RESUMO
BACKGROUND: Delays before treatment initiation increase the likelihood of later-stage diagnosis of breast cancer and reduce survival. Among Chinese women living in mainland China, Hong Kong, and Taiwan, the amount of time lost in delay and the factors influencing it are unclear. OBJECTIVE: This integrative review aimed to characterize delay intervals among Chinese women, identify factors contributing to delay, and develop a conceptual model of these factors. METHODS: Using Whittemore and Knafl's methodology for integrative reviews, PubMed, CINAHL, Web of Science, SCOPUS, PsycINFO, and China National Knowledge Infrastructure were searched for primary research articles. For 15 selected studies, quality evaluation was performed employing the Crowe Critical Appraisal Tool. A narrative synthesis was developed to summarize and explain the findings. RESULTS: Total delay intervals (from first discovery of breast symptoms to treatment initiation) exceeded 3 months for 50.2% to 52% of breast cancer patients. The greatest delay occurred between symptom discovery and first presentation (patient intervals). Factors affecting delay in presentation, diagnosis, and treatment included symptom appraisal, Chinese cultural factors, knowledge of breast cancer symptoms and screening, health history, personality, social and healthcare factors, and background factors. CONCLUSIONS: Half of Chinese breast cancer patients delayed long enough to lower their chances of survival. Our review sheds light on how the reviewed factors contribute to delay and their unique influences in this population. IMPLICATIONS FOR PRACTICE: Factors identified can inform nursing interventions that raise breast cancer awareness and promote timely diagnosis and treatment in Chinese women.
Assuntos
Neoplasias da Mama , Diagnóstico Tardio , População do Leste Asiático , Feminino , Humanos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etnologia , Neoplasias da Mama/terapia , China/epidemiologia , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , População do Leste Asiático/psicologia , População do Leste Asiático/estatística & dados numéricos , Hong Kong , Conhecimentos, Atitudes e Prática em Saúde/etnologia , CulturaRESUMO
BACKGROUND: The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures. METHODS: Clinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures. RESULTS: We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period. CONCLUSIONS: There was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization.
Assuntos
COVID-19 , Doenças Cardiovasculares , Ponte de Artéria Coronária/estatística & dados numéricos , Diagnóstico Tardio , Intervenção Coronária Percutânea/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Listas de Espera/mortalidade , COVID-19/epidemiologia , COVID-19/prevenção & controle , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/psicologia , Doenças Cardiovasculares/cirurgia , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Mortalidade , Ontário/epidemiologia , SARS-CoV-2 , Tempo para o Tratamento/organização & administraçãoRESUMO
BACKGROUND: Delays in diagnosis and treatment from first noticeable breast cancer symptoms are associated with poor outcomes. Understanding the reasons and barriers for patients' delay in seeking medical care is critical to mitigating the problem. METHODS: In-person surveys were conducted among 462 women, aged 18-79, with incident breast cancer cases, recruited from two cancer hospitals in North Vietnam. Delay, defined as the time interval between symptom recognition to the diagnosis and initiation of treatment equal to or exceeding 3 months, was categorized as follows: no delay (<3 months), moderate delay (3-8 months), and serious delay (≥9 months). Multivariable multinomial logistic regression was applied in data analyses. RESULTS: Over one-quarter patients (31.5%) experienced moderate delays, and close to one-fifth (17.5%) experienced serious delays. Adjusted odds ratios and 95% confidence intervals for moderate and serious delays were 5.60 (3.00-10.47) and 4.25 (2.05-8.85) for financial and physical barriers, respectively. Moderate delay was positively associated with psychological barriers (5.55 [1.75-17.57]) and lack of proper knowledge (3.15 [1.47-6.74]). The associations of barriers with delays in diagnosis and treatment appeared stronger among women living in rural areas. A lack of proper knowledge was significantly associated with delay among young women (<45 years old) and those with high incomes, while psychological barriers were significantly associated with delay among older women (≥45 years old). CONCLUSION: Delays in diagnosis and treatment are common among Vietnamese breast cancer patients and are affected by several noted barriers. Proper policy needs to be developed to address this public health issue.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Diagnóstico Tardio/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Tempo para o Tratamento , Adolescente , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , Detecção Precoce de Câncer , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Incidência , Pessoa de Meia-Idade , População Rural , Fatores Socioeconômicos , Vietnã/epidemiologia , Adulto JovemRESUMO
BACKGROUND: We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal. METHODS: Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson's chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0). RESULTS: Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55-140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients' admission until treatment ranged from 42-61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61-12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals. CONCLUSIONS: Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.
Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Pulmonares/diagnóstico , Oncologistas/psicologia , Pneumologistas/psicologia , Adulto , Diagnóstico Tardio/psicologia , Humanos , Neoplasias Pulmonares/epidemiologia , Pessoa de Meia-Idade , Portugal , Qualidade da Assistência à Saúde , Fatores Socioeconômicos , Inquéritos e QuestionáriosAssuntos
COVID-19 , Diagnóstico Tardio , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , SARS-CoV-2 , Doenças Assintomáticas , COVID-19/prevenção & controle , COVID-19/psicologia , Transformação Celular Viral , Diagnóstico Tardio/prevenção & controle , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Educação em Saúde , Promoção da Saúde , Humanos , Incidência , National Cancer Institute (U.S.) , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/etiologia , Obesidade/complicações , Obesidade/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa , SARS-CoV-2/patogenicidade , Autocuidado , Sociedades Médicas , Manejo de Espécimes , Estados UnidosAssuntos
Anemia Ferropriva/diagnóstico , COVID-19/psicologia , Diagnóstico Tardio/psicologia , Pandemias , SARS-CoV-2 , Anemia Ferropriva/sangue , Anemia Ferropriva/etiologia , Anemia Ferropriva/terapia , Transfusão de Eritrócitos , Medo , Feminino , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico , Pessoa de Meia-Idade , Síncope/etiologia , Hemorragia Uterina/complicações , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnósticoRESUMO
Basal cell carcinoma is the most common skin cancer for which surgery is usually the unique and definitive treatment. Advanced basal cell carcinoma is not eligible to surgery when underlying structures are destroyed. Delayed consultation is the principal cause of advanced basal cell carcinoma. It is questionable why some patients seek care only when the tumour is advanced. The objective of this study was to identify the psychosocial factors involved in delayed consultation. We used a qualitative approach, conducting semi-structured interviews with advanced basal cell carcinoma patients and the healthcare staff of a dermatology unit to explore why some patients consult only when basal cell carcinoma is advanced. We then put our findings into perspective and created a logical model for change. We interviewed 14 patients and 12 healthcare staff. The first lesion was associated with banalization. Then, denial and fear of diagnosis or treatment were post common. Finally, the advanced basal cell carcinoma's symptoms, along with social pressure, created the intention to seek medical help and improved disease awareness. We developed a logical model that summarizes these findings. In this pilot study, we modelled factors that delayed consultation. This will aid future research and targeted interventions reducing delay, in particular by improving knowledge and by using social pressure as facilitators. Trial registration: NCT04124796.
Assuntos
Carcinoma Basocelular/diagnóstico , Diagnóstico Tardio/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Carcinoma Basocelular/psicologia , Carcinoma Basocelular/cirurgia , Diagnóstico Tardio/estatística & dados numéricos , Medo , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Projetos Piloto , Estudos Prospectivos , Pesquisa Qualitativa , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/cirurgia , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricosAssuntos
Atitude Frente a Saúde , COVID-19 , Diagnóstico Tardio/psicologia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pacientes/psicologia , SARS-CoV-2 , Neoplasias Cutâneas/psicologia , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Carcinoma/diagnóstico , Carcinoma/psicologia , Estudos Transversais , Progressão da Doença , Detecção Precoce de Câncer , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medo , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Ceratoacantoma/diagnóstico , Ceratoacantoma/psicologia , Masculino , Melanoma/diagnóstico , Melanoma/psicologia , Recidiva Local de Neoplasia/diagnóstico , Quarentena , Encaminhamento e Consulta , Neoplasias Cutâneas/diagnóstico , Inquéritos e Questionários , TelemedicinaRESUMO
BACKGROUND: Although early diagnosis is a key determinant factor for breast cancer survival, delay in presentation and advanced stage diagnosis are common challenges in low and middle income countries including Ethiopia. Long patient delays in presentation to health facility and advanced stage diagnosis are common features in breast cancer care in Ethiopia but the reasons for patient delays are not well explored in the country. Therefore we aimed to explore the reasons for patient delay in seeking early medical care for breast cancer in North-west Ethiopia. METHODS: A qualitative study was conducted from November to December 2019 using in-depth interviews from newly diagnosed breast cancer patients in the two comprehensive specialized hospitals in North West Ethiopia. Verbal informed consent was taken from each participant before interviews. A thematic content analysis was performed using Open Code software version 4.02. RESULTS: Lack of knowledge and awareness about breast cancer, cultural and religious beliefs, economic hardships, lack of health care and transportation access, fear of surgical procedures and lack of trusts on medical care were the major reasons for late presentation of breast cancer identified from the patient's narratives. CONCLUSIONS: The reasons for late presentation of patients to seek early medical care for breast cancer had multidimensional nature in Northwest Ethiopia. Health education and promotion programs about breast cancer should be designed to increase public awareness to facilitate early detection of cases before advancement on the existing health care delivery system.
Assuntos
Neoplasias da Mama/psicologia , Diagnóstico Tardio/tendências , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Neoplasias da Mama/diagnóstico , Diagnóstico Tardio/psicologia , Detecção Precoce de Câncer/tendências , Etiópia/epidemiologia , Feminino , Educação em Saúde/métodos , Instalações de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Women in developing countries usually delay in presenting their symptoms as a part of the early diagnosis program. This study was conducted for analyzing the reason of patient's delay and its relation with socioeconomic and health conditions, knowledge, and women's belief about breast cancer (BC). METHODOLOGY: This study used a cross-sectional design in the early detection center in Kurdistan (North Iraq). Women were interviewed about socioeconomic and health background, knowledge, and belief about BC. RESULTS: The median of patient delay in the BC symptomatic women in this study was higher (30 days) as compared with developed countries. Patient delay was longer in women who were widows, had a barely self-perceived economic status, and had chronic diseases. There was a significant relationship of patient delay with women's health motivation and perceived barrier to seeking medical care. CONCLUSIONS: Health promotion program should emphasize on the women's motivation about early diagnosis and seeking to early detection.
Assuntos
Neoplasias da Mama/diagnóstico , Comparação Transcultural , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Países Desenvolvidos , Países em Desenvolvimento , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Iraque , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autoimagem , Fatores Socioeconômicos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto JovemAssuntos
Infecções por Coronavirus , Endoscopia Gastrointestinal/estatística & dados numéricos , Neoplasias Gastrointestinais , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral , Psico-Oncologia , Atitude Frente a Saúde , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Diagnóstico Tardio/prevenção & controle , Diagnóstico Tardio/psicologia , Neoplasias Gastrointestinais/diagnóstico , Neoplasias Gastrointestinais/psicologia , Humanos , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Risco , SARS-CoV-2 , Percepção Social , Reino Unido/epidemiologiaRESUMO
OBJECTIVES: Minority patients are under-screened for chronic hepatitis C (CHC) in the USA, and limited data exist for minority patients with advanced fibrosis. METHODS: In this cross-sectional study, CHC patients who were prescribed direct-acting antiviral agents were divided into White patients and minority patient groups. Primary measurements were the mean fibrosis scores and percentages of patients with stage III-IV fibrosis (late presenters) for the two groups. RESULTS: Among the 1421 patients with self-reported ethnicity, 697 were White patients, and 724 were minority patients (484 Hispanic, 175 Black, 65 Asians). Compared to the White, minority patients had significantly higher mean fibrosis score (p < 0.001) and a higher percentage of late presenters (p < 0.001). In subgroup analyses, the mean fibrosis scores for Hispanic, Black and Asian patients were 2.58 ± 1.38, 2.28 ± 1.41 and 2.28 ± 1.40, respectively. CONCLUSIONS: Minority populations with CHC in the USA experience disparities in access to treatment in the early stages of liver fibrosis. Public health strategies are necessitated to address the inequality, as late presenters are at risk of hepatocellular carcinoma.
Assuntos
Antivirais/uso terapêutico , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Fibrose/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Povo Asiático/psicologia , Povo Asiático/estatística & dados numéricos , População Negra/psicologia , População Negra/estatística & dados numéricos , Estudos Transversais , Feminino , Fibrose/diagnóstico , Fibrose/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População Branca/psicologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Breast cancer is the most common cancer globally and among South African women. Women from socioeconomically disadvantaged South African communities more often present later and receive total mastectomy compared to those from more affluent communities who have more breast conserving surgery (which is less invasive but requires mandatory radiation treatment post-operatively). Standard chemotherapy and total mastectomy treatments are known to cause traumatizing side effects and emotional suffering among South African women; moreover, many women face limited communication with physicians and psychological support. OBJECTIVE: This article investigates the experiences of women seeking breast cancer treatment at the largest public hospital in South Africa. METHODS: We interviewed 50 Black women enrolled in the South African Breast Cancer Study to learn more about their health system experiences with detection, diagnosis, treatment, and follow-up care for breast cancer. Each interview was between 2-3 hours, addressing perceptions, experiences, and concerns associated with breast cancer and comorbidities such as HIV and hypertension. RESULTS: We found most women feared diagnosis, in part, because of the experience of chemotherapy and physical mutilation related to mastectomy. The importance of social support from family, religion, and clinical staff was fundamental for women coping with their condition and adhering to treatment and medication. CONCLUSIONS: These findings exemplify how interventions might promote early detection of breast cancer and better adherence to treatment. Addressing community perceptions of breast cancer, patient needs and desires for treatment, structural barriers to intensive therapies, and the burden of invasive treatments are imperative next steps for delivering better breast cancer care in Soweto and other resource-constrained settings.
Assuntos
Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Mastectomia/psicologia , Adaptação Psicológica , Adulto , Idoso , População Negra , Comorbidade , Diagnóstico Tardio/psicologia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Apoio Social , África do Sul , Estresse PsicológicoRESUMO
BACKGROUND: Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients experience metabolic, musculoskeletal, and psychological disorders. OBJECTIVES: To determine the delay in HS diagnosis and its consequences for patients and the healthcare system. METHODS: This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated. RESULTS: The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians - most frequently general practitioners, dermatologists, surgeons, gynecologists - and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed. CONCLUSION: This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.
Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Hidradenite Supurativa/diagnóstico , Adolescente , Adulto , Idade de Início , Idoso , Comorbidade , Estudos Transversais , Diagnóstico Tardio/psicologia , Atenção à Saúde , Depressão/etiologia , Procedimentos Cirúrgicos Dermatológicos/estatística & dados numéricos , Erros de Diagnóstico/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Hidradenite Supurativa/epidemiologia , Hidradenite Supurativa/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Receiving a new breast cancer (BC) diagnosis can cause significant patient anxiety, which is amplified by delays in diagnosis. There is a lack of defined time periods for delays in the workup of BC. This study aims to evaluate national variations in timing from first abnormal mammogram to first biopsy and to determine independent predictors of delay in diagnosis. PATIENTS AND METHODS: Data were derived from SEER-Medicare linked claims database from 2007 to 2013. Time intervals from abnormal mammogram, either screening or diagnostic, to biopsy were assessed. The fourth quartile for timing from first mammogram to first biopsy was utilized to define delay in diagnosis. Multivariate analyses were used to evaluate the association between clinicopathologic variables and delays in diagnosis. RESULTS: We analyzed 53,758 patients with stage 0-II BC who underwent upfront surgery. Significant variations in timing of care were identified, with mean times from mammogram to biopsy, surgeon visit, and breast surgery of 23.3, 31.6, and 52.6 days, respectively. Over the study period, there was a decrease in delays from mammogram to biopsy. Non-White race, Northeast location, and earlier stage disease were found to be independent predictors of delays in the diagnosis of BC (p < 0.0001). CONCLUSIONS: The study demonstrates significant variations in time to diagnostic biopsy. More efficient processes of care to address these delays should be implemented, and further studies are needed to determine whether improved efficiency decreases patient anxiety. The large variations in time to diagnosis speak to the need for consensus guidelines to establish a standard of care.
Assuntos
Neoplasias da Mama , Diagnóstico Tardio , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Mamografia , Mastectomia , Medicare/estatística & dados numéricos , Estados UnidosRESUMO
OBJECTIVES: This study aimed to explore the lived experience of parents with children who have had retinoblastoma. METHODS: The study adopted a qualitative approach using the data collection method of written accounts. Eleven parents were recruited via snowball sampling from across the UK. Parents were asked to retrospectively produce a written account of their experiences. These narrative autobiographical accounts were analysed using thematic analysis. RESULTS: Data analysis elicited three themes: waiting and misdiagnosis; emotional rollercoaster; and support needs. Parents described experiencing prolonged periods of waiting from referral to clinical investigations and the implementation of a treatment plan. Difficulties in obtaining an accurate diagnosis for their child elicited anxiety for parents. Emotions were described in terms of a rollercoaster with highs and lows and times of despair, anger, relief, and hope. Experiences of personal support varied and had lasting impacts on relationships. However, the support from other parents with a child with retinoblastoma was perceived to be instrumental in facilitating coping. CONCLUSIONS: The findings show parental experiences were characterised by numerous difficulties and suggest a need for greater awareness of childhood eye cancer. This research highlights the importance of psychological and social support for parents of a child with retinoblastoma.
Assuntos
Narração , Pais/psicologia , Neoplasias da Retina/diagnóstico , Retinoblastoma/diagnóstico , Apoio Social , Adaptação Psicológica , Ira , Ansiedade/psicologia , Diagnóstico Tardio/psicologia , Erros de Diagnóstico/psicologia , Emoções , Feminino , Medicina Geral , Esperança , Humanos , Lactente , Masculino , Avaliação das Necessidades , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , Encaminhamento e Consulta , Neoplasias da Retina/cirurgia , Retinoblastoma/cirurgia , Reino UnidoRESUMO
BACKGROUND: People with severe mental disorders have a worse cancer prognosis, with higher mortality rates than the general population, and this could be partially attributed to a later detection. Breast cancer and colorectal cancer have mass population screenings in Spain, but the influence in early diagnosis is unknown in persons with severe mental disorders. OBJECTIVE: To compare the severity of breast and colorectal cancers at diagnosis in people with and without mental disorders. METHODS: This was an observational, retrospective, case-control study with 1:2 matching performed in Eastern Spain. Data were retrieved for analysis from electronic medical records. RESULTS: The study included 111 oncology patients (75 with breast cancer and 36 with colorectal cancer). Individuals with mental disorders had a significantly higher (P = .002) relative risk (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.60-9.65) to be diagnosed with an advanced tumor stage (clinical stages IIIA, IIIB, IIIC, and IV), for both breast and colorectal cancers when analyzed separately. The variables associated with advanced cancer at the time of diagnosis were the presence of a previous mental disorder (OR, 4.67; 95% CI, 1.73-12.61) and older age (OR, 1.08; 95% CI, 1.02-1.14). CONCLUSIONS: Individuals with severe mental disorders showed a higher risk of being diagnosed with breast and colorectal cancers at advanced stages. IMPLICATIONS FOR PRACTICE: Cancer screening for earlier detection and intervention in people with severe mental disorders needs improvement. Mental health nurses, screening nurses, and oncology nurses could serve an essential role in increasing the screening adherence of this group of individuals.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias Colorretais/diagnóstico , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Transtornos Mentais/complicações , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , EspanhaRESUMO
Tumor-induced osteomalacia is a rare hypophosphatemic disease caused by unregulated production of fibroblast growth factor 23 by a tumor, thereby inducing renal phosphate wasting and inhibiting appropriate increase of calcitriol production. Symptoms of tumor-induced osteomalacia, including muscle weakness, bone pain, and pathologic fractures, are nonspecific and warrant further workup. We report the case of a 50-year-old African American female with no known psychiatric illness who was admitted after a failed suicide attempt provoked by severe bone pain. She had been treated for fibromyalgia and hypophosphatemic rickets at other facilities with no improvement. The findings of profound renal phosphate wasting initiated further evaluation, which revealed an elevated fibroblast growth factor 23 level and a right proximal fibular mesenchymal tumor on octreotide scintigraphy. Magnetic resonance imaging confirmed the findings of a solid intramuscular tumor corresponding to the octreotide avid lesion. After wide excision of the tumor, serum phosphate and parathyroid hormone levels began to normalize. This case highlights the importance of extensively investigating the cause of bone pain, weakness, and fatigue in patients without a family history of hypophosphatemia or bone disorders. The aforementioned symptoms may precede recurrent pathological fractures, and a thorough workup ensures that a diagnosis of tumor is not delayed or overlooked, as tumor resection confers a favorable prognosis and dramatic increase in the quality of life for patients.
Assuntos
Fatores de Crescimento de Fibroblastos/sangue , Neoplasias de Tecido Conjuntivo/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Tentativa de Suicídio/psicologia , Diagnóstico Tardio/psicologia , Feminino , Fator de Crescimento de Fibroblastos 23 , Fibromialgia/etiologia , Humanos , Hipofosfatemia/etiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias de Tecido Conjuntivo/sangue , Neoplasias de Tecido Conjuntivo/complicações , Osteomalacia , Dor/etiologia , Síndromes Paraneoplásicas/sangue , Síndromes Paraneoplásicas/complicações , Fosfatos/sangue , Cintilografia , Raquitismo Hipofosfatêmico/etiologiaRESUMO
The aim of this study was to evaluate delays in the presentation of symptomatic breast cancer in women (time interval between the perception of their first sign or symptom until the first medical appointment) and its risk factors. A cohort study composed of patients with breast cancer (symptomatic) admitted to an oncological centre in the city of Rio de Janeiro, Brazil was performed. The patients were interviewed during their first hospital visit. To assess time interval as a continuous variable, the median and interquartile ranges (IQR) were calculated. The outcome comprised delay in breast cancer presentation when time from the first sign or symptom perception to the first medical appointment was ≥90 days. A descriptive analysis was performed. The association between independent variables (epidemiological, social and demographic data, related to individual healthcare, clinical and current disease) and the outcome (delay in symptomatic presentation) was assessed by a univariate analysis applying odds ratios (OR). Associations with p < .20 in the univariate analysis were included in the multiple logistic regression model. Variables with a p < .05 were retained in the final model. A total of 388 women were included. The median time was of 41 days (interquartile range - IQR: 13.2-130.0); 34.3% delayed presentation at ≥ 90 days. After adjustment, the variables associated with a delay in presentation were frequency of gynaecological examination of over than 1 year (OR: 2.59, 95% CI: 1.67-4.05), no family history of breast cancer (OR: 1.96, 95% CI: 1.15-3.35), and income lower than the minimum wage (OR: 1.62, 95% CI: 1.03-2.55). A higher score in tangible support (OR: 0.98; 95% CI: 0.96-0.99) was associated with a lesser chance of delay in presentation. Thus, delay in presentation was associated with social barriers, access to health service, health information and individual factors.
Assuntos
Neoplasias da Mama/diagnóstico , Diagnóstico Tardio/psicologia , Acessibilidade aos Serviços de Saúde/normas , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Idoso , Brasil , Neoplasias da Mama/psicologia , Estudos de Coortes , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Fatores de TempoRESUMO
BACKGROUND: Most women with breast cancer in Ethiopia are diagnosed at an advanced stage of the disease, but the reasons for this have not been systematically investigated. This study, therefore, aimed to explore the main reasons for diagnosis of advanced stage breast cancer from the perspective of patients, family members, and health care providers. METHODS: A qualitative study with in-depth interviews was conducted with 23 selected participants at Tikur Anbessa Specialized Hospital, Oncology Clinic using a semi-structured interview guide. These participants were 13 breast cancer patients, 5 family members, and 5 health care providers. Data were transcribed into English, coded and analyzed using thematic analysis. RESULTS: Awareness about the causes, risk, initial symptoms, early detection methods, and treatment of breast cancer were uncommon, and misconceptions about the disease prevailed among breast cancer patients and family members. There was a sense of hopelessness and uncertainty about the effectiveness of conventional medicine amongst patients and family members. Consequently, performing spiritual acts (using holy water) or seeking care from traditional healers recurred amongst the interviewees. Not taking initial symptoms of breast cancer seriously by the patients, reliance on traditional medicines, competing priorities, financial hardship, older age, fear of diagnosis of cancer, and weak health systems (e.g., delay in referral and long waiting period for consultation) were noted as the main contributors to late diagnosis. In contrast, persuasion by family members and friends, higher educational attainment, and prior experience of neighboring women with breast cancer were mentioned to be facilitators of early diagnosis of breast cancer. CONCLUSIONS: The causes of late diagnosis of breast cancer in Ethiopia are multi-factorial and include individual, cultural, and health system factors. Interventions targeting these factors could alleviate the misconceptions and knowledge gap about breast cancer in the community, and shorten waiting time between symptom recognition and diagnosis of breast cancer.