Factors associated with diagnostic and pre-treatment intervals among breast cancer patients at the Uganda Cancer Institute

Abstract

Background: Most breast cancer (BC) patients in Uganda are diagnosed with advanced stage disease (stage III and IV) and experience poor outcome including survival. There is limited data on the factors that are associated with long diagnostic and pre-treatment intervals among breast cancer patients in Uganda. This study determined the diagnostic and pre-treatment intervals, and the factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI). Methods: This was a cross-sectional facility-based study. Structured questionnaires were administered by trained research assistants. Data were analyzed using Stata version 14.0. At univariate and bivariate analyses, descriptive statistics including proportions, means and medians, and diagnostic and pre-treatment intervals were calculated. Modified Poisson regressions models were used to determine strength of associations between the independent variables (patient and health system factors) and the diagnostic and pre-treatment intervals. Prevalent ratios and their 95% confidence intervals have been computed. Results: Of 401 patients interviewed, 96.5% were female. The mean age was 47.1±11.7 years. Most patients were in either stage III or stage IV of breast cancer 168 (41.9%) and 140 (34.7%) respectively. The median interval from first consultation to diagnosis (diagnostic interval) was 5.6 months (IQR: 1.5-17.0), while the median interval from histological diagnosis to start of cancer specific treatment (pre-treatment interval) 1.7 months (IQR: 0.7 - 4.5). About 85% (n=341) of patients were diagnosed by or after 3 months from first consultation with clinicians. Patients with tertiary education and those who lived within 100 – 199 km from the UCI were about 4 times and twice more likely to be diagnosed within 3 months from first consultation (PR=3.88; 95%CI: 1.15 – 13.0) and (PR=2.19; 95%CI: 1.06 – 4.55) respectively. About half (48.3%, 176/368) of patients started cancer specific treatments within one month from diagnosis. The only factor associated with pre-treatment interval was residing in northern Uganda (PR=0.50; 95%CI: 0.28 – 0.87). Age, education attainment and marital status of participants were not associated with pre-treatment intervals. Conclusion: Most patients take more than 3 months from first consultation to histological diagnosis of breast cancer and are diagnosed in advanced cancer stages. Only about half of breast cancer patients start cancer specific treatment within one month of histology diagnosis. Middle aged women need to be encouraged to seek care, and the health system or UCI need to be empowered to timely diagnose breast cancer in early stages when treatment can still lead to good outcomes.