Factors related to time from symptom onset to breast cancer diagnosis among patients presenting to Kamuzu Central Hospital
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Date
2022-02-09
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Kamuzu University of Health Sciences
Abstract
structured interviewer- administered questioner.
Among women, breast cancer is the most common cancer worldwide and incidence and
mortality rates continue to rise. Annually 2.1 million new cases and over 600,000 deaths were
reported worldwide in 2018. The breast cancer cases in Africa are on the rise and in Malawi
1486 new cases and 821 deaths were estimated in 2020.
Breast cancer in Africa affects women in the most active phase of their social and economic life
leading to death in the premenopausal age. Additionally, most women are diagnosed with late
stage breast cancer in Sub-Saharan Africa [SSA] leading to poor survival. Studies have shown
that modifiable social and health system factors contribute to poor survival among breast cancer
patients in Africa. In Malawi, patients with breast symptoms typically present to primary health
care facilities and are referred to secondary or tertiary health care facilities for diagnostic
evaluation. Minimizing time to diagnosis is dependent on: 1] timely patient recognition of
symptoms 2] presentation of women to primary health facilities after symptom recognition and
3] appropriate assessment and referral at primary health care level to secondary or tertiary health
care facilities.
This study aims at establishing patient and health care system factors influencing the time the
patient recognizes breast cancer symptoms to the time she presents to a health worker [patient
interval] and the time from patient’s initial health care presentation to diagnosis of breast cancer
[diagnostic interval] among breast cancer patients at KCH. The specific objectives are: To
identify patient factors that affect the patient interval among breast cancer patients at KCH, to
recognize patient and health system factors that affect the diagnostic interval among breast
cancer patients at KCH and to analyze the patient and diagnostic interval among breast cancer
patients at KCH.
This study will be conducted at Kamuzu central Hospital, a tertiary hospital in Lilongwe. The
study population will be newly histopathologically diagnosed breast cancer patients and those
who have been enrolled to breast cancer cohort [ LCCC 1611]. They should be 18 years of age
and above and should able to provide consent. Our sample size is 80 and data collection will be
done in six months from December 2021 to May 2022.
One time off, face to face interview using a questionnaire will be used to collect data on
knowledge of breast cancer and symptom appraisal, first health centre visit and breast cancer
diagnosis. We also abstract data from the parent study [LCCC 1611] on patient demographics,
social economic status, histopathological diagnosis and stage breast cancer at time of diagnosis.
The collected data will be entered in Microsoft database which will be password protected. Then
the data will be analysed using STATA version 14.1. Basic descriptive statistics will be
conducted on collected patient information. Long patient interval will be defined as ≥6 months from symptom recognition to presentation to primary health facility and long diagnostic interval and long diagnostic interval will be defined as > 3 months from first presentation to primary health facility to histopathological diagnosis. Chi-square and Fishers exact will test to identify factors associated
with stage of presentation and stage of diagnosis [early versus late]. Multivariate logistic
regression will be used to identify factors associated with late presentation and late diagnosis.
We anticipate that there will be long patient and diagnostic interval and we will be able to
identify associated factors.
The findings of this research will be presented to KCH management and at Ministry of Health.
A copy of the final report will be submitted to; The College of Medicine Research and Ethics
Committee, College of Medicine Library, The Health Sciences Research and Ethic committee,
The university Research and Publication Committee and University of North Carolina Project
Library. Dissemination will be through attendance of local and international conferences.
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Keywords
Breast cancer diagnosis and symptom onset