Delay in breast cancer care: A study in Thai women
Delay in breast cancer care: A study in Thai women
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DOI：
10.1097/00005650-200001000-00012
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发表时间：
2000-01-01
期刊：
影响因子：
3
通讯作者：
Sriplung, H
中科院分区：
文献类型：
--
作者：
Thongsuksai, P;Chongsuvivatwong, V;Sriplung, H
背景乳腺癌是泰国妇女癌症死亡的第二大常见原因。癌症登记数据显示，诊断时晚期疾病的患病率很高。在泰国造成延误的因素尚未调查。确定乳腺癌治疗延迟的程度和影响因素。1994年6月至1996年6月期间首次在Songklanagarind医院接受治疗的乳腺癌妇女接受了回顾性图表审计。因变量包括患者延迟（症状识别到急救）和系统延迟（急救到治疗）。自变量包括人口统计学因素、求助行为和癌症知识。单因素分析采用非参数秩和检验，多因素分析采用考克斯回归分析。研究纳入了94例病例。中位患者和系统延迟为4周;分别有26.6%和24.4%的患者经历了>12周的患者和系统延迟。只有婚姻状况（未婚与已婚女性相比）与患者延迟显著相关（风险比[HR] 2.78，95% CI 1.23-6.25）。首先联系省级医院而不是大学医院（风险比2.50，1.23-5.26），得到诊断而不是什么都不知道（风险比2.04，1.14-3.57），得到治疗而不是立即转诊（风险比4.55，2.22-9.09）与系统延迟有关。乳腺癌护理中的患者延迟和系统延迟是泰国疾病控制的重要弱点。教育项目应该针对未婚女性，她们更容易迟到。大学以外医院的系统延迟需要通过良好的转诊系统来改善。
BACKGROUND. Breast cancer is the second most common cause of cancer death in Thai women. Cancer registry data reveal a high prevalence of late-stage disease at diagnosis. The factors resulting in delay in Thailand have not yet been investigated.OBJECTIVES. To determine the extent of, and the factors contributing to, delay in breast cancer care.DESIGN. Women with breast cancer who were first treated at Songklanagarind Hospital between June 1994 and June 1996 were interviewed with retrospective chart audits of care.MEASURES. Dependent variables included patient delay (symptom recognition to first care) and system delay (first care to treatment). Independent variables tested included demographic factors, help-seeking behavior, and cancer knowledge. Nonparametric rank sum tests were used for univariate analysis, and Cox regression was used for multivariate analysis.RESULTS. Ninety-four cases were included in the study. The median patient and system delays were 4 weeks; 26.6% and 24.4% of patients, respectively, experienced patient and system delay >12 weeks. Only marital status (unmarried compared with married women) was significantly associated with patient delay (hazard ratio [HR] 2.78, 95% CI 1.23-6.25). Contacting a provincial hospital instead of a university hospital as first medical care (hazard ratio 2.50, 1.23-5.26), being given a diagnosis rather than being told nothing (HR 2.04, 1.14-3.57) and being given treatment rather than being immediately referred (HR 4.55, 2.22-9.09) were associated with system delay.CONCLUSIONS. Patient delay and system delay in breast cancer care are important weaknesses of disease control in Thailand. Educational programs should target unmarried women, who are at higher risk of delay. System delay in hospitals outside the university needs to be improved by a good referral system.