Shorter delay to treatment by integrated diagnostic services and NGO-provided support among breast cancer patients in two Brazilian referral centres
Background: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies.
Design and Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals.
Results: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050).
Conclusion: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.
Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015. A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2017;3:524-48. DOI: https://doi.org/10.1001/jamaoncol.2016.5688
Torre LA, Sauer AM, Chen MS Jr, et al. Cancer statistics for Asian Americans, native Hawaiians, and Pacific islanders, 2016: Converging incidence in males and females. CA Cancer J Clin 2016;66:182-202. DOI: https://doi.org/10.3322/caac.21335
Instituto Nacional de Câncer. [Estimativa 2019: Incidência de Câncer no Brasil].[in Portuguese]. Available from: http://www1.inca.gov.br/estimative/2018/estimative-2018.pdf
Instituto Nacional de Câncer. [Estimativa 2005: Incidência de Câncer no Brasil].[in Portuguese]. Available from: http://www1.inca.gov.br/vigilancia/docs/portugal2005/estimativa%202005.pdf
Freitas AGQ, Weller M. Patient delays and system delays in breast cancer treatment in developed and developing countries. Cienc Saude Col 2015;20:3177-89. DOI: https://doi.org/10.1590/1413-812320152010.19692014
Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol 2014;5:465-77. DOI: https://doi.org/10.5306/wjco.v5.i3.465
Unger-Saldaña K, Fitch- Picos K, Villarreal-Garza C. Breast cancer diagnostic delays among young Mexican women are associated with a lack of suspicion by health care providers at first presentation. J Glob Oncol 2019;5:1-12. DOI: https://doi.org/10.1200/JGO.19.00093
Caplan L. Delay in breast cancer: Implications for stage at diagnosis and survival. Front Public Health 2014;2:1-5. DOI: https://doi.org/10.3389/fpubh.2014.00087
Williams F. Assessment of breast cancer treatment delay impact on prognosis and survival: a look at the evidence from systematic analysis of the literature. A pilot study. J Cancer Biol Res 2015;3:1071.
Khorana IAA, Tullio K, Elson P, et al. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS One 2019;14:e0213209. DOI: https://doi.org/10.1371/journal.pone.0213209
Trufelli DC, Bensi CG, Pane CEV, et al. [Onde está o atraso? Avaliação do tempo necessário para o diagnóstico e tratamento do câncer de mama nos serviços de oncologia da Faculdade de Medicina do ABC].[Article in Portuguese]. Rev Bras Mastol 2007;17:14-8.
Trufelli DC, Miranda VC, Santos MBB, et al. [Análise do atraso no diagnóstico e tratamento do câncer de mama em um hospital público].[Article in Portuguese]. Rev Assoc Med Bras 2008;54:72-6. DOI: https://doi.org/10.1590/S0104-42302008000100024
Trufelli DC, Matos LL, Santi PX, Del Giglio, A. Adjuvant treatment delay in breast cancer patients. Rev Assoc Med Bras 2015; 61:411-16. DOI: https://doi.org/10.1590/1806-9282.61.05.411
Souza VO, Grando JPS, Couto Filho JO. [Tempo decorrido entre o diagnóstico de câncer de mama e o início do tratamento, em pacientes atendidas no Instituto de Câncer de Londrina (ICL)].[Article in Portuguese]. Rev Bras Med 2008;65:135-38.
Souza CB, Fustinoni SM, Amorim MHC, et al. [Estudo do tempo entre o diagnóstico e início do tratamento do câncer de mama em idosas de um hospital de referência em São Paulo, Brasil].[Article in Portuguese]. Cien Saude Col 2015;20:3805-16. DOI: https://doi.org/10.1590/1413-812320152012.00422015
Rezende MCR, Koch HA, Figueiredo JA, Thuler, LCS. [Causas do retardo na confirmação diagnóstica de lesões mamárias em mulheres atendidas em um centro de referência do Sistema Único de Saúde no Rio de Janeiro].[Article in Portuguese]. Rev Bras Ginecol Obstet 2009;31:75-81. DOI: https://doi.org/10.1590/S0100-72032009000200005
Lourenço AV. Women cancer prevention and pharmaceutical contribution. Braz J Pharm Sci 2010;46:45-52. DOI: https://doi.org/10.1590/S1984-82502010000100006
Soares PBM, Filho SQ, Souza WP, Gonçalves RCR et al. Characteristics of women with breast cancer seen at reference services in the North of Minas Gerais. Rev Bras Epidemiol 2012;15:595-604. DOI: https://doi.org/10.1590/S1415-790X2012000300013
Barros FA, Uemura G, Macedo JLS. [Tempo pará acesso ao tratamento do câncer de mama não Distrito Federal, Brasil Central].[Article in Portuguese]. Rev Bras Ginecol Obstet 2013;35:458-63. DOI: https://doi.org/10.1590/S0100-72032013001000006
Oshiro ML, Bergmann A, Silva RG, et al. Câncer de mama avançado como evento sentinela para avaliação do programa de detecção precoce do câncer de mama no centro-oeste do Brasil].[Article in Portuguese]. Rev Bras Canc 2014;60:15-23. DOI: https://doi.org/10.32635/2176-9745.RBC.2014v60n1.488
Guerra MR, Silva GA, Nogueira MC et al. [Sobrevida por câncer de mama e iniquidade em saúde].[Article in Portuguese]. Cad Saude Pub 2015;31:1673-84. DOI: https://doi.org/10.1590/0102-311X00145214
Lopes TCR, Gravena AAF, Demitto MO, et al. Delay in diagnosis and treatment of breast cancer among women attending a reference service in Brazil. Asian Pac J Canc Prev 2017;18:3017–23.
Cavalcanti LPG, Simões PSF, Silva MRR, Galdino PNR. [Assistência em mastologia em uma unidade de referência do Sistema Único de Saúde no Ceará, Brasil].[Article in Portuguese]. Rev Bras Canc 2012;58:63-9. DOI: https://doi.org/10.32635/2176-9745.RBC.2012v58n4.562
Paiva CJK, Cesse EAP. [Aspectos relacionados ao atraso no diagnóstico e tratamento do câncer de mama em uma unidade hospitalar de Pernambuco].[Article in Portuguese]. Rev Bras Canc 2015;61:23-30. DOI: https://doi.org/10.32635/2176-9745.RBC.2015v61n1.374
Ferreira NAS, Carvalho SMF, Valenti VE et al. Treatment delays among women with breast cancer in a low socio-economic status region in Brazil. BMC Womens Health 2017;17:1-8. DOI: https://doi.org/10.1186/s12905-016-0359-6
Malta DC, Stopa SR, Pereira CA, et al. Private health care coverage in the brazilian population, according to the 2013 Brazilian National Health Survey. Cienc Saude Col 2017;22:179-90. DOI: https://doi.org/10.1590/1413-81232017221.16782015
McGregor AJ, Siqueira CE, Zaslavsky AM, Blendon RJ. Do elections matter for private- sector healthcare management in Brazil? An analysis of municipal health policy. BMC Health Serv Res 2017;17:483-96. DOI: https://doi.org/10.1186/s12913-017-2427-5
Instituto Brasileiro de Geografia e Estatística. [População do Brasil].[ in Portuguese]. Rio de Janeiro: IBGE; 2014. Available from: https://ibge.gov.br/
Alves SAV, Batiston AP, Weller M. Impact of education and health treatment options on performance of clinical breast examination. Acta Sci Women Health 2019;1:2-9.
Alves SAV, Weller M. Breast cancer risk perception and mammography screening behavior of women in northeast Brazil. Womens Health Rep (New Rochelle) 2020;1:150-8. DOI: https://doi.org/10.1089/whr.2019.0026
Norsa'adah B, Rampal KG, Rahmah MA, et al. Diagnosis delay of breast cancer and its associated factors in Malaysian women. BMC Cancer 2011;11:141. DOI: https://doi.org/10.1186/1471-2407-11-141
Brand NR, Qu LG, Chao A, Ilbawi AM. Delays and barriers to cancer care in low- and middle-income countries: A systematic review. Oncologist 2019;24:1-10. DOI: https://doi.org/10.1634/theoncologist.2019-0057
Medeiros GC, Thuler LCS, Bergmann A. Delay in breast cancer diagnosis: a Brazilian cohort study. Public Health 2019;167:88-95. DOI: https://doi.org/10.1016/j.puhe.2018.10.012
Poum A, Promthet S, Duffy SW, Parkin DM. Factors associated with delayed diagnosis of breast cancer in northeast Thailand. J Epidemiol 2014;24:102-8. DOI: https://doi.org/10.2188/jea.JE20130090
Nouws S, Brandão M, Fontes F, et al. Factors associated with time to breast cancer diagnosis and treatment in unscreened women in Portugal. Women Health 2019;59:601-14. DOI: https://doi.org/10.1080/03630242.2018.1539430
Foy KC, Fisher JL, Lustberg MB. Disparities in breast cancer tumor characteristics, treatment, time to treatment, and survival probability among African American and white women. NPJ Breast Cancer 2018;4:7. DOI: https://doi.org/10.1038/s41523-018-0059-5
Unger-Saldaña K, Ventosa-Santaulària D, Miranda A, Verduzco-Bustos G. Barriers and explanatory mechanisms of delays in the patient and diagnosis intervals of care for breast cancer in Mexico. Oncologist 2018;23:440-53. DOI: https://doi.org/10.1634/theoncologist.2017-0431
Gebrim LHA. [Detecção precoce do câncer de mama no Brasil].[Article in Portuguese]. Cad Saude Pub 2016;32:eCO010516. DOI: https://doi.org/10.1590/0102-311XCO010516
- Abstract views: 615
- PDF: 206
- HTML: 0
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.