| Résumé: | Breast cancer is the commonest form of cancer among women in Malaysia. Although
there is a scarcity of data on the relation between delays and survival, it is generally
accepted that optimum outcomes are dependent on early detection and adherence to
treatment. This study was conducted to evaluate the time intervals and associated factors
with delays and non-adherence among breast cancer patients in Malaysia. A multicentre
cross-sectional study was conducted in six public hospitals in Malaysia, involving all
newly diagnosed breast cancer patients from 1st January to 31st December 2012. Data
were collected through medical record reviews and interview by using structured
questionnaire. Presentation delay was defined as the time taken from symptoms discovery
to first presentation of more than 3 months. Diagnosis delay was defined as the time taken
from first presentation to diagnosis disclosure of more than 1 month and treatment delay
was defined as the time taken from diagnosis disclosure to initial treatment of more than
1 month. Meanwhile, non-adherence was categorized as any breast cancer patients
refusing or discontinuing treatments due to non-medical reasons. Univariable logistic
regression and multiple logistic regressions were used for analysis. A total number of 340
patients participated in this study. The median times for presentation, diagnosis, and
treatment were 2.4 months, 26 days and 21 days respectively. Presentation delay was seen
in 35% of the patients and the factors associated with presentation delay were Kelantan
site (OR 4.78; 95% CI: 1.45, 15.7) and complementary and alternative medicine (CAM)
use (OR 1.67; 95% CI: 1.01, 2.76). Diagnosis delay was seen in 41.8% and the associated
factors were CAM use (OR 2.68; 95% CI: 1.63, 4.41), symptoms without lump (OR 1.98;
95% CI: 1.45, 4.12), having two or more biopsies (OR 3.02; 95% CI: 2.42, 6.45) and
having a surgical biopsy (OR 2.56; 95% CI: 1.30, 5.04). Treatment delay was seen in
35.3% and it was associated with localities involving Kuala Lumpur (2) (OR 3.10; 95%
CI: 1.48, 6.49), Johor (OR 4.95; 95% CI: 2.13, 11.5), Kelantan (OR 6.68; 95% CI: 2.02,
iv
22.06) and Sarawak sites (OR 3.88; 95% CI: 1.52, 9.88), and those diagnosed at other
hospitals (OR 2.18; 95% CI: 1.14, 4.15). Meanwhile, the proportion for non-adherence to
surgery was 14%. The factors associated with non-adherence to surgery were localities
involving Kuala Lumpur (2) (OR 3.41; 95% CI: 1.00, 11.60), Johor (OR 8.38; 95% CI:
2.38, 29.51) and Kelantan sites (OR 6.32; 95% CI: 1.20, 33.23) and those required
mastectomy (OR 5.66; 95% CI: 1.52, 21.03). The proportion for non-adherence to
chemotherapy, radiotherapy and hormonal therapy were 30.1%, 33.3% and 36.3%
respectively and the only independent factor associated with non-adherence to oncology
therapy was the Perak site (OR 1.42; 95% CI: 1.18, 1.97). Delays in presentation,
diagnosis, and non-adherence to treatment were high among breast cancer patients
attending public hospitals in Malaysia. Factors influencing delays and non-adherence
were multifactorial implicating a complex interaction between variations influence of
socio-culture, patients and health systems in Malaysia. Mutual collaboration from
multiple areas involving patients and multidisciplinary healthcare sectors are important
to reduce delays and non-adherence to treatments. Therefore, a comprehensive
intervention study and audits are suggested to improve breast cancer care quality in
Malaysia.
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