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

Abstract

Objective: Breast cancer survival is lower in low-and middle-income countries (LMICs) partially due to many women being diagnosed with late-stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta-analysis of the duration of the patient interval in LMICs and investigate the socio-demographic and socio-cultural factors related to longer delays in presentation. Methods:We conducted a systematic review with meta-analysis (pre-registered protocol CRD42020200752). We searched seven information sources (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. Results:The longest patient intervals were reported in studies from the Middle East (3-4 months), followed by South-East Asia (2 months), Africa (1-2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio-economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South-East Asia, and Africa and distrust in the healthcare system in Eastern Europe. Conclusions:There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Global psycho‐oncology in low middle‐income countries: Challenges and opportunities

“…Thaduria et al 16 report on the association between financial toxicity, employment and well-being in oral cancer survivors in a sub-Himalayan city in North India in the era of Covid-19. In a systematic review of the duration of time from symptom onset to the first consultation with a health professional in breast cancer patients, Petrova et al 17 demonstrated the role that literacy and education, stigma, low socioeconomic status and social support play in delaying help-seeking in this population. Ainembabazi et al 18 have demonstrated the link between perception of risk and seeking of screening in female relatives of patients with breast cancer in Uganda.…”