Delayed presentation of symptomatic breast cancers in Hong Kong: Experience in a public cancer centre

Abstract

Objective Delayed presentation is an important obstacle to improving cancer treatment outcomes. We aimed to study the magnitude of this problem in Hong Kong and the factors associated with delayed presentation of patients with symptomatic breast cancers. Design Retrospective study using self-administered questionnaires. Setting Clinical Oncology Department in a regional public hospital in Hong Kong. Patients A total of 158 Chinese women with breast cancer referred to our hospital between October 2006 and December 2007 consented to participate in this study. Among these, 59 (37%) patients were referred after having surgery in private sector. Results The mean total delay (from first symptom to treatment) was 22 weeks. The mean patient delay (from first symptom to first consultation) was 13 weeks, constituting the largest component (60%) of the total delay. After symptom onset, the delay exceeded 12 weeks for consulting a doctor in 29%, and for receipt of treatment in 52% of them. Low family income (<HK$5000 per month; P<0.001) and surgery in public hospitals (P=0.013) were both independent predictors of patient delay. Surgery in public hospitals (P=0.006) and low family income (P=0.005) were the only predictors of doctor/system delay and total delay, respectively. Conclusions Delayed presentation and treatment of symptomatic breast cancer remains an important issue in Hong Kong. Apart from socio-economic factors, limited access to public medical care was likely an important contributing factor in delays related to patients as well as to doctor/system.

目的: 延遲就醫是影響癌症治療效果的重要因素。本文探討香港在這方面的現況，以及有乳癌症狀的患者延遲就醫的原因。 設計: 透過患者自行填寫的問卷調查進行回顧研究。 安排: 香港一所分區公立醫院的臨床腫瘤科。 患者: 2006年10月至2007年12月期間，被轉介至本院並同意參與研究的158名華籍乳癌患者，當中59名（37%）患者於私家醫院接受手術後獲轉介。 結果: 總延遲時間（由出現症狀至治療時間）平均為22週 。 患 者 延 診 時 間 （ 由 出 現 症 狀 至 求 診 時 間 ）平 均 為 1 3 週 ， 也 是 構 成 總 延 遲 時 間 的 最 大 成因（60%）。出現症狀後，29%患者的個人延診時間和52%患者的總延遲時間皆超過12週。低家庭收入（即少於每月港幣5000；P< 0.001）以及於公立醫院進行手術（P=0.013）都是患者延遲就醫的獨立預測因子；而只有於公立醫院進行手術（P=0.006）和低家庭收入（P=0.005）兩項依次屬於醫生／系統延遲和總延遲的預測因子。 結論: 在香港，有乳癌症狀的患者延遲就醫和接受治療仍是一個重要問題。除了社會經濟因素，有限的公共衛生保健服務很可能是造成患者延遲就醫和醫生／系統延遲的重要因素。