arndt, V ;
Stürmer, T ;
Stegmaier, C ;
Ziegler, H ;
Dhom, G ;
Brenner, H .
BRITISH JOURNAL OF CANCER, 2002, 86 (07) :1034-1040
[7]   Interval for access to treatment for breast cancer in the Federal District, Brazil [J].
Barros, Angela Ferreira ;
Uemura, Gilberto ;
Soares de Macedo, Jefferson Lessa .
REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA, 2013, 35 (10) :458-463
[8]   Determinants of patient and health system delays for women with breast cancer in Morocco, 2013 [J].
Benbakhta, B. ;
Tazi, M. ;
Benjaafar, N. ;
Khattabi, A. ;
Maaroufi, A. .
REVUE D EPIDEMIOLOGIE ET DE SANTE PUBLIQUE, 2015, 63 (03) :191-201
[9]   Breast cancer in Sub-Saharan Africa: opportunities for prevention [J].
Brinton, Louise A. ;
Figueroa, Jonine D. ;
Awuah, Baffour ;
Yarney, Joel ;
Wiafe, Seth ;
Wood, Shannon N. ;
Ansong, Daniel ;
Nyarko, Kofi ;
Wiafe-Addai, Beatrice ;
Clegg-Lamptey, Joe Nat .
BREAST CANCER RESEARCH AND TREATMENT, 2014, 144 (03) :467-478
[10]  
Clegg-Lamptey J, 2009, Ghana Med J, V43, P127