Breast Cancer Care Timeliness Framework: A Quality Framework for Cancer Control

Abstract

PURPOSE The aim of this study is to determine the pathway that women follow for Breast Cancer Care (BCC) and the time intervals from symptom discovery to treatment initiation and to develop a quality matrix framework. METHODS A retrospective cohort study was conducted at six tertiary centers in Malaysia. All women with newly diagnosed breast cancer were interviewed, and a medical records review was conducted using a structured questionnaire. The BCC timeliness framework showed that the total time between a woman discovering their first breast changes and the date of initial treatment was divided into three distinct intervals: presentation interval, diagnostic interval, and treatment interval. Four diagnosis subintervals, referral, biopsy, report, and diagnosis resolution intervals, were also looked into. RESULTS The BCC timeliness framework was used to capture important time points. The median total time, presentation interval, diagnostic interval, and treatment interval were 4.9 months (range, 1 month to 10 years), 2.4 months (range, 7 days to 10 years), 26 days (range, 4 days to 9.3 months), and 21 days (range, 1 day to 7.2 months), respectively. Meanwhile, the median time for the diagnosis subinterval of referral, biopsy, report, and diagnosis resolution was 8 days (range, 0 day to 8 months), 0 day (range, 0 day to 20 days), 7 days (range, 3 days to 3.5 months), and 4 days (range, 1 day to 1.8 months), respectively. CONCLUSION The BCC timeliness framework is based on the current sequenced trajectory of the BCC journey. Clarity in the measurement of timeliness provides a standardized language for monitoring and outcome research. It can serve as a quality indicator for community and hospital-based breast cancer programs.

Duration of the patient interval in breast cancer and factors associated with longer delays in low‐and middle‐income countries: A systematic review with meta‐analysis

“…Detailed information about each article is included in Table S1. The majority of articles reported on studies conducted in countries in Africa (32%), 22–37 followed by South‐East Asia (30%), 38–51,71 the Middle East (20%), 52–61 Latin America (16%), 62–69 and Eastern Europe (2%) 45,70 . Two articles reported on patients from more than one country 24,45 …”

“…Detailed information about each article is included in Table S1 . The majority of articles reported on studies conducted in countries in Africa (32%), 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 followed by South‐East Asia (30%), 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 71 the Middle East (20%), 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 Latin America (16%), 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 and Eastern Europe (2%). 45 , 70 Two articles reported on patients from more than one country.…”

“…Ten out of the 15 articles 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 50 from this region investigated what factors were associated with the duration of the patient interval in patients from Bangladesh, 71 India, 40 , 41 , 42 , 43 , 45 China, 38 , 39 , 46 , 47 Malaysia, 50 and Thailand. 44 Older age, lower literacy, rural residence, and lower education or income were generally related to longer patient intervals (with the exception of one study that found that higher income was related to longer patient delay in Thailand 44 ).…”

Psychological characteristics of women with breast cancer who have applied for specialized medical care late

“…Delays can lead to disease progression, complications in treatment, and death. Scientific studies have focused on either the interval between a woman discovering her breast cancer symptoms and visiting a doctor, the time interval between applying to a health care facility and diagnosis, or the time interval between diagnosis and initiation of treatment (Yung et al, 2020;Moodley et al, 2018;O'Mahony et al, 2017;Alves Soares Ferreira et al, 2017;MohdMujar et al, 2022;Ho et al, 2020;Nnaji et al, 2022;Grosse Frie et al, 2018). Richards et al, in a systematic review of studies of the duration of breast cancer symptoms and patient survival, note that patients with a 3-month delay in visiting the doctor had a 12% lower fiveyear survival rate than patients with a shorter delay and patients with a 3-6 month delay had a 7% lower survival rate than patients with a shorter delay (Richards et al, 2014).…”

A Comparison between the Online Prognostic Tool PREDICT and myBeST for Women with Breast Cancer in Malaysia

“…Similarly, women with breast cancer in Malaysia contributed 33.9% of new cancer cases diagnosed between 2012 and 2016, leaving colorectal cancer (10.7%) far behind as the second most commonest female cancer [ 4 ]. Individuals diagnosed with breast cancer face enormous challenges in terms of financial cost [ 5 , 6 ], adherence to multimodal intervention and long-term cancer surveillance [ 7 , 8 ].…”