Delay in breast cancer care : a study in Thai women
ความล่าช้าในการรักษาพยาบาลผู้ป่วยโรคมะเร็งเต้านมในผู้หญิงไทย
Paramee Thongsuksai, Asst. Prof., D. of Pathology, F. of Medicine, PSU.
Virasakdi Chongsuvivatwong, Assoc. Prof., Epidemiology Unit, F. of Medicine, PSU.
Hutcha Sriplung, Assoc. Prof., D. of Pathology, F. of Medicine, PSU.
Corresponding e-mail : tparamee@ratree.psu.ac.th
Grant : Faculty of Medicine and Thailand Research Fund
Published : Medical Care 2000, 38(1) : 1-7
Key words : breast cancer, patient delay, system delay, help-seeking behavior
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. 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 - June 1996 were interviewed with retrospective chart audits of care.
Measures : Dependent variables include 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. Non-parametric 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 delay were 4 weeks. 26.6% and 24.4% of patients experienced patient and system delay longer than 12
weeks respectively. Only marital status (unmarried compared to married women) was significantly associated with patient delay (Hazard ratio 2.78, 95% CI 1.23-.25). Contacting a provincial hospital instead of a university hospital as first medical care (HR 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 im-mediately 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 Program 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.
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