Understanding Delays in Diagnosis and Treatment of Breast Cancer in India

描述（由申请人提供）：在全球范围内，50%的乳腺癌病例和59%的乳腺癌死亡发生在低收入和中等收入国家（LMIC）。印度占全球乳腺癌负担的7%，每年有115，000名妇女被诊断患有乳腺癌，其中近一半死于这种疾病。尽管有这种疾病负担，印度缺乏一个全国性的有组织的筛查计划。乳腺癌通常在晚期被发现，当一个女人寻求照顾的迹象/症状。只有大约一半的印度妇女在诊断后的前5年存活，而美国妇女的这一比例为90%。促进及时提供乳腺癌护理（诊断/治疗）是减少全球乳腺癌负担和改善印度等中低收入国家癌症死亡率结果的高度优先事项。然而，很少有理论驱动的研究已经在中低收入国家进行，以确定因素，无论是促进或构成障碍，介绍乳腺癌护理。我们的研究，告知行为的社会生态理论，因为它适用于癌症护理连续体，建议通过使用混合方法研究来解决这一差距，以开发和验证一种定量工具，以检查可能促进或构成障碍的多层次背景因素之间的关联，及时介绍印度乳腺癌护理。这将为美国国立卫生研究院未来的应用奠定基础，以进行这些协会的定量研究，并确定多层次的干预措施，以促进及时诊断和治疗乳腺癌。我们的2年混合方法研究将在印度本尼迪克特的圣约翰医学院医院（SJMCH）的癌症中心进行。我们将开始进行半结构化的深入访谈，有目的地选择女性乳腺癌患者的诊断阶段的基础上（n=30），家庭成员（n=20），和卫生保健提供者（n=10）。这些访谈将使我们能够了解女性如何感知，理解和体验他们的癌症症状，诊断和治疗，并探索家庭，提供者/医疗保健组织和社区如何塑造他们的癌症护理实践（目标1）。使用这些数据，我们将完善我们的概念模型，在介绍乳腺癌护理延迟和开发一个结构化的工具来衡量多层次的背景因素。我们将有一个专家小组审查该工具的内容和表面效度，然后用SJMCH新登记的乳腺癌患者（n=100）的便利样本进行试点测试，以检查维度，收敛和判别效度，时间可靠性和内部一致性。根据研究结果，我们将改进工具，用于未来的定量研究，研究这些因素与印度乳腺癌诊断和治疗之间的关联（目标2）。总之，这项研究将提供迫切需要的概念和经验的见解，影响妇女的介绍乳腺癌护理的LMIC，制定有效的全球癌症控制政策的关键的第一步的结构和过程。

DESCRIPTION (provided by applicant): Worldwide, 50% of breast cancer cases and 59% of breast cancer deaths occur in low- and middle-income countries (LMICs). India bears 7% of the global burden of breast cancer, with 115,000 women diagnosed with breast cancer annually and nearly half that many dying of the disease. Despite this disease burden, India lacks a nationwide organized screening program. Breast cancer is typically detected at an advanced stage when a woman seeks care for signs/symptoms. Only about half of Indian women survive the first 5 years post-diagnosis, compared to 90% of women in the United States. Promoting timely presentation for breast cancer care (diagnosis/treatment) is a high priority for reducing the global burden of breast cancer and improving cancer mortality outcomes in LMICs like India. However, few theory-driven studies have been conducted in LMICs to identify factors that either facilitate or pose barriers to presentation for breast cancer care. Our study, informed by the social-ecological theory of behavior as it applies to the cancer care continuum, proposes to address this gap by using mixed-methods research to develop and validate a quantitative instrument to examine the association between multilevel contextual factors that may facilitate or pose barriers to timely presentation for breast cancer care in India. This will lay the foundation for a future National Institutes of Health application to conduct a quantitative study o these associations and to identify multilevel interventions to promote timely diagnosis and treatment of breast cancer. Our 2-year mixed-methods study will be conducted at the cancer center at St. John's Medical College Hospital (SJMCH) in Bengaluru, India. We will begin by conducting semi-structured in-depth interviews with female breast cancer patients purposively selected on the basis of their stage at diagnosis (n=30), family members (n=20), and health care providers (n=10). These interviews will enable us to understand how women perceive, understand, and experience their cancer symptoms, diagnosis, and treatment, and explore how families, providers/health care organizations, and communities shape their cancer care practices (Aim 1). Using these data, we will refine our conceptual model of delays in presentation for breast cancer care and develop a structured instrument to measure multilevel contextual factors. We will have an expert panel review the instrument for content and face validity and then pilot-test it with a convenience sample of newly registered breast cancer patients (n=100) at SJMCH to examine dimensionality, convergent and discriminant validity, temporal reliability, and internal consistency. Based on the findings, we will refine the instrumen for use in a future quantitative study on the associations between these factors and presentation for breast cancer diagnosis and treatment in India (Aim 2). In conclusion, this study will provide urgently needed conceptual and empirical insights on the structures and processes that influence women's presentation for breast cancer care in an LMIC, a critical first step toward developing effective global cancer control policies.