Open AccessFactors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali
Author(s) -
Kirstin Grosse Frie,
Bakarou Kamaté,
C B Traoré,
Madani Ly,
Brahima Mallé,
Boubacar Coulibaly,
Andreas Wienke,
Eva Johanna Kantelhardt
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0207928
Subject(s) - medicine , breast cancer , health care , cancer , proportional hazards model , prospective cohort study , cohort , family medicine , pediatrics , economics , economic growth
Objective To analyse patient and healthcare system related factors influencing the time to first healthcare visit, diagnosis and treatment of breast cancer patients in sub-Saharan Africa and the impact on survival in order to advise on early detection strategies. Methods A prospective hospital cohort study was conducted at the only pathology department in Mali, at the University Hospital in Bamako. All the female patients with a breast cancer diagnosis between January and April 2016 were interviewed with a structured questionnaire ( N = 64) to gather information about breast symptom recognition and first healthcare visit. Information on beginning of treatment and survival were collected at 18-months follow-up. Simple Cox regression analyses were performed. Results The median time to first healthcare visit was 4.8 months, from first healthcare visit to diagnosis was 0.9 months and for the patients who started treatment ( N = 46) the time from diagnosis to treatment was 1.3 months. Knowledge of breast-self-examination and correct symptom interpretation increased the chance of an earlier healthcare visit. Prolonged time to diagnosis was found with shorter duration to first healthcare visit, for working women compared to housewives and for those living within Bamako. Living outside Bamako and smaller tumour size (T1/T2) prolonged time to treatment. Visit of a traditional healer and larger tumour size (T3/T4) shortened survival time, whereas time to first healthcare visit and subsequent time to diagnosis had no influence on survival. Conclusions Down-staging strategies are only useful if the continuum of breast cancer care is warranted for the majority of patients.