Shorter delay to treatment by integrated diagnostic services and NGO- provided support among breast cancer patients in two Brazilian referral centres

Lorena Sofia dos Santos Andrade; Tácila Thamires de Melo Santos; Milena Edite Case de Oliveira; Kedma Anne Lima Gomes; Adriana Raquel Araújo Pereira Soares; Tiago Almeida de Oliveira; Mathias Weller

doi:10.4081/jphr.2021.1880

https://doi.org/10.4081/jphr.2021.1880

Lorena Sofia dos Santos Andrade Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil.
Tácila Thamires de Melo Santos Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil.
Milena Edite Case de Oliveira Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil.
Kedma Anne Lima Gomes Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil. https://orcid.org/0000-0001-6720-011X
Adriana Raquel Araújo Pereira Soares Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil.
Tiago Almeida de Oliveira Department of Statistics, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil. https://orcid.org/0000-0003-4147-7721
Mathias Weller | mathiasweller@hotmail.com Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande-Paraíba, Brazil.

Abstract

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.

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References

Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H 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(4):524-48. DOI: https://doi.org/10.1001/jamaoncol.2016.5688

Torre LA, Sauer AM, Chen MS Jr, Kagawa-Singer M, Jemal A, Siegel RL. Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females. CA Cancer J Clin. 2016;66(3):182-202. DOI: https://doi.org/10.3322/caac.21335

Instituto Nacional de Câncer. Estimativa 2019: Incidência de Câncer no Brasil. Retrieved from: http://www1.inca.gov.br/estimative/2018/estimative-2018.pdf

Instituto Nacional de Câncer. Estimativa 2005: Incidência de Câncer no Brasil. Retrieved 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. Ciência & Saúde Col. 2015;20(10):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(3):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(87):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(4):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(3):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. Rev Bras Mastol. 2007;17(1):14-8.

Trufelli DC, Miranda VC, Santos MBB, Fraile NMP et al. Análise do atraso no diagnóstico e tratamento do câncer de mama em um hospital público. Rev Assoc Med Bras. 2008;54(1):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(5):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). Rev Bras Med. 2008;65(5):135-38.

Souza CB, Fustinoni SM, Amorim MHC, Zandonade E, Matos JC, Schirmer, J. 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. Ciência & Saúde Col. 2015;20(12): 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. Rev Bras Ginecol Obstet. 2009;31(2):75-81. DOI: https://doi.org/10.1590/S0100-72032009000200005

Lourenço AV. Women cancer prevention and pharmaceutical contribution. Braz J Pharm Sci. 2010;46(1):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(3):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. Rev Bras Ginecol Obstet. 2013;35(10):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. Rev Bras Canc. 2014;60(1):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. Cad Saúde Pública. 2015;31(8):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(11):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. Rev Bras Canc. 2012;58(4):63-9.

Paiva CJK, Cesse EAP. Aspectos Relacionados ao Atraso no Diagnóstico e Tratamento do Câncer de Mama em uma Unidade Hospitalar de Pernambuco. Rev Bras Canc. 2015;61(1):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 Women’s Health. 2017;17(13):1-8.

Malta DC, Stopa SR, Pereira CA et al. Private Health Care Coverage in the Brazilian population, according to the 2013 Brazilian National Health Survey. Ciência & Saúde Col. 2017;22(1):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(1):483-96. DOI: https://doi.org/10.1186/s12913-017-2427-5

Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro, 2014. Retrieved 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 Scien Women’s Health. 2019;1(6):2-9.

Alves SAV and Weller M. Breast Cancer Risk Perception and Mammography Screening Behavior of Women in Northeast Brazil. Women’s Health Reports 2020;1(1):150-58. DOI: https://doi.org/10.1089/whr.2019.0026

Norsa'adah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM. 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. The 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(2):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(6):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(4):440-53. DOI: https://doi.org/10.1634/theoncologist.2017-0431

Gebrim, LHA. Detecção precoce do câncer de mama no Brasil. Cad Saúde Púb. 2016;32(5):eCO010516. DOI: https://doi.org/10.1590/0102-311XCO010516