Cargando…

Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania

PURPOSE: In Tanzania, high breast cancer mortality can be attributed to delays in diagnosis and treatment initiation. We adapted the cascade analysis method to depict sequential steps along the breast cancer care pathway in a tertiary hospital in Mwanza, to identify where correction of loss to attri...

Descripción completa

Detalles Bibliográficos
Autores principales: Friebel-Klingner, Tara M., Joo, Emma, Kirahi, Matogoro, Pace, Lydia E., Platz, Elizabeth A., Masalu, Nestory, Washington, Leonard, Rositch, Anne F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10497297/
https://www.ncbi.nlm.nih.gov/pubmed/36947729
http://dx.doi.org/10.1200/GO.22.00345
_version_ 1785105276580397056
author Friebel-Klingner, Tara M.
Joo, Emma
Kirahi, Matogoro
Pace, Lydia E.
Platz, Elizabeth A.
Masalu, Nestory
Washington, Leonard
Rositch, Anne F.
author_facet Friebel-Klingner, Tara M.
Joo, Emma
Kirahi, Matogoro
Pace, Lydia E.
Platz, Elizabeth A.
Masalu, Nestory
Washington, Leonard
Rositch, Anne F.
author_sort Friebel-Klingner, Tara M.
collection PubMed
description PURPOSE: In Tanzania, high breast cancer mortality can be attributed to delays in diagnosis and treatment initiation. We adapted the cascade analysis method to depict sequential steps along the breast cancer care pathway in a tertiary hospital in Mwanza, to identify where correction of loss to attrition would have the biggest impact on improving outcomes. METHODS: This prospective cohort included adult women presenting with breast concerns between February 2020 and January 2022. Five cascade steps beginning with patients' initial clinical breast assessment (CBA) through cancer treatment were identified: (1) CBA, (2) ordering diagnostic test(s), (3) completion of diagnostic test(s), (4) receipt of final diagnosis, and (5) initiating cancer treatment. RESULTS: Overall, 721 eligible women with a median age of 42.8 years (IQR, 32.5-55.0) were included. Median time from presentation to treatment initiation was 35 days (IQR, 20-63). For step 1, 39.1% (n = 282) of patients were diagnosed with a benign concern and removed from the cascade. Completion rates for steps 2-4 were 95.0%, 90.2%, and 91.0, respectively. There were 156 (45.6%) patients diagnosed with breast cancer, and for step 5, 71.2% of patients initiated cancer treatment. In steps 2, 3, 4, and 5, there was a loss of 22, 41, 34, and 45 patients, respectively. If loss was eliminated at steps 2, 3, 4, or 5, an additional 6, 12, 11, or 45 patients, respectively, would have completed the pathway. CONCLUSION: Initiating cancer treatment was identified as the step with the biggest loss and, if remedied, would have the biggest impact on improving breast cancer outcomes at Bugando Medical Centre. These results will inform future programs focused on reducing overall loss in the system and supporting patients with breast cancer.
format Online
Article
Text
id pubmed-10497297
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-104972972023-09-13 Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania Friebel-Klingner, Tara M. Joo, Emma Kirahi, Matogoro Pace, Lydia E. Platz, Elizabeth A. Masalu, Nestory Washington, Leonard Rositch, Anne F. JCO Glob Oncol ORIGINAL REPORTS PURPOSE: In Tanzania, high breast cancer mortality can be attributed to delays in diagnosis and treatment initiation. We adapted the cascade analysis method to depict sequential steps along the breast cancer care pathway in a tertiary hospital in Mwanza, to identify where correction of loss to attrition would have the biggest impact on improving outcomes. METHODS: This prospective cohort included adult women presenting with breast concerns between February 2020 and January 2022. Five cascade steps beginning with patients' initial clinical breast assessment (CBA) through cancer treatment were identified: (1) CBA, (2) ordering diagnostic test(s), (3) completion of diagnostic test(s), (4) receipt of final diagnosis, and (5) initiating cancer treatment. RESULTS: Overall, 721 eligible women with a median age of 42.8 years (IQR, 32.5-55.0) were included. Median time from presentation to treatment initiation was 35 days (IQR, 20-63). For step 1, 39.1% (n = 282) of patients were diagnosed with a benign concern and removed from the cascade. Completion rates for steps 2-4 were 95.0%, 90.2%, and 91.0, respectively. There were 156 (45.6%) patients diagnosed with breast cancer, and for step 5, 71.2% of patients initiated cancer treatment. In steps 2, 3, 4, and 5, there was a loss of 22, 41, 34, and 45 patients, respectively. If loss was eliminated at steps 2, 3, 4, or 5, an additional 6, 12, 11, or 45 patients, respectively, would have completed the pathway. CONCLUSION: Initiating cancer treatment was identified as the step with the biggest loss and, if remedied, would have the biggest impact on improving breast cancer outcomes at Bugando Medical Centre. These results will inform future programs focused on reducing overall loss in the system and supporting patients with breast cancer. Wolters Kluwer Health 2023-03-22 /pmc/articles/PMC10497297/ /pubmed/36947729 http://dx.doi.org/10.1200/GO.22.00345 Text en © 2023 by American Society of Clinical Oncology https://creativecommons.org/licenses/by/4.0/Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/
spellingShingle ORIGINAL REPORTS
Friebel-Klingner, Tara M.
Joo, Emma
Kirahi, Matogoro
Pace, Lydia E.
Platz, Elizabeth A.
Masalu, Nestory
Washington, Leonard
Rositch, Anne F.
Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania
title Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania
title_full Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania
title_fullStr Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania
title_full_unstemmed Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania
title_short Cascade Analysis for Women Presenting With Breast Concerns to a Zonal Hospital in Mwanza, Tanzania
title_sort cascade analysis for women presenting with breast concerns to a zonal hospital in mwanza, tanzania
topic ORIGINAL REPORTS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10497297/
https://www.ncbi.nlm.nih.gov/pubmed/36947729
http://dx.doi.org/10.1200/GO.22.00345
work_keys_str_mv AT friebelklingnertaram cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT jooemma cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT kirahimatogoro cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT pacelydiae cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT platzelizabetha cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT masalunestory cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT washingtonleonard cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania
AT rositchannef cascadeanalysisforwomenpresentingwithbreastconcernstoazonalhospitalinmwanzatanzania